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Saeedi A, von Sneidern M, Abend A, Taufique ZM, Eytan DF. Predictors of 30-day complications, readmission, and postoperative length of stay in children undergoing autologous rib grafting for microtia. J Plast Reconstr Aesthet Surg 2024; 98:73-81. [PMID: 39241679 DOI: 10.1016/j.bjps.2024.08.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 08/07/2024] [Accepted: 08/20/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Predictors of outcomes in pediatric microtia surgery are not well understood within the current literature. A multi-institutional database study may reveal insights into these predictors. OBJECTIVES To explore the predictors of 30-day complications, 30-day readmission, and postoperative length of stay (PLOS) in pediatric microtia patients undergoing autologous rib grafting. METHODS The Pediatric National Surgical Quality Improvement Program was queried for details on patients with microtia (ICD-9/10 744.23/Q17.2) who underwent autologous rib grafting (CPT 21230) between 2012-2021. Demographics, comorbidities, inpatient status, 30-day complications, PLOS, and 30-day readmissions were analyzed. Statistical analyses were performed to compare the preoperative characteristics with postoperative outcomes. RESULTS Overall, 667 patients met the inclusion criteria. Sixty-three (9.4%) had at least one complication, and 19 (2.9%) were readmitted. Univariate analysis showed that inpatient status (p = 0.011) and race (p = 0.023) were associated with higher complication rates. Multivariate analysis revealed that outpatient status was associated with significantly lower odds of complications (OR: 0.49, 95% CI [0.27, 0.87], p = 0.018), and developmental delay was associated with higher odds of 30-day readmission (OR: 2.80, 95% CI [1.05, 7.17], p = 0.036). Longer operative time was associated with older age (13.9% increase per five-year age increase, p < 0.001) and inpatient status (35.3% increase, p < 0.001). PLOS was shorter for outpatients (45.45% shorter, p < 0.001) and cases performed by plastic surgeons (14.2% shorter, p < 0.001). CONCLUSION Microtia reconstruction using autologous cartilage is a relatively safe procedure with low complication and readmission rates. Significant predictors of postoperative outcomes include inpatient status, race, developmental delay, and age. These findings highlight the importance of considering these factors in surgical planning and patient counseling.
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Affiliation(s)
- Arman Saeedi
- University of Colorado Anschutz School of Medicine, USA
| | - Manuela von Sneidern
- NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery, USA
| | - Audrey Abend
- NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery, USA
| | - Zahrah M Taufique
- NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery, USA
| | - Danielle F Eytan
- NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery, USA.
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Malick R, Sham M, Reddy TJ, Jacob P. Reconstruction of the external ear using implant-supported alloplasts-Our experience. Natl J Maxillofac Surg 2023; 14:499-503. [PMID: 38273915 PMCID: PMC10806312 DOI: 10.4103/njms.njms_160_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/25/2022] [Accepted: 12/27/2022] [Indexed: 01/27/2024] Open
Abstract
Surgical reconstruction of the missing external ear is difficult, and the results are often far from satisfactory. An implant-retained auricular prosthesis is a suitable alternative. Microtia, malformation, deformity, and partial or complete loss of the external ear may be due to various congenital or acquired factors. A case series of three patients treated with implant-retained auricular prostheses is presented in this article. For each missing pinna, two titanium implants were placed in the temporal bone. After 6 months of osseointegration, the implants were loaded. All three cases were rehabilitated with a bar and clip retained prosthesis. There were two male and one female patient with an average age of 16.6 years. One patient had unilateral absence of external ear and two had bilateral absence. A total of 10 implants were placed, 4 on the right side and 6 on the left. The average post rehabilitation follow-up was 18 months. Peri-implant tissue reactions were observed at two sites. The implant-retained auricular prosthesis is an alternative treatment approach with good retention and patient satisfaction. Long-term follow-up is required to assess delayed sequelae.
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Affiliation(s)
- Rayan Malick
- Department of Oral and Maxillofacial Surgery, Vydehi Institute of Dental and Medical Sciences and Research Centre, Bangalore, Karnataka, India
| | - M.E. Sham
- Department of Oral and Maxillofacial Surgery, Vydehi Institute of Dental and Medical Sciences and Research Centre, Bangalore, Karnataka, India
| | - Thyagraj Jayaram Reddy
- Department of Prosthodontics, Vydehi Institute of Dental and Medical Sciences and Research Centre, Bangalore, Karnataka, India
| | - P.C. Jacob
- Department of Plastic and Reconstructive Surgery, Vydehi Institute of Dental and Medical Sciences and Research Centre, Bangalore, Karnataka, India
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Liang J, Cao T, Wang Y, Wang B, Qian J, Chen Q, Zhang Q. A modified tissue expander method for ear reconstruction in patients with excessively insufficient postauricular skin. EAR, NOSE & THROAT JOURNAL 2023; 102:NP449-NP456. [PMID: 37139961 DOI: 10.1177/01455613231172332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
OBJECTIVE For microtia patients with excessively insufficient postauricular skin, it is difficult to obtain a satisfied outcome with existing strategies. In this study, we developed a modified tissue expander method for auricular reconstruction. METHODS The modified tissue expander method divided into 4 stages. In the first stage, a 30 ml or 50 ml kidney-shaped tissue expander was implanted in the mastoid region. A short time expansion (average 33.5 days) was conducted subsequently. In the second stage, the expander was removed and a modified cartilage framework without tragus was inserted through the same incision. A crescent-shaped cartilage pad was inserted into the incision of cartilage-harvest site at the same time. In the third stage, the reconstructed ear was elevated. Lobule rotation and remanent modification were performed in the fourth stage. The patients were followed up between half a year and 10 years. The outcomes of the reconstructed ears were scored with evaluation criteria. RESULTS From January 2010 to December 2019, a total of 45 microtia patients with excessively insufficient postauricular skin were performed the modified tissue expander method. Fourty-two patients showed satisfied outcomes. Complications such as hyperpigmentation in the skin graft area (3, 6.7%), scar hyperplasia (3, 6.7%) and folliculitis (1, 2.2%) were found. There were no complications related to the tissue expander. CONCLUSION The modified tissue expander method is an effective and safe technique for auricular reconstruction in patients having excessively insufficient postauricular skin, with satisfying medium-term results.
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Affiliation(s)
- Jiaxin Liang
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Tongyu Cao
- Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Yue Wang
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Bingqing Wang
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jin Qian
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Chen
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qingguo Zhang
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing, China
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4
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Seiwerth I, Plößl S, Herzog M, Schilde S, Radetzki F, Krämer S, Rahne T, Plontke SK. Individual computer-assisted 3D planning for placement of auricular prosthesis anchors in combination with an implantable transcutaneous bone conduction hearing device in patients with aural atresia. HNO 2023; 71:1-9. [PMID: 36083471 PMCID: PMC10409664 DOI: 10.1007/s00106-022-01190-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The simultaneous implantation of the Bonebridge (MED-EL, Innsbruck, Austria), a semi-implantable active transcutaneous bone conduction hearing device and anchors for auricular prostheses can be challenging as both implants contain magnets and compete for the narrow space in the designated implantation area. MATERIAL AND METHODS A preoperative planning tool (virtual surgery) was used with individual 3D computer models of the skull and implants for finding optimal implant positions for both the floating mass transducer (FMT) and the anchors for the auricular prosthesis. The interaction between the magnetic prosthesis anchors and the FMT was measured by means of static magnetic forces. A retrospective data analysis was conducted to evaluate the surgical and audiological outcome. RESULTS Between 2014 and 2021, a 3D planning of a simultaneous implantation of the Bonebridge with auricular prosthesis anchors was conducted on 6 ears of 5 patients (3 males, 2 females; age range 17-56 years). The individual preoperative planning was considered very useful for the optimal placement of bone anchors in combination with the Bonebridge. Audiological data showed a clear benefit for hearing 3 months and > 11 months after implantation. No adverse interactions between the magnetic prosthesis anchors and the FMT were observed. In two patients, revision surgery was carried out due to skin inflammation or wound healing problems. No long-term complications were observed 3-5 years after surgery. CONCLUSION Preoperative 3D planning represents a clear benefit for the simultaneous audiological and esthetic rehabilitation using the Bonebridge and anchors for auricular prostheses.
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Affiliation(s)
- Ingmar Seiwerth
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Halle (Saale), Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Sebastian Plößl
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Halle (Saale), Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Martha-Maria Hospital Halle-Dölau, Halle (Saale), Germany
| | - Michael Herzog
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Halle (Saale), Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
- Department of Otorhinolaryngology, Carl Thiem Klinikum, Cottbus, Germany
| | - Sebastian Schilde
- Department of Orthopedic and Trauma Surgery, University Medicine Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Florian Radetzki
- Department of Orthopedic and Trauma Surgery, University Medicine Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Department of Orthopedic und Trauma Surgery, Brandenburg Medical School Theodor Fontane, Klinikum Dessau, Dessau, Germany
| | | | - Torsten Rahne
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Halle (Saale), Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Stefan K Plontke
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Halle (Saale), Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
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5
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Slijepcevic AA, Afshari A, Vitale AE, Couch SM, Jeanpierre LM, Chi JJ. A Contemporary Review of the Role of Facial Prostheses in Complex Facial Reconstruction. Plast Reconstr Surg 2023; 151:288e-298e. [PMID: 36696329 DOI: 10.1097/prs.0000000000009856] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Maxillofacial prostheses provide effective rehabilitation of complex facial defects as alternatives to surgical reconstruction. Although facial prostheses provide aesthetically pleasing reconstructions, multiple barriers exist that prevent their routine clinical use. The accessibility of facial prostheses is limited by the scarce supply of maxillofacial prosthodontists, significant time commitment and number of clinic appointments required of patients during prosthesis fabrication, short lifespan of prostheses, and limited outcomes data. METHODS A literature review was completed using PubMed and Embase databases, with search phrases including face and maxillofacial prostheses. Patient cases are included to illustrate the use of facial prostheses to reconstruct complex facial defects. RESULTS The clinical use of facial prostheses requires a multidisciplinary team including a reconstructive surgeon, a maxillofacial prosthodontist, and an anaplastologist, if available, to provide patients with aesthetically appropriate facial prostheses. Developing technology including computer-aided design and three-dimensional printing may improve the availability of facial prostheses by eliminating multiple steps during prosthesis fabrication, ultimately decreasing the time required to fabricate a prosthesis. In addition, enhanced materials may improve prosthesis durability. Long-term outcomes data using validated measures is needed to support the continued use of facial prostheses. CONCLUSIONS Facial prostheses can be used to reconstruct complex facial defects, and bone-anchored prostheses are associated with high patient satisfaction. Multiple barriers prevent prostheses from being used for facial reconstruction. New technologies to assist the design and fabrication of prostheses, and cost reduction measures, may allow their use in the appropriately selected patient.
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Affiliation(s)
| | - Azadeh Afshari
- Division of Maxillofacial Prosthodontics, Barnes-Jewish Hospital
| | - Ann E Vitale
- Division of Maxillofacial Prosthodontics, Barnes-Jewish Hospital
| | | | | | - John J Chi
- Division of Facial Plastic and Reconstructive Surgery, Washington University in St. Louis
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6
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Long-Term Clinical Results of Two-Stage Total Ear Reconstruction of Microtia Using Autologous Cell-Engineered Chondrocytes. Plast Reconstr Surg 2023; 151:282e-287e. [PMID: 36696327 DOI: 10.1097/prs.0000000000009854] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Microtia repair requires a large volume of reconstruction material.In pediatric patients, the collectable volume of autologous cartilage is limited, and the impact of surgical invasion and donor-site morbidity can be particularly severe. The authors developed a new treatment method using cultured autologous human auricular chondrocytes that provides a sufficiently large volume of reconstruction material. METHODS Approximately 1 cm2 of auricular cartilage was collected from the affected site. Chondrocytes were isolated and cultured with autologous serum to accelerate cell proliferation. The cells were subcultured and formed a gel-form mass without a scaffold. In our two-stage implantation, the cultured chondrocytes were first injected into the patient's lower abdomen, where the cells grew into a large, newly generated cartilage in 6 months. Thereafter, this cartilage was sculpted into an ear framework and subcutaneously reimplanted into the new ear location. Clinical outcomes were assessed over a long-term follow-up. RESULTS Eight patients underwent surgery using cultured autologous auricular chondrocytes from 2002 to 2008. The patients' ages ranged from 6 to 10 years. The follow-up period ranged from 11 to 18 years. None of the patients experienced absorption of cultured chondrocytes after the second stage. Complications included one case of absorption and one case of allergic reaction in the first stage. CONCLUSIONS The authors' patients represent the first successful cases of regenerative surgery for microtia using cultured chondrocytes. No malignant transformation, change in size, deformation, or other abnormalities were observed during the long-term follow-up, demonstrating the safety of cultured cartilage. No major complications occurred. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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7
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[Individual computer-assisted 3D planning for placement of auricular prosthesis anchors in combination with an implantable transcutaneous bone conduction hearing device in patients with aural atresia. German version]. HNO 2022:10.1007/s00106-022-01189-3. [PMID: 35920881 DOI: 10.1007/s00106-022-01189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The simultaneous implantation of the Bonebridge (MED-EL, Innsbruck, Austria), a semi-implantable active transcutaneous bone conduction hearing device and anchors for auricular prostheses can be challenging as both implants contain magnets and compete for the narrow space in the designated implantation area. MATERIAL AND METHODS A preoperative planning tool (virtual surgery) was used with individual 3D computer models of the skull and implants for finding optimal implant positions for both the floating mass transducer (FMT) and the anchors for the auricular prosthesis. The interaction between the magnetic prosthesis anchors and the FMT was measured by means of static magnetic forces. A retrospective data analysis was conducted to evaluate the surgical and audiological outcome. RESULTS Between 2014 and 2021 a 3D planning of a simultaneous implantation of the Bonebridge with auricular prosthesis anchors was conducted on 6 ears of 5 patients (3 males, 2 females; age range 17-56 years). The individual preoperative planning was considered very useful for the optimal placement of bone anchors in combination with the Bonebridge. Audiological data showed a clear benefit for hearing 3 months and > 11 months after implantation. No adverse interactions between the magnetic prosthesis anchors and the FMT were observed. In two patients, revision surgery was carried out due to skin inflammation or wound healing problems. No long-term complications were observed 3-5 years after surgery. CONCLUSION Preoperative 3D planning represents a clear benefit for the simultaneous audiological and esthetic rehabilitation using the Bonebridge and anchors for auricular prostheses.
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8
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Tingaud-Sequeira A, Trimouille A, Sagardoy T, Lacombe D, Rooryck-Thambo C. Oculo-auriculo-vertebral spectrum: new genes and literature review on a complex disease. J Med Genet 2022; 59:417-427. [PMID: 35110414 DOI: 10.1136/jmedgenet-2021-108219] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/30/2021] [Indexed: 12/23/2022]
Abstract
Oculo-auriculo-vertebral spectrum (OAVS) or Goldenhar syndrome is due to an abnormal development of first and second branchial arches derivatives during embryogenesis and is characterised by hemifacial microsomia associated with auricular, ocular and vertebral malformations. The clinical and genetic heterogeneity of this spectrum with incomplete penetrance and variable expressivity, render its molecular diagnosis difficult. Only a few recurrent CNVs and genes have been identified as causatives in this complex disorder so far. Prenatal environmental causal factors have also been hypothesised. However, most of the patients remain without aetiology. In this review, we aim at updating clinical diagnostic criteria and describing genetic and non-genetic aetiologies, animal models as well as novel diagnostic tools and surgical management, in order to help and improve clinical care and genetic counselling of these patients and their families.
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Affiliation(s)
- Angèle Tingaud-Sequeira
- Univ. Bordeaux, Maladies Rares: Génétique et Métabolisme (MRGM), U 1211 INSERM, F-33000 Bordeaux, France
| | - Aurélien Trimouille
- Univ. Bordeaux, Maladies Rares: Génétique et Métabolisme (MRGM), U 1211 INSERM, F-33000 Bordeaux, France.,CHU de Bordeaux, Service de Génétique Médicale, Centre de Référence Anomalies du Développement et Syndromes Malformatifs, F-33076, Bordeaux, France
| | - Thomas Sagardoy
- CHU de Bordeaux, Service d'oto-rhino-laryngologie, de chirurgie cervico-faciale et d'ORL pédiatrique, 33076 Bordeaux, France
| | - Didier Lacombe
- Univ. Bordeaux, Maladies Rares: Génétique et Métabolisme (MRGM), U 1211 INSERM, F-33000 Bordeaux, France.,CHU de Bordeaux, Service de Génétique Médicale, Centre de Référence Anomalies du Développement et Syndromes Malformatifs, F-33076, Bordeaux, France
| | - Caroline Rooryck-Thambo
- Univ. Bordeaux, Maladies Rares: Génétique et Métabolisme (MRGM), U 1211 INSERM, F-33000 Bordeaux, France .,CHU de Bordeaux, Service de Génétique Médicale, Centre de Référence Anomalies du Développement et Syndromes Malformatifs, F-33076, Bordeaux, France
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9
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Srivastava A, Hazra R, Kumar D. Bridging form and function: A bilateral auricular prosthesis. J Indian Prosthodont Soc 2022; 22:300-304. [PMID: 36511062 PMCID: PMC9416953 DOI: 10.4103/jips.jips_546_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Unfortunate loss or absence of an ear has a far-reaching impact on an individual psyche. Auricular defects are seen commonly due to trauma, congenital abnormalities, and malignancies which result in disfigurment of the pinna. Rehabilitation of an auricular defect with a custom-made auricular prosthesis improves social acceptance and self-confidence in an individual. Auricular defects present reconstructive challenges, especially if they are bilateral. Surgical reconstruction provides effective results for defects; however, for some patients, surgical intervention is contraindicated. This case report describes an innovative technique to rehabilitate patients with auricular defects with mixed hearing loss and bilateral microtia using a multidisciplinary approach. The patient was provided with a functional auricular prosthesis. The prime purpose of the treatment rendered was to restore the lost auricular structure to the patient's satisfaction comfortably and cost-effectively. An early rehabilitation promotes physical as well as psychological healing of the patient.
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Affiliation(s)
- Ayush Srivastava
- Department of Prosthodontics and Crown and Bridge, Army Dental Center (Research and Referral), New Delhi, India,Address for correspondence: Dr. Ayush Srivastava, Department of Prosthodontics and Crown and Bridge, Army Dental Center (Research and Referral), New Delhi - 110 010, India. E-mail:
| | - Ranjoy Hazra
- Department of Prosthodontics and Crown and Bridge, Army Dental Center (Research and Referral), New Delhi, India
| | - Dinesh Kumar
- Department of Prosthodontics and Crown and Bridge, Army Dental Center (Research and Referral), New Delhi, India
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10
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Abstract
Implant-retained craniofacial prostheses (or epitheses) made of silicone are state of the art for prosthetic rehabilitation of facial defects. With the modern extraoral implant systems, prostheses may be securely anchored to the bone regardless of size and location of the defect. Prerequisite for successful implantation is the classical atraumatic surgical technique with avoidance of any thermal trauma to the bone. The treatment intention may be a temporary measure, a rescue procedure after failed (re)construction, or a definitive treatment option. This article gives an overview of the strategies in various facial regions stratified according to the age of the patient and the etiology of the defect. Moreover, prosthetic rehabilitation offers additional options for septal perforations, distorted and leaky tracheostomies, and treatment-resistant tracheoesophageal fistula.
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11
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Hopkins B, Dean K, Appachi S, Drake AF. Craniofacial Interventions in Children. Otolaryngol Clin North Am 2019; 52:903-922. [PMID: 31353139 DOI: 10.1016/j.otc.2019.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Craniofacial interventions are common and the surgical options continue to grow. The issues encountered include micrognathia, macroglossia, midface hypoplasia, hearing loss, facial nerve palsy, hemifacial microsomia, and microtia. In addition, a unifying theme is complex upper airway obstruction. Throughout a child's life the focus of interventions may change from airway management to speech, hearing, and language optimization, and finally to decannulation and procedures aimed at social integration and self-esteem. Otolaryngologists play an important role is this arena and provide high-quality care while continuing to expand what can be done for our patients.
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Affiliation(s)
- Brandon Hopkins
- Pediatric Otolaryngology, Pediatric Center for Airway Voice and Swallowing, Cleveland Clinic, 9500 Euclid Avenue, 7th Floor Crile Building, Cleveland, OH 44195, USA.
| | - Kelly Dean
- Department of Otolaryngology/Head and Neck Surgery, UNC Hospitals, University of North Carolina, 170 Manning Drive, CB# 7070, Chapel Hill, NC 27599-7070, USA
| | - Swathi Appachi
- Cleveland Clinic Head and Neck Institute, Cleveland Clinic, 9500 Euclid Avenue, 7th Floor Crile Building, Cleveland, OH 44195, USA
| | - Amelia F Drake
- Department of Otolaryngology/Head and Neck Surgery, UNC Hospitals, Craniofacial Center, University of North Carolina, 170 Manning Drive, CB# 7070, Chapel Hill, NC 27599-7070, USA
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12
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Cubitt JJ, Chang LY, Liang D, Vandervord J, Marucci DD. Auricular reconstruction. J Paediatr Child Health 2019; 55:512-517. [PMID: 30920067 DOI: 10.1111/jpc.14444] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/01/2019] [Indexed: 11/29/2022]
Abstract
External ear abnormalities are common. These may affect ear shape, size, prominence and degree of development. They may also be associated with hearing loss. The early identification and management of hearing loss is essential. There are several options for reconstruction of the external ear using both autologous and non-autologous techniques. The aim of this article is to outline the different reconstructive options.
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Affiliation(s)
- Jonathan J Cubitt
- Department of Plastic and Reconstructive Surgery, Children's Hospital Westmead, Westmead, New South Wales, Australia.,The Welsh Centre of Burns and Plastic Surgery, Morriston, United Kingdom
| | - Ling-Yun Chang
- Department of Plastic and Reconstructive Surgery, Children's Hospital Westmead, Westmead, New South Wales, Australia
| | - Derek Liang
- Department of Plastic and Reconstructive Surgery, Children's Hospital Westmead, Westmead, New South Wales, Australia
| | - John Vandervord
- Department of Plastic and Reconstructive Surgery, Children's Hospital Westmead, Westmead, New South Wales, Australia
| | - Damian D Marucci
- Department of Plastic and Reconstructive Surgery, Children's Hospital Westmead, Westmead, New South Wales, Australia.,Children's Hospital Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
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13
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Zhang Z, Liu R, Wang R, Tang J, Liu C, Chen X, Cen Y, Li Z. [Application of three-dimensional mechanical equilibrium concept in cartilage scaffold construction for total auricular reconstruction]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:332-336. [PMID: 30874391 PMCID: PMC8337930 DOI: 10.7507/1002-1892.201807137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/07/2019] [Indexed: 02/05/2023]
Abstract
Objective To summarize clinical experience and curative effect in applying three-dimensional mechanical equilibrium concept to cartilage scaffold construction in total auricular reconstruction. Methods Between June 2015 and June 2017, ninety-seven microtia patients (102 ears) were treated with total ear reconstruction by using tissue expanders. The patients included 43 males and 54 females and their age ranged from 7 to 45 years with an average of 14 years. There were 92 unilateral cases (45 in left side and 47 in right side) and 5 bilateral ones. There were 89 congenital cases and 8 secondary cases. According to microtia classification criteria, there were 21 cases of type Ⅱ, 67 cases of type Ⅲ, and 9 cases of type Ⅳ. Tissue expander was implanted in the first stage. In the second stage, autogenous cartilage was used to construct scaffolds which were covered by enlarged flap. According to the three-dimensional mechanical equilibrium concept, the stable ear scaffold was supported by the scaffolds base, the junction of helix and inferior crura of antihelix, and helix rim. The reconstructed ears were repaired in the third stage operation. Results All patients had undergone ear reconstruction successfully and all incisions healed well. No infection, subcutaneous effusion, or hemorrhage occurred after operation. All skin flaps, grafts, and ear scaffolds survived completely. All patients received 5- to 17-month follow-up time (mean, 11.3 months) and follow-up time was more than 12 months in 61 cases (64 ears). All reconstructed ears stood upright, and subunits structure and sensory localization of reconstructed ears were clear, and the position, shape, size, and height of bilateral ears were basically symmetrical. Mastoid region scar hyperplasia occurred in 3 patients, which was relieved by anti-scar drugs injection. No scaffolds exposure, absorption, or structural deformation occurred during follow-up period. Conclusion Application of three-dimensional mechanical equilibrium concept in cartilage scaffold construction can reduce the dosage of costal cartilage, obtain more stable scaffold, and acquire better aesthetic outcomes.
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Affiliation(s)
- Zhenyu Zhang
- Department of Aesthetic Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Ruiqi Liu
- Department of Aesthetic Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Ru Wang
- Department of Aesthetic Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Jun Tang
- Department of Aesthetic Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Chuanqi Liu
- Department of Aesthetic Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Xinghan Chen
- Department of Aesthetic Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Ying Cen
- Department of Aesthetic Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Zhengyong Li
- Department of Aesthetic Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
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Ear Reconstruction Simulation: From Handcrafting to 3D Printing. Bioengineering (Basel) 2019; 6:bioengineering6010014. [PMID: 30764524 PMCID: PMC6466171 DOI: 10.3390/bioengineering6010014] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/29/2019] [Accepted: 02/01/2019] [Indexed: 12/05/2022] Open
Abstract
Microtia is a congenital malformation affecting one in 5000 individuals and is characterized by physical deformity or absence of the outer ear. Nowadays, surgical reconstruction with autologous tissue is the most common clinical practice. The procedure requires a high level of manual and artistic techniques of a surgeon in carving and sculpting of harvested costal cartilage of the patient to recreate an auricular framework to insert within a skin pocket obtained at the malformed ear region. The aesthetic outcomes of the surgery are highly dependent on the experience of the surgeon performing the surgery. For this reason, surgeons need simulators to acquire adequate technical skills out of the surgery room without compromising the aesthetic appearance of the patient. The current paper aims to describe and analyze the different materials and methods adopted during the history of autologous ear reconstruction (AER) simulation to train surgeons by practice on geometrically and mechanically accurate physical replicas. Recent advances in 3D modelling software and manufacturing technologies to increase the effectiveness of AER simulators are particularly described to provide more recent outcomes.
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15
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Development of a New Patient-reported Outcome Measure for Ear Conditions: The EAR-Q. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1842. [PMID: 30324053 PMCID: PMC6181510 DOI: 10.1097/gox.0000000000001842] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/04/2018] [Indexed: 11/25/2022]
Abstract
Background: Patient-reported outcome measures are widely used to improve health services and patient outcomes. The aim of our study was to describe the development of 2 ear-specific scales designed to measure outcomes important to children and young adults with ear conditions, such as microtia and prominent ears. Methods: We used an interpretive description qualitative approach. Semi-structured qualitative and cognitive interviews were performed with participants with any type of ear condition recruited from plastic surgery clinics in Canada, Australia, United States, and United Kingdom. Participants were interviewed to elicit new concepts. Interviews were audio-recorded, transcribed, and coded using the constant comparison approach. Experts in ear reconstruction were invited to provide input via an online Research Electronic Data Capture survey. Results: Participants included 25 patients aged 8–21 years with prominent ears (n = 9), microtia (n = 14), or another condition that affected ear appearance (n = 2). Analysis of participant qualitative data, followed by cognitive interviews and expert input, led to the development and refinement of an 18-item ear appearance scale (eg, size, shape, look up close, look in photographs) and a 12-item adverse effects scale (eg, itchy, painful, numb). Conclusions: The EAR-Q in currently being field-tested internationally. Once finalized, we anticipate the EAR-Q will be used in clinical practice and research to understand the patient’s perspective of outcomes following ear surgery.
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