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Huang J, Zou K, Yuan P, Yang M, Miao Y, Zhao L, Fan Y. Correction of congenital auricle deformities with ear mould: A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2024; 179:111903. [PMID: 38574649 DOI: 10.1016/j.ijporl.2024.111903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 11/30/2023] [Accepted: 02/27/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To assess the effectiveness and safety of ear moulds for congenital auricle deformities. METHODS Databases including Medline, EMBASE, Cochrane Library, Chinese BioMedical Literature Database (CBM) and Web of Science were systematically reviewed. Randomised controlled trials (RCT), non-randomised control trials (non-RCT), quasi-randomised control trials (quasi-RCT) and self-controlled before-after trials were also included. Data extraction was independently conducted by two authors. The Risk Of Bias In Non-randomised Studies of Interventions (ROBIN-I) was used to evaluate the risk bias. Heterogeneity was assessed using I2 and chi-square tests. Effective rate, adverse reaction rate and their 95%CI were calculated. Funnel plots, Begg's test as well as sensitivity and subgroup analyses were performed. RESULTS The analysis encompassed ten studies, comprising one RCT and nine self-controlled before-after trials, involving 1860 ears (1248 children). The pooled effective rate and adverse reaction rate of ear mould were 91% (95% CI: 0.87-0.94) and 9% (95%CI: 0.02-0.17), respectively. No serious adverse reactions were reported. The effective rate of ear mould intervention showed no significant difference between age at correction≤42 days group (90%, 95%CI: 0.85-0.94) and that >42 days group (93%, 95%CI: 0.83-0.99). Similarly, there was no statistical difference in the correction efficiency between duration of wearing ear mould≤30 days group (90%, 95%CI: 0.85-0.94) and that >30 days group (92%, 95%CI: 0.86-0.96). The effective rate for correcting cryptotia ear (98%, P < 0.001), cup ear (93%, P = 0.004) and prominent ear (90%, P = 0.014) was higher than that of helical rim deformity (66%). CONCLUSIONS In the short term, the use of ear moulds is effective and safe in correcting congenital auricle deformities. Notably, the correction efficacy for cryptotia, cup ear and prominent ear deformities surpasses that of helical rim deformities. However, further research is required to ascertain the impact of the duration of wearing on the correction of congenital auricle deformities.
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Affiliation(s)
- Jincheng Huang
- Chengdu Center for Disease Control and Prevention, Sichuan Province, 610041, China
| | - Kun Zou
- West China Second Hospital/West China Maternity and Children's Hospital, Chengdu, Sichuan province, 610041, China; West China Research Centre for Rural Health Development, Sichuan University, Chengdu, Sichuan province, 610041, China
| | - Ping Yuan
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan province, 610041, China
| | - Min Yang
- West China Research Centre for Rural Health Development, Sichuan University, Chengdu, Sichuan province, 610041, China; Faculty of Health, Art and Design, Swinburne Technology University, Melbourne, Australia
| | - Yunqi Miao
- Chengdu Center for Disease Control and Prevention, Sichuan Province, 610041, China
| | - Li Zhao
- West China Second Hospital/West China Maternity and Children's Hospital, Chengdu, Sichuan province, 610041, China; Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Chengdu, Sichuan province, 610041, China.
| | - Yanjun Fan
- National Center for Women and Children's Health, China Center for Disease Control and Prevention, Beijing, 100050, China
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2
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Vella JB. Pediatric Otoplasty and Auricular Molding. Facial Plast Surg Clin North Am 2024; 32:95-103. [PMID: 37981420 DOI: 10.1016/j.fsc.2023.07.006] [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: 11/21/2023]
Abstract
With the advent of widespread use of commercial ear molding products, the literature addressing the indications for and timing of perinatal intervention in auricular deformations and malformations has increased significantly. Although the rationale for perinatal ear molding seems to be hormonally mediated, the common assertion that breastfeeding may prolong the window of effective intervention remains without convincing evidence. The common auricular anomalies as well as indications, timing, and methodology of effective intervention including ear molding or surgical otoplasty are reviewed herein.
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Affiliation(s)
- Joseph B Vella
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Rutgers Cleft and Craniofacial Center, Rutgers-Robert Wood Johnson Medical School, 10 Plum Street, 5th Floor, New Brunswick, NJ 08901, USA.
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3
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Xu H, Ding S, Zhang F, Zhang Z, Chen X, Li M, Yang H, Han F, Liu H. The application of the strip-shaped cymba conchae orthosis in the nonsurgical correction of complex auricular deformity. J Otol 2024; 19:24-29. [PMID: 38313761 PMCID: PMC10837530 DOI: 10.1016/j.joto.2023.12.002] [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: 08/19/2023] [Revised: 11/16/2023] [Accepted: 12/05/2023] [Indexed: 02/06/2024] Open
Abstract
Objective This study aims to evaluate the efficacy and safety of using a strip-shaped cymba conchae orthosis for the nonsurgical correction of complex auricular deformities. Methods Clinical data were collected from 2020 to 2021 for 6 patients who underwent correction using a strip-shaped cymba conchae orthosis. The indications, corrective effects, and complications associated with use of the orthosis were analyzed. Results There were four indications for treatment: cryptotia with helix adhesion; cryptotia with grade I microtia; cryptotia with excessive helix thickness; and auricular deformity beyond the treatment time window (≥6 months). Excellent corrective effects were observed in all 6 patients. Complications occurred in one patient, who recovered after symptomatic treatment. Conclusion The use of a strip-shaped cymba conchae orthosis alone or combined with a U-shaped helix orthosis presents a feasible approach for correcting complex auricular deformities or deformities beyond the treatment time window in pediatric patients.
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Affiliation(s)
- Huijuan Xu
- Department of Otolaryngology Head and Neck Surgery, People's Hospital of Henan University, Henan Provincial People's Hospital, Zhengzhou, China
| | - Shaoguang Ding
- Department of Otolaryngology Head and Neck Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Fei Zhang
- Department of Otolaryngology Head and Neck Surgery, Henan Children's Hospital, Zhengzhou, China
| | - Zhifeng Zhang
- Department of Otolaryngology Head and Neck Surgery, The Third People's Hospital of Zhengzhou, Zhengzhou, China
| | - Xiangyu Chen
- Department of Otolaryngology Head and Neck Surgery, People's Hospital of Henan University, Henan Provincial People's Hospital, Zhengzhou, China
| | - Mingyang Li
- Department of Otolaryngology Head and Neck Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | | | - Fugen Han
- Department of Otolaryngology Head and Neck Surgery, Henan Children's Hospital, Zhengzhou, China
| | - Hongjian Liu
- Department of Otolaryngology Head and Neck Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
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4
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Lin Y, Ronde EM, Butt HA, van Etten-Jamaludin F, Breugem CC. Objective evaluation of nonsurgical treatment of prominent ears: A systematic review. JPRAS Open 2023; 38:14-24. [PMID: 37694192 PMCID: PMC10491642 DOI: 10.1016/j.jpra.2023.07.002] [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: 06/16/2023] [Accepted: 07/09/2023] [Indexed: 09/12/2023] Open
Abstract
Background The prominent ear is a type of congenital ear deformity that can be corrected by a variety of nonsurgical treatments, such as splinting and the taping method. However, there is no objective evaluation method that is universally accepted. The aim of this review is to evaluate objective measurement methods that are used in the available literature to analyze nonsurgical treatment of prominent ears. Methods A systematic review was performed in the MEDLINE and Embase databases in December 2022 and updated on April 2023 according to Preferred Reporting Items for Systematics and Meta-Analyses (PRISMA) guideline. Any study using objective measurements (continuous variables such as distance and angle) to evaluate the effect of nonsurgical treatment of prominent ears was included. The Joanna Briggs Institute (JBI) critical appraisal for case series was used for quality assessment. Results A total of 286 studies were screened for eligibility, of which five articles were eligible for inclusion. All of the included studies were case series. The helix mastoid distance (HMD) is the most commonly used parameter to measure treatment outcome. Pinna and cartilage stiffness, length, and width were also used, but without clear statistical relevance. HMD was classified into grading groups (i.e. good, moderate, and poor) to evaluate the treatment's effect. Conclusion Based on the included studies, objective measurements are rarely used, and when used, they are largely heterogeneous. Although HMD was the most frequent measurement used, all studies used different definitions for the measurement and grouped subsequent outcomes differently. Automated algorithms, based on three-dimensional imaging, could be used for object measurements in the nonsurgical treatment of prominent ears.
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Affiliation(s)
- Yangyang Lin
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, The Netherlands
| | - Elsa M. Ronde
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, The Netherlands
| | - Hashir A. Butt
- Bachelor of Science in Medicine, Amsterdam UMC, location AMC, University of Amsterdam, The Netherlands
| | - F.S. van Etten-Jamaludin
- Amsterdam UMC, University of Amsterdam, Research Support, Medical Library Academic Medical Center, Amsterdam, the Netherlands
| | - Corstiaan C. Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, The Netherlands
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Burns HR, Dinis J, Ding Y, Buchanan EP. Seminars in Plastic Surgery: Pediatric Ear Anomalies and Reconstruction. Semin Plast Surg 2023; 37:287-298. [PMID: 38098685 PMCID: PMC10718655 DOI: 10.1055/s-0043-1775888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Congenital ear anomalies affect 15 to 20% of neonates and can be categorized as either auricular deformations or malformations. Deformations involve a fully developed, albeit abnormally shaped, chondrocutaneous framework, which makes them amenable to correction with ear molding within the first few months of life. Malformations involve hypoplastic or fully absent auricular structures that require augmentation with alloplastic and/or autogenous reconstruction. The goal of this article is to outline the various auricular deformities and malformations, followed by a description of the latest clinical management options, both nonsurgical and surgical, by auricular anomaly.
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Affiliation(s)
- Heather R. Burns
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Jacob Dinis
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Yang Ding
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Edward P. Buchanan
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
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Yotsuyanagi T, Yamashita K, Sugai A, Gonda A, Kitada A, Onuma M, Ueda N, Harada J. Correction of Cryptotia With Double Z-plasty:Modified Large Z-plasty Technique. J Craniofac Surg 2023; 34:2092-2094. [PMID: 37271863 DOI: 10.1097/scs.0000000000009427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 04/06/2023] [Indexed: 06/06/2023] Open
Abstract
Some cases of moderate or severe cryptotia are accompanied by a shortage of the helix. Although various operative techniques for correcting cryptotia have been reported, elongation of the helix is not considered in most of those techniques. In cases of a shortage of the helix, a drooped wide helix like a constricted ear or a cranially and posteriorly hypoplastic ear, which is characteristic of cryptotia, can appear after surgery if the helix has not been elongated. We previously reported a large Z-plasty technique that has become one of the popular techniques for correcting cryptotia. However, satisfactory results are not always achieved by using this technique in cases with a shortage of the helix. We developed a new technique (double Z-plasty) in which a small Z-plasty in the helical rim is added to the usual large Z-plasty technique. An improved helical shape and enlargement of the ear can be achieved by using this technique. Almost all types of cryptotia can be treated by appropriately using the large Z-plasty and double Z-plasty techniques.
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Affiliation(s)
- Takatoshi Yotsuyanagi
- Department of Plastic and Reconstructive Surgery, Sapporo Medical University School of Medicine, S1W16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
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Li J, Tan J, Yang D, Chen L. The advantages of domestic ear molding system in molding bilateral neonatal congenital auricular deformities. BMC Pediatr 2023; 23:101. [PMID: 36869317 PMCID: PMC9983205 DOI: 10.1186/s12887-023-03916-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 02/16/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND There are different types of ear molding devices on the market. However, due to high cost, the wide application of the ear molding is hindered, especially for children with bilateral congenital auricular deformities (CAD). This study is designed to correct the bilateral CAD with the flexible use of Chinese domestic ear molding system. METHODS Newborns diagnosed with bilateral CAD were recruited in our hospital from September 2020 to October 2021. For each subject, one ear wore a set of domestic ear molding system, while the contralateral ear used only matching Retractor and Antihelix Former. Medical charts were reviewed to collect data on the types of CAD, the incidence of complications, the initiation and duration of treatment, as well as the satisfaction after treatment. Treatment outcomes were graded into three levels: excellent, good, and poor, according to the improvement of auricular morphology evaluated by both doctors and parents, respectively. RESULTS A total of 16 infants (32 ears) were treated with the Chinese domestic ear molding system, which contains 4 cases with Stahl's ear (8 ears), 5 cases with Helical rim deformity (10 ears), 3 cases with Cup ear (6 ears), 4 cases with Lop ear (8 ears). All infants accomplished the correction completely. Both parents and doctors were satisfied with the outcomes. No obvious complication was observed. CONCLUSIONS Ear molding is an effective nonsurgical treatment for CAD. Molding with Retractor and Antihelix Former is simple and effective. Domestic ear molding system can be flexibly used in correcting bilateral CAD. With this approach, infants with bilateral CAD will benefit more in the near future.
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Affiliation(s)
- Jie Li
- Department of Otorhinolaryngology, Fu Xing Hospital, Capital Medical University, No. 20 Fuxingmenwai Street, Xicheng District, Beijing, 100038, China.
| | - Junlong Tan
- Department of Otorhinolaryngology, Fu Xing Hospital, Capital Medical University, No. 20 Fuxingmenwai Street, Xicheng District, Beijing, 100038, China
| | - Denghua Yang
- Department of Otorhinolaryngology, Fu Xing Hospital, Capital Medical University, No. 20 Fuxingmenwai Street, Xicheng District, Beijing, 100038, China
| | - Liyan Chen
- Department of Otorhinolaryngology, Fu Xing Hospital, Capital Medical University, No. 20 Fuxingmenwai Street, Xicheng District, Beijing, 100038, China
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8
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Nonsurgical Creation of an Auriculocephalic Sulcus in Children With Congenital Auricular Deformities. J Craniofac Surg 2023; 34:964-968. [PMID: 36862570 DOI: 10.1097/scs.0000000000009180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 10/11/2022] [Indexed: 03/03/2023] Open
Abstract
Nonsurgical correction of congenital auricular deformity is known to be effective in newborns. In this study, the authors investigated factors influencing the outcome of nonsurgical or surgical correction of the auriculocephalic sulcus, an important auricular structure and one that is necessary for wearing glasses or a mask. A total of 80 ears (63 children) were splinted using a metallic paper clip and thermoplastic resin in our outpatient clinic between October 2010 and September 2019. The ears were divided into a group, in which the auriculocephalic sulcus was formed nonsurgically (n =5 6) and a group, in which surgery was needed (n = 24). The authors compared the clinical characteristics of the deformities, whether cryptotia affected the superior or inferior crus, and whether constricted ears were Tanzer group IIA or IIB between the two study groups by retrospective chart review. There was a significant correlation between the age, at which ear-molding treatment was initiated and outcome (P < 0.001). The optimal cutoff value for age, before which ear-molding treatment should be initiated was 7 months. Inferior crus-type cryptotia was corrected adequately by splinting, but all Tanzer group IIB constricted ears needed surgical treatment. Earlier initiation of ear-molding treatment is recommended, preferably before 6 months of age. Nonsurgical treatment is an effective intervention for the creation of the auriculocephalic sulcus in ears with cryptotia and Tanzer group IIA constricted ears but cannot correct for an inadequate amount of skin over the auricular margin or a defect in the antihelix.
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9
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Chen L, Li C, He A, Tong H, Lu X, Yang R, Chen X, Wu X, Wang X, Wang S, Ma J, Fu Y, Zhang T. Changes of Age-related Auricular Cartilage Plasticity and Biomechanical Property in a Rabbit Model. Laryngoscope 2023; 133:88-94. [PMID: 35385162 DOI: 10.1002/lary.30124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/18/2022] [Accepted: 03/15/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Ear molding is an emerging technique that can correct auricular deformities. Treatment initiation time is the most important prognostic determinant of ear molding. Here, we aimed to examine why auricular cartilage plasticity appeared to diminish with age. Thus, we characterized age-related changes in the biomechanical, biochemical, and morphological properties of auricular cartilage. METHODS New Zealand rabbits were used as the experimental animal. We examined immature [postnatal 0 day (P0), 5 days (P5), 15 days (P15)], young [2 months (2M)], and mature [6 months (6M)] rabbits. Rabbits' ears were splinted and folded using adhesive fixation strips. Folding duration ranged from 1 day to 5 days to 10 days. Photographs were taken to calculate the retained fold angle. Cartilage morphology and extracellular matrix (ECM) content were examined histologically (using hematoxylin-eosin, Safranin O, elastic Van Gieson, and Masson's trichrome). Water content, DNA content, and cell density were also analyzed. Biomechanical properties were measured using a Nano indenter. RESULTS Immature ears had smaller angles after strip removal, and the angled deformation lasted a longer time. Cartilage matrix compositions, including glycosaminoglycan (GAG), elastin fiber, and collagen, increased over development. The water content, DNA content, and cell density decreased with age. Young's modulus was significantly higher in mature cartilage. CONCLUSIONS Here, we successfully established an animal model of ear molding and demonstrated that immature cartilage was associated with better plasticity. We also found that the cartilage's biomechanical property increased with the accumulation of ECM. The biomechanical change could underlie age-related shape plasticity. LEVEL OF EVIDENCE NA Laryngoscope, 133:88-94, 2023.
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Affiliation(s)
- Lili Chen
- ENT institute, Eye & ENT Hospital, Fudan University, Shanghai, China.,Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Chenlong Li
- ENT institute, Eye & ENT Hospital, Fudan University, Shanghai, China.,Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Aijuan He
- ENT institute, Eye & ENT Hospital, Fudan University, Shanghai, China.,Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Hua Tong
- ENT institute, Eye & ENT Hospital, Fudan University, Shanghai, China.,Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Xinyu Lu
- ENT institute, Eye & ENT Hospital, Fudan University, Shanghai, China.,Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Run Yang
- ENT institute, Eye & ENT Hospital, Fudan University, Shanghai, China.,Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Xin Chen
- ENT institute, Eye & ENT Hospital, Fudan University, Shanghai, China.,Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Xu Wu
- ENT institute, Eye & ENT Hospital, Fudan University, Shanghai, China.,Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Xin Wang
- ENT institute, Eye & ENT Hospital, Fudan University, Shanghai, China.,Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Shuqi Wang
- ENT institute, Eye & ENT Hospital, Fudan University, Shanghai, China.,Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Jing Ma
- ENT institute, Eye & ENT Hospital, Fudan University, Shanghai, China.,Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Yaoyao Fu
- ENT institute, Eye & ENT Hospital, Fudan University, Shanghai, China.,Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Tianyu Zhang
- ENT institute, Eye & ENT Hospital, Fudan University, Shanghai, China.,Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
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10
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Dinis J, Junn A, Long A, Phillips S, Reategui A, Kaplan A, Alperovich M. Non-Surgical Correction of Congenital Ear Anomalies: A Critical Assessment of Caretaker Burdens and Aesthetic Outcomes. Aesthetic Plast Surg 2022; 46:898-906. [PMID: 34608514 DOI: 10.1007/s00266-021-02610-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/19/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Congenital ear anomalies result from cartilage and skin compression in utero. They can be corrected in infancy before the cartilage hardens and loses its malleability. Caretaker burden of ear molding and its impact on esthetic outcomes has not been studied. METHODS Demographic and procedural variables were retrospectively collected for infants who underwent ear molding. Parents were surveyed regarding their experience, caretaker burden, and esthetic outcome. Outside physicians were provided with pre- and post-treatment photographs and asked to rate outcomes. A Likert scale was developed for responses and converted to a numeric score from 1 to 5 with 5 as the most desirable. RESULTS Seventy-four patients comprising 121 ears were included. Mean age at treatment was 20.1 ± 21.4 days with treatment duration of 21.1 ± 7.7 days. Parental participation in the survey was 70.1%. Questions that queried parents' experiences revealed a "very positive" experience with minor burden related to bathing and cleaning (Mean Likert Score 4.1, Range 1-5). Favorable parent-reported outcomes were obtained regarding anticipated social distress (4.28, 1-5), satisfaction with results (4.27, 1-5), and perception of final appearance (4.18, 1-5). Physician assessments of esthetic outcomes were slightly lower, but favorable between "somewhat effective" and "very effective" (3.46, 1-5). Earlier treatment trended favorably, but did not reach significance. Ear malformations had higher parent-reported satisfaction than ear deformations (4.75 ± 0.46 vs 4.21 ± 1.25, p = 0.025). CONCLUSION Despite the additional obligation for new parents, infant ear molding is rated low in terms of caretaker burden. Esthetic outcomes are excellent as assessed by parents and physicians. However, caretakers reported higher esthetic outcomes than physician evaluations. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Jacob Dinis
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, 330 Cedar Street, Boardman Building, 3rd Floor, New Haven, CT, 06519, USA
| | - Alexandra Junn
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, 330 Cedar Street, Boardman Building, 3rd Floor, New Haven, CT, 06519, USA
| | - Aaron Long
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, 330 Cedar Street, Boardman Building, 3rd Floor, New Haven, CT, 06519, USA
| | - Sarah Phillips
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, 330 Cedar Street, Boardman Building, 3rd Floor, New Haven, CT, 06519, USA
| | - Alvaro Reategui
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, 330 Cedar Street, Boardman Building, 3rd Floor, New Haven, CT, 06519, USA
| | - Anna Kaplan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, 330 Cedar Street, Boardman Building, 3rd Floor, New Haven, CT, 06519, USA
| | - Michael Alperovich
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, 330 Cedar Street, Boardman Building, 3rd Floor, New Haven, CT, 06519, USA.
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11
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Wu H, Niu Z, Li G, Li Y, Wang B, Qian J, Wang Y, Jiang H, Chen Y, Han Y. Nonsurgical Treatment for Congenital Auricular Deformities: A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2022; 46:173-182. [PMID: 34231021 DOI: 10.1007/s00266-021-02427-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/13/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The effectiveness and safety of non-surgical correction for congenital auricular deformities (CADs) remain unclear owing to a lack of high-level evidence. This systematic review and meta-analysis aimed to estimate the overall success and complication rates of the non-surgical correction for CAD. METHODS We searched PubMed, Medline, and Cochrane Library for eligible studies. The pooled success and complication rates of non-surgical correction were estimated using a random effects model. Subgroup analyses were performed to compare the success rates between patients treated with splints and molding systems, between those younger and older than 6-weeks, and among those with different types of CADs. RESULTS The review yielded 14 studies. The pooled success rate of non-surgical treatment was 93% (95% CI: 88%-97%). The success rates with splints and commercialized molding systems were 94% and 92%, respectively. The success rate was higher if non-surgical correction was initiated before age 6 weeks (96% vs. 82%). Prominent ears showed a lower success rate (85%) than other types of CADs (all > 90%). The pooled complication rate was 18% (95% CI: 10%-29%). Complications, including skin wound, irritation, and rash, were mild and easily treatable. CONCLUSION The non-surgical correction of CADs is highly effective and safe. Splints and molding systems offer similar effectiveness. Non-surgical correction is more beneficial if applied within 6 weeks of birth. Prominent ears have a lower, but still acceptable, success rate compared to other types of CAD. We recommend the early use of non-surgical correction to achieve favorable outcomes. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Huanhuan Wu
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Beijing, 100144, China
| | - Zehao Niu
- Department of Plastic and Reconstructive Surgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Guo Li
- Department of Plastic and Reconstructive Surgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yan Li
- Department of Plastic and Reconstructive Surgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Bingqing Wang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Beijing, 100144, China
| | - Jing Qian
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Beijing, 100144, China
| | - Yue Wang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Beijing, 100144, China
| | - Hanyi Jiang
- Graduate School of North, China University of Science and Technology, Tangshan, 063210, China
| | - Youbai Chen
- Department of Plastic and Reconstructive Surgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Yan Han
- Department of Plastic and Reconstructive Surgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Duvdevani SI, Knoller H, Rozendorn N, Alon EE, Madgar O. A Novel Nonsurgical Technique for Correcting Congenital Auricular Anomalies. Facial Plast Surg 2021; 38:245-249. [PMID: 34814224 DOI: 10.1055/s-0041-1735976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Congenital ear anomalies are associated with psychological morbidity. Ear deformities can usually be corrected by nonsurgical techniques such as splinting or molding in the neonatal period, initiated before 6 weeks. Without early corrections, many will require otoplasty during childhood. We introduce a novel silicone-based custom mold technique for congenital ear anomalies. The highly malleable silicone was pushed into every part of the auricle, enabling the auricle to remain in the desired shape, with new molds made weekly. Of 31 newborns (18 males, 13 females), 54 ears were treated. Average age at treatment initiation was 26.8 days. The mean treatment duration was 43.2 days, with a median of 28 days. Normal appearance and parent's satisfaction were achieved in 30 patients with 49 deformed ears and also in four newborns older than 6 weeks. Three concha type microtia in two patients achieved great improvements and parents' satisfaction. No complications were reported. Marked aesthetic improvements and normal appearance were achieved for all deformed auricles treated, and improvements in the concha type microtia will partially alleviate future surgical corrections. The results are not inferior to other techniques. The advantages are as follows: cost-effective, time-saving, simple to master, no need for hair shaving, and easy use for parents. Patients older than 6 weeks of age achieved normal auricle appearance, enabling the correction in older newborns. Custom made silicone auricle molding offers a simple nonsurgical technique for correcting congenital ear anomalies, alleviating the need for future surgical corrections.
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Affiliation(s)
- Shay I Duvdevani
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Hadas Knoller
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | - Noa Rozendorn
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | - Eran E Alon
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Ory Madgar
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
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Shin H, Shin J, Song JK, Ko JG, Lee JY. Minimally Invasive Method for Correcting Reducible Cryptotia. J Craniofac Surg 2021; 31:1827-1828. [PMID: 32371708 DOI: 10.1097/scs.0000000000006475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Various surgical methods have been used to treat cryptotia; however, there is a drawback of these methods in that they leave a permanent scar. The authors describe a 7-year-old child who missed the optimal corrective time for cryptotia. Minimally invasive surgery was planned as a 3rd alternative to external splinting or invasive surgery by taking advantage of 2 methods. Silly putty was prefabricated as an auricular sulcus retainer, and fixation sutures between the deep dermis and temporal fascia were placed through small incisions along the future auricular sulcus. Then the prefabricated auricular sulcus retainer was maintained for 2 months. After 6 months, the corrected ear shape remained stable with the inconspicuous scar. With minimally invasive correction, a successful treatment effect can be expected while minimizing scarring in patients who are not expected to have a therapeutic effect with a simple reduction.
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Affiliation(s)
- Hyojeong Shin
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Non-surgical Correction of Congenital Ear Anomalies: A Review of the Literature. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3250. [PMID: 33299713 PMCID: PMC7722567 DOI: 10.1097/gox.0000000000003250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/14/2020] [Indexed: 12/02/2022]
Abstract
Congenital ear anomalies have been known to cause lasting psychosocial consequences for children. Congenital ear anomalies can generally be divided into malformations (chondro-cutaneous defect) and deformations (misshaped pinna). Operative techniques are the standard for correction at a minimal age of 5–7, exposing the children to teasing and heavy complications. Ear molding is a non-operative technique to treat ear anomalies at a younger age. Having been popularized since the 1980s, its use has increased over the past decades. However, uncertainties about its properties remain. Therefore, this review was conducted to look at what is known and what has been newly discovered in the last decade, comparing different treatment methods and materials. A literature search was performed on PubMed, and 16 articles, published in the last decade, were included. It was found that treatment initiated at an early age showed higher satisfactory outcome rates and a shorter duration of treatment. A shorter duration of treatment also led to higher satisfactory rates, which might be attributable to age at initiation, individual moldability, and treatment compliance. Complications were minor in all articles. Recurrence rate was low and mostly concerned prominent ears, which proved to be the most difficult to correct deformity as well. Malformations, however, were even more difficult to treat than deformations. Our analysis shows ear molding to be a successful treatment method for ear anomalies with a preference for early diagnosis and treatment.
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Public Perception of Helical Rim Deformities and Their Correction With Ear Molding. J Craniofac Surg 2020; 31:741-745. [PMID: 32176020 DOI: 10.1097/scs.0000000000006400] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Among congenital ear deformities, helical rim deformities are most common. Non-surgical ear molding has emerged as an effective option to treat helical rim deformities and could reduce the need for surgery later in a child's life. Despite this, there has never been a study examining how the general public rates corrections after ear molding. METHODS A retrospective chart review was conducted of all consecutive patients with helical rim deformities treated with InfantEar TM Molding System. Amazon Mechanical Turk (MTurk) was used to survey blinded respondents using photographs of patients' ears to determine the degree of normalcy on a scale of 1 (not normal) to 10 (completely normal) before and after molding. Ratings of ears were compared using a paired t test and percent improvement from baseline. RESULTS A total of 59 ears met criteria for evaluation by 497 MTurk respondents. Average age of patients at the time of treatment was 34.2 ± 16.8 days and mean therapy duration was 31.3 ± 13.1 days. A paired t test analysis found that MTurk respondents identified significant improvement in 91.5% of ears (n = 54) (P < 0.05). The percent improvement in observed helical rim change was on average 82.7 ± 61.1%. CONCLUSION Ear molding is an effective and safe way to address helical rim deformities early in the neonatal period. The general public is able to recognize ears with rim deformities as abnormal, and appreciate the difference in architecture after molding. Crowdsourcing technology offers an opportunity to measure laypeople's perceptions regarding outcomes after ear molding.
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Nonoperative Molding of Congenital Ear Deformities: The Impact of Birth-Initiation Delay on Correction Outcome. J Craniofac Surg 2020; 31:1588-1592. [PMID: 32371707 DOI: 10.1097/scs.0000000000006473] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Ear molding can improve the majority congenital ear deformities when employed early after birth. However, the best time to initiate treatment remains debated. In describing one surgeon's experience over the past near decade, this study aims to highlight differences conferred by treatment timing. The authors hypothesize that auricular outcomes are superior when deformities are molded beginning in the first 3 weeks of life. A retrospective review (2010-2018) of 272 cases was performed to compare early initiation of molding (<3 weeks of birth) and delayed initiation (>3 weeks). The mean patient age was 20.4 days and the mean follow-up was 0.5 months. The overall treatment was approximately 31 days. The number of devices required was similar (2.3 versus 2.5) between early and delayed molding cases, but fall-outs (1.0 versus 0.7, P = 0.02) and replacements (0.9 versus 0.6, P = 0.004) were more common after delayed molding. Skin complications developed in 13.6% (37) of ears overall and did not differ by treatment timing. Follow-up surgery was reported in 2 (0.7%) ears. The 85% of families reported subjective satisfaction with the final outcome; satisfaction was significantly higher for early cases (97% versus 79%, P = 0.03). Ear molding of congenital ear deformities should begin within 3 weeks of birth. From our experience, setting realistic expectations helps limit discrepancies between expectation and outcome.
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Xiong H, Wang X, Li G, Xu J, Zhai J, Chen S, Lu Y, Chen Y, Zheng Y, Yang H. Comparison of 2 Ear Molding Systems for Nonsurgical Management of Newborn Auricular Deformities. EAR, NOSE & THROAT JOURNAL 2020; 100:652S-656S. [PMID: 32031003 DOI: 10.1177/0145561320901398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Congenital auricular deformities are common diseases in newborn infants. We compared the efficacy of 2 ear molding systems in the nonsurgical management of newborn auricular deformities in Chinese infants. METHODS A total of 462 newborns with auricular deformities were treated with either the EarWell or the LiangEar ear molding systems. The posttreatment outcome was graded as excellent, fair, and poor. The differences in effectiveness between the 2 ear molding systems and factors that may affect the posttreatment outcome were analyzed. RESULTS Both ear molding systems showed substantial efficacy in the treatment of newborn auricular deformities. The effective rate was comparable between the EarWell and the LiangEar systems for 4 types of auricular deformities (cryptotia, prominent ear, helical rim abnormality, and cup ear), while the costs for the LiangEar systems were half as much as that for the EarWell systems. Multivariate regression analysis showed that earlier time points at treatment initiation, less severe auricular deformities, treatment duration, and breastfeeding were the most significant predictive factors for a better outcome. CONCLUSION Our findings demonstrate that using the EarWell and the LiangEar systems are both optimal nonsurgical approaches for treatment of most newborn auricular deformities.
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Affiliation(s)
- Hao Xiong
- Department of Otolaryngology, 56713Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Institute of Hearing and Speech-Language Science, 26469Sun Yat-sen University, Guangzhou, China.,Department of Hearing and Speech Science, 517769Xinhua College, Sun Yat-sen University, Guangzhou, China
| | - Xiaoya Wang
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Genghui Li
- Department of Hearing and Speech Science, 517769Xinhua College, Sun Yat-sen University, Guangzhou, China.,Department of Otolaryngology, Maoming People's Hospital, Maoming, China
| | - Jingjing Xu
- Department of Hearing and Speech Science, 517769Xinhua College, Sun Yat-sen University, Guangzhou, China
| | - Jinming Zhai
- 220741The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Siyi Chen
- Department of Hearing and Speech Science, 517769Xinhua College, Sun Yat-sen University, Guangzhou, China
| | - Yuewen Lu
- Department of Hearing and Speech Science, 517769Xinhua College, Sun Yat-sen University, Guangzhou, China
| | - Yueling Chen
- Department of Hearing and Speech Science, 517769Xinhua College, Sun Yat-sen University, Guangzhou, China
| | - Yiqing Zheng
- Department of Otolaryngology, 56713Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Institute of Hearing and Speech-Language Science, 26469Sun Yat-sen University, Guangzhou, China.,Department of Hearing and Speech Science, 517769Xinhua College, Sun Yat-sen University, Guangzhou, China
| | - Haidi Yang
- Department of Otolaryngology, 56713Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Institute of Hearing and Speech-Language Science, 26469Sun Yat-sen University, Guangzhou, China.,Department of Hearing and Speech Science, 517769Xinhua College, Sun Yat-sen University, Guangzhou, China
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18
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Wang D, Jiang H, Yang Q, Liu X, He L, Pan B, Lin L. Non-surgical correction of cryptotia and the analysis of treatment time and other influence factors. Int J Pediatr Otorhinolaryngol 2020; 129:109771. [PMID: 31731016 DOI: 10.1016/j.ijporl.2019.109771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/03/2019] [Accepted: 11/04/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore correlations between post-treatment outcomes of non-surgical correction for cryptotia and treatment time and other influence factors. METHODS Forty-seven consecutive patients with 64 cryptotias were treated with the adjusted external stretching device and followed up over 12 months. A subjective evaluation scale was designed for patients to collect clinical data. Pretreatment and posttreatment evaluation were conducted by two blinded investigators. The correlations between influence factors and outcomes were explored through fractional polynomial method, multiple logistic regression, and robust linear regression methods. RESULTS Thirty-five patients with 49 cryptotias were included. Twenty-nine cryptotias (23 patients) have been successfully managed. Two of 17 unilateral cryptotias achieved nearly complete symmetry. The final optimal cutoff value for initiating treatment time is 6 months and for the duration of treatment per day is 5 h per day. Positive relationships between initiating treatment time >6 months and onset time, type II and onset time, initiating treatment time >6 months and effect stabilization time were observed. CONCLUSIONS Initiating treatment time <6 months and duration of treatment per day >5 h benefit for the posttreatment outcomes. Patients wearing the device under 6 months old would have earlier onset time and effect stabilization time. It is hard to achieve complete bilateral symmetry in unilateral patients. The adjustable devices can used for the auricles with different sizes and removed and equipped conveniently.
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Affiliation(s)
- Di Wang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haiyue Jiang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qinghua Yang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xia Liu
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Leren He
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Pan
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Lin
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Abstract
The incidence of congenital ear deformities has been documented to be as high as 58% of all newborns. Unfortunately, the majority of these deformations do not spontaneously self-correct, leaving the child with a permanent deformity that can only be corrected through surgery. With the evolving simplicity of ear molding that can be done in the office, this can obviate the need for unnecessary surgery that comes with its own set of complications and a higher cost. Early detection and early treatment is key for successful ear molding. The purpose of this article is to review the types of deformational ear deformities and the most up-to-date literature on ear molding, increase awareness to this topic, and ultimately increase patient and parental satisfaction with their overall care.
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Affiliation(s)
- Catherine S Chang
- 1 Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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20
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Schratt J, Kuegler P, Binter A, Rab M. [Non-invasive correction of congenital ear deformities with the EarWell Correction System: a prospective study]. HANDCHIR MIKROCHIR P 2019; 52:350-355. [PMID: 30754066 DOI: 10.1055/a-0821-5813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Congenital ear deformities occur in 5 % of all newborns. Molding of the ear is possible during the first six weeks of life because of the maternal hormones which are still circulating in the newborns. For several years we have been using the EarWell™ Correction System, which allows us to correct ear deformities within the first weeks of life. PATIENTS AND METHODS This prospective study included 19 newborns. The following ear deformities were treated: cup ear, lop ear, steel ear, helical rim abnormalities, antihelical rim abnormalities. The results of the EarWell™ system were reevaluated two years after the procedure. Two independent examiners evaluated the clinical results on the basis of preand postprocedural pictures. In addition, the following parameters were evaluated: time of application, complications, satisfaction of parents, cost comparison between the EarWell™ system and otoplasty. RESULTS In all, 32 ears were treated with the EarWell™ system. 63 % were male and 37 % female. The system was placed in the first three weeks of life. The average treatment time was 12-28 days. The rate of complications was 1.3 %. The clinical results were rated as follows: 23 % very satisfactory, 35 % fully satisfactory, 30 % satisfactory, 3 % less satisfactory and 9 % not satisfactory. 95 % of the parents would use the EarWell™ system again. The costs of the EarWell™ system are EUR 660, those of otoplasty EUR 2826. CONCLUSION Ear deformities are easily treated with the EarWell™ system during the first weeks of life. It reduces the need for surgical correction at a later age and prevents children from further stress. Another advantage is the low costs compared with the costs of otoplasty.
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Affiliation(s)
- Johanna Schratt
- Klinikum Klagenfurt Plastische, Ästhetische und Rekonstruktive Chirurgie
| | - Paul Kuegler
- Medical University of Graz Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery
| | - Anja Binter
- Klinikum Klagenfurt Plastische, Ästhetische und Rekonstruktive Chirurgie
| | - Matthias Rab
- Klinikum Klagenfurt Plastische, Ästhetische und Rekonstruktive Chirurgie
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Abstract
The known classifications for microtia have been cumbersome and difficult to apply in daily consultation. The lack of a progressive surgical behavior according to each degree of affection also contributes to confusion and in a lower success rate in clinical application. The authors propose a progressive surgical classification that takes into consideration the principal anatomical defect and the corresponding correction with modern techniques, having eliminated from previous classifications, those elements that are now considered deformations of the ear, capable of conservative treatment in early stages of life.
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Chang CS, Bartlett SP. A Simplified Nonsurgical Method for the Correction of Neonatal Deformational Auricular Anomalies. Clin Pediatr (Phila) 2017; 56:132-139. [PMID: 27075023 DOI: 10.1177/0009922816641368] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite reported success of early nonsurgical splinting of congenital ear deformities, the technique has not been widely utilized due to difficulty with application and positional maintenance of these devices. Delay in treatment can result in unnecessary surgery for the child later in life. In response to this need, we developed a simplified system consisting of Velcro, conformers, and polysiloxane gel that can be applied in 3 steps. Before and after photos after application of the device were graded by a plastic surgeon independent of the study. A total of 33 ear deformities were treated. In all, 92.3% of ears achieved significant improvement and normalization of their ears after therapy. This device allows for a more straightforward and individualized application than current products available. Our hope is that practitioners involved early in the infant's care will utilize this technology resulting in improved outcomes and avoiding unnecessary surgery.
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Kim JH, Sheen YH, Kim KE, Heo JS, Jeon JH, Chung SH. Treatment of Auricular Deformities with the EarWell System in Three Newborns. NEONATAL MEDICINE 2017. [DOI: 10.5385/nm.2017.24.3.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ji Hee Kim
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Youn Ho Sheen
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Ki Eun Kim
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Ju Sun Heo
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Ji Hyun Jeon
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Sung Hoon Chung
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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Correction of Congenital Auricular Deformities Using the Ear-Molding Technique. Arch Plast Surg 2016; 43:512-517. [PMID: 27896180 PMCID: PMC5122538 DOI: 10.5999/aps.2016.43.6.512] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 10/18/2016] [Accepted: 10/19/2016] [Indexed: 11/20/2022] Open
Abstract
Background Studies of the ear-molding technique have emphasized the importance of initiating molding early to achieve the best results. In the present study, we describe the immediate effects and long-term outcomes of this technique, focusing on children who were older than the ideal age of treatment initiation. Methods Patients who visited our institution from July 2014 to November 2015 were included. Medical charts were reviewed to collect data on demographics, the duration of treatment, the types of deformities, and the manner of recognition of the deformity and referral to our institution. Parents were surveyed to assess the degree of improvement, the level of procedural discomfort at the end of treatment, any changes in the shape of the molded auricle, and overall satisfaction 12 months after their last follow-up visits. Results A review of 28 ears in 18 patients was conducted, including the following types of deformities: constricted ear (64.2%), Stahl ear (21.4%), prominent ear (7.1%), and cryptotia (7.1%). The average score for the degree of improvement, rated on a 5-point scale (1, very poor; 5, excellent), was 3.5 at the end of treatment, with a score of 2.6 for procedural discomfort (1, very mild; 5, very severe). After 12 months, the shapes of all ears were well maintained. The average overall satisfaction score was 3.6 (1, very dissatisfied; 5, very satisfied). Conclusions We had reasonable outcomes in older patients. After 1 year of follow-up, these outcomes were well maintained. Patients past the ideal age at presentation can still be candidates for the molding technique.
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27
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Doft MA, Goodkind AB, Diamond S, DiPace JI, Kacker A, LaBruna AN. The Newborn Butterfly Project. Plast Reconstr Surg 2015; 135:577e-583e. [DOI: 10.1097/prs.0000000000000999] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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van Wijk MP, Breugem CC, Kon M. A prospective study on non-surgical correction of protruding ears: the importance of early treatment. J Plast Reconstr Aesthet Surg 2011; 65:54-60. [PMID: 21903493 DOI: 10.1016/j.bjps.2011.08.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 08/06/2011] [Accepted: 08/09/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Splinting is an elegant method to correct ear deformities in the newborn. However evidence is lacking on the relation between age and efficacy and duration of the treatment. We prospectively studied these questions on protruding ears in 132 babies. METHODS A splint in the scaphal hollow was used in combination with tape (Earbuddies(®)). Treatment continued until the desired shape persisted. Results were judged from photographs and mastoid-helical distance was measured. RESULTS In 132 babies 209 ears were treated. Twenty-four patients had no follow-up, 27 stopped therapy for skin irritation and fixation problems. In the remaining patients results were good in 28%, fair in 36%, poor in 36%. Efficacy deteriorates with age; with fair or good results in 66.7% if therapy started before the sixth week. Older children needed to be splinted longer. The anti-helical fold was easier corrected than a deep concha (correction in 69.8% versus 26.8%). CONCLUSIONS Considering splinting therapy for protruding ears, a reasonable chance of success can only be offered to parents of children up to six weeks of age. It is favorable if the deformity is mainly due to a flat antihelix.
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Affiliation(s)
- M P van Wijk
- Dutch Center of Ear Reconstruction, Division of Pediatric Plastic Surgery KE.04.140.0, Wilhelmina Children's Hospital University Medical Center Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands.
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Smith W, Toye J, Reid A, Smith R. Nonsurgical correction of congenital ear abnormalities in the newborn: Case series. Paediatr Child Health 2011; 10:327-31. [PMID: 19675840 DOI: 10.1093/pch/10.6.327] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine whether a simple, nonsurgical treatment for congenital ear abnormalities (lop-ear, Stahl's ear, protruding ear, cryptotia) improved the appearance of ear abnormalities in newborns at six weeks of age. METHODS This is a descriptive case series. All newborns with identified abnormalities were referred by their family physician to one paediatrician (WGS) in a small level 2 perinatal centre. The ears were waxed and taped in a standard manner within 10 days of birth. Pictures were taken before taping and at the end of taping (one month). All patients and pictures were assessed by one plastic surgeon (JWT) at six weeks of age and scored using a standard scoring system. A telephone survey of the nontreatment group was conducted. RESULTS The total number of ears assessed was 90. Of this total, 69 ears were taped and fully evaluated in the study (77%). The refusal rate was 23%. In the treatment group, 59% had lop-ear, 19% had Stahl's ear, 17% had protruding ear and 3% had cryptotia. Overall correction (excellent/improved) for the treatment group was 90% (100% for lop-ear, 100% for Stahl's ear, 67% for protruding ear and 0% for cryptotia). In the nontreatment (refusal) group, 67% of the ears failed to correct spontaneously. No complications were recognized by the authors or parents by six weeks. The percentage of newborns in one year in the perinatal centre with recognized ear abnormalities was 6% (90 of 1600). CONCLUSIONS A simple, nonsurgical treatment in a Caucasian population appeared to be very effective in correcting congenital ear abnormalities with no complications and high patient/parent satisfaction.
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Affiliation(s)
- Wg Smith
- Orillia Soldiers' Memorial Hospital, Orillia
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Sakamoto Y, Nakajima H, Kishi K, Imanishi N. A new surgical correction of cryptotia with superior auricular myocutaneous flap. J Plast Reconstr Aesthet Surg 2010; 63:1995-2000. [PMID: 20338835 DOI: 10.1016/j.bjps.2010.02.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 02/20/2010] [Indexed: 11/18/2022]
Affiliation(s)
- Yoshiaki Sakamoto
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ward, Tokyo 160-8582, Japan.
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A new method to correct Stahl's ear. J Plast Reconstr Aesthet Surg 2010; 64:48-52. [PMID: 20462821 DOI: 10.1016/j.bjps.2010.03.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 03/19/2010] [Accepted: 03/28/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Stahl's ear is a rare congenital auricular malformation in which an abnormal 'third crus' traverses the upper pole of the scapha. A number of different treatment options have been published to correct Stahl's ear deformity; however, none of them corrects all the variations perfectly. In this article, we describe our new method to correct this deformity. METHODS To correct Stahl's ear and acquire a natural-looking appearance, a technique of cartilage scoring and a folding cartilage flap was used. The entire layer of the cartilage was cut through and the anterior skin covering the cartilage was dissected to the external border of the desired superior crus and antehelix to form a fan-shape flap. After scoring of the posterior surface of the cartilage, the cartilage flap was folded and sutured to the cartilage below to build the superior crus. RESULTS Seventeen patients ranging in age from 9 to 46 years were operated upon using this technique. The ears that were created were of normal size and shape. All patients and their families were satisfied with the final result. There were no complications. CONCLUSION We have developed a new method to correct Stahl's ear deformity. Outcomes of this technique on 17 patients suggest that our method is simple, effective and successful.
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Xu JH, Wu WH, Tan WQ. Surgical correction of cryptotia with the square flap method: A preliminary report. ACTA ACUST UNITED AC 2009; 43:29-35. [DOI: 10.1080/02844310802410075] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schonauer F, La Rusca I, Molea G. Non-surgical correction of deformational auricular anomalies. J Plast Reconstr Aesthet Surg 2009; 62:876-83. [DOI: 10.1016/j.bjps.2007.11.072] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Accepted: 11/07/2007] [Indexed: 11/26/2022]
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Non-surgical correction of congenital deformities of the auricle: A systematic review of the literature. J Plast Reconstr Aesthet Surg 2009; 62:727-36. [DOI: 10.1016/j.bjps.2009.01.020] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2008] [Revised: 01/05/2009] [Accepted: 01/08/2009] [Indexed: 11/24/2022]
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Early Surgical Intervention for Proliferating Hemangiomas of the Scalp: Indications and Outcomes. Plast Reconstr Surg 2008; 122:457-462. [DOI: 10.1097/prs.0b013e31817d5fa2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Postpartum splinting can completely correct congenital ear deformities and obviate the need for later surgery
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Affiliation(s)
- Andrew J Lindford
- Department of Plastic and Reconstructive Surgery, Queen Victoria Hospital, East Grinstead RH19 3DZ
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Massengill PL, Goco PE, Norlund LL, Muir-Padilla J. Enzymatic recontouring of auricular cartilage in a rabbit model. ARCHIVES OF FACIAL PLASTIC SURGERY 2005; 7:104-10. [PMID: 15781721 DOI: 10.1001/archfaci.7.2.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of contouring auricular cartilage in a rabbit model using biologically active enzymes injected subcutaneously. METHODS The first phase determined the most effective volume and concentration required to affect the cartilage. To accomplish this task, we used ex vivo rabbit ears from a slaughterhouse. In the second phase, we injected 1 mL of hyaluronidase (150 U per milliliter of isotonic sodium chloride solution [saline]), elastase (1 mg per milliliter of saline), or saline into the ears of live rabbits. The study took place at the Madigan Army Medical Center (Tacoma, Wash), and included 10 animals. In each rabbit, we injected the test compound in one ear and saline in the other ear (control). We injected hyaluronidase in 5 ears and elastase in 5 ears. After injection, the ears were contoured and splinted for 4 weeks. In the third phase, we changed the injection pathway in 5 animals. RESULTS At 4 weeks, 4 (80%) of the 5 ears injected with hyaluronidase showed full response and 1 (20%) had a partial response. Of the 5 ears injected with elastase, 4 (80%) showed a full response while 1 (20%) demonstrated a partial response. There was a response in all 10 of the ears injected with a test compound. Of the 10 control ears, 3 (30%) showed a partial response. At 6 weeks, approximately 6 (30%) of the ears had maintained contour demonstrating a full response. The difference between the test ears and the control ears was statistically significant (P = .006). Compared with the control ears, the results were statistically significant for elastase (P = .004) and hyaluronidase (P = .02). Overall, both agents demonstrated a subjective and objective response compared with control ears. CONCLUSION This study demonstrates that bioactive enzymes and splinting can be effective in correcting ear deformities in a rabbit model.
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Affiliation(s)
- Phillip L Massengill
- Otolaryngology Service, Department of Surgery, Madigan Army Medical Center, Tacoma, Wash, USA.
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Hunter AGW, Yotsuyanagi T. The external ear: More attention to detail may aid syndrome diagnosis and contribute answers to embryological questions. Am J Med Genet A 2005; 135:237-50. [PMID: 15887280 DOI: 10.1002/ajmg.a.30723] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The human pinna has a complex shape and yet the basic components of normal structure are remarkably constant between individuals. It is precocious in its appearance during embryogenesis and it has been subject to many developmental and surgical studies, yet questions remain as to its primary embryogenesis and the causes of its malformations. Unfortunately, the vast majority of clinical reports of syndromes and of individuals with dysmorphic signs provide limited and inadequate description of the external ear. Given the intricate pattern of the pinna, and hence its potential for morphological variation, we think that more attention to the specific description of ear anomalies may lead to a better appreciation of the etiology and embryology of the malformations. Furthermore, in some cases correlation with specific syndromes may provide an aid to diagnosis. Towards those ends this paper reviews some of the controversy concerning the embryology of the pinna, and discusses a number of the better-defined anomalies of the external ear. Although it has been suggested that anomalies of the insertion and orientation of intrinsic muscles of the pinna may be responsible for variations in external ear morphology, we think it likely that in many cases the anomalous insertions may be secondary.
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Affiliation(s)
- Alasdair G W Hunter
- Eastern Ontario Genetics Program, Children's Hospital of Eastern Ontario, Ottawa, Canada.
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Bader D, Grun M, Riskin-Mashiah S, Grunfeld A, Kugleman A, Kogelman A, Chistyakov I, Merlob P. Auricular mild errors of morphogenesis: epidemiological analysis, local correlations and clinical significance. ACTA ACUST UNITED AC 2004; 47:225-34. [PMID: 15337467 DOI: 10.1016/j.anngen.2004.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2003] [Accepted: 02/04/2004] [Indexed: 11/22/2022]
Abstract
BACKGROUND The mild errors or morphogenesis (MEMs) are well known and accepted markers of alterations in embryonic development with predictive value in identification of major malformations, specific genetic syndromes, metabolic and psychiatric disease and childhood malignancy. OBJECTIVE The goal of this study was to assess the contribution of auricular MEMs as part of total MEMs in an effort to study the factors influencing the different potential informative value of different types of MEMs and their variability with perinatal factors. METHOD Three thousand one hundred and seven consecutive born neonates were screened for auricular and non-auricular MEMs, inregistered concomitantly with major malformations and postural defects. The study was accomplished by our specially designed computerized program in a relatively large nonhomogeneous ethnic population, in the metropolitan area of Haifa, Israel. RESULTS The general prevalence of auricular MEMs was 43.1%; the most frequent pathogenetic type was the postural one. Significantly higher rates of auricular MEMs were associated with male sex, small- and large-for-gestational age, IVF pregnancy, triplet pregnancy, maternal diabetes and parental consanguinity. CONCLUSION We conclude that the presence, number, and association or concomitance of auricular MEMs in the same neonate may have important clinical, diagnostic, pathogenetic, screening, and therapeutic value.
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Affiliation(s)
- David Bader
- Department of Neonatology, Bnei Zion Medical Center, 47, Golomb Street, Haifa 31048, Israel.
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Abstract
A technique of correction of Stahl's ear is presented and is compared with other techniques reported in the literature.
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Affiliation(s)
- M M Al-Qattan
- Division of Plastic Surgery, King Saud University and King Faisal Specialist Hospital, Riyadh, Saudi Arabia
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43
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Cho BC, Chung HY, Park JW. Surgical Correction of Prominent Ear Using Modified Tube Technique and Posterior Approach. J Craniofac Surg 2003; 14:767-73. [PMID: 14501345 DOI: 10.1097/00001665-200309000-00031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In patients with a prominent ear, the most common deformities are a poorly developed antihelical fold and the formation of excessive conchal cartilage, particularly in the posterior conchal wall. As such, the main goal for surgical correction of a prominent ear is to narrow the conchoscaphal angle by folding the antihelix and reducing the concha. In the current study, cartilage-sparing tubing otoplasty is refined by the addition of a minimal dissection of the edge of the conchal and scaphal cartilages, and horizontal mattress sutures between the two edges. Nine patients with 13 cases were operated on between 1999 and 2001. Of the nine patients, four had bilateral procedures, and five had unilateral surgery. The age distribution was 11 to 22 years. The follow-up periods ranged from 6 months to 2 years. No hematomas or skin necrosis occurred. A mild recurrence of the upper antihelical fold was experienced in one case, and the patient required further surgery. Suture extrusions developed in two cases. In conclusion, the proposed technique is a simple and safe procedure with reliable results and no anterior scarring.
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Affiliation(s)
- Byung Chae Cho
- Department of Plastic and Reconstructive Surgery, College of Medicine, Kyungpook National University, Daegu, Korea.
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Smith WG, Toye J, Smith R. Nonsurgical treatment of protruding ears: A case report and review of literature. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2003; 11:87-9. [PMID: 24222992 DOI: 10.1177/229255030301100202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The nonsurgical correction of congenital ear deformities has been reported in the world literature. To date, there has been little interest in this procedure in pediatric centres and no reports in the Canadian literature. Two case reports are presented with a review of the literature. A description of this simple, user friendly office procedure is presented.
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Affiliation(s)
- W Gary Smith
- Orillia Soldiers Memorial Hospital, Orillia, Ontario
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Abstract
Normal ears come in a wide variety of sizes and shapes, likely because of the impact of racial and familial characteristics (phenotypes), the complexity of the embryologic development (malformations), and the potential for intrauterine factors such as oligohydramnios or intrauterine compression to produce distinct physical characteristics in normally formed tissues (deformations). This article will provide an overview of the embryologic origins of the external ear. Relevant terminology used to describe the ear will be reviewed, along with objective guidelines for the assessment of ear size, shape, and position. Clinical implications of abnormal findings will be discussed along with recommendations for referral and follow-up.
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Affiliation(s)
- Lynn Spilman
- NICU, Children's Hospital, Albany Medical Center, 43 New Scotland Ave, Albany, NY 12208, USA.
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Abstract
Nonsurgical treatment does not always correct all auricular deformities. However, we believe that all types of deformities can be treated if the gradual and continuous correction is made. Therefore, it is recommended that nonsurgical treatment should be tried first, even in older children. Even if the correction with the splint is not satisfactory, the improved form with the splint will make it easier to obtain a good, delicate form by surgery at a later stage.
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Affiliation(s)
- Takatoshi Yotsuyanagi
- Department of Plastic and Reconstructive Surgery, Hirosaki University School of Medicine, Japan.
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Ullmann Y, Blazer S, Ramon Y, Blumenfeld I, Peled IJ. Early nonsurgical correction of congenital auricular deformities. Plast Reconstr Surg 2002; 109:907-13; discussion 914-5. [PMID: 11884806 DOI: 10.1097/00006534-200203000-00013] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Congenital auricular deformation is not an uncommon phenomenon, and it may cause substantial annoyance to the growing child. Many parents of affected children will seek surgical correction of the deformed auricles. The variety of techniques that have been described for the correction of this anomaly suggests that none has been considered satisfying. The consequent possible surgical complications should also be considered, when the surgical procedure can be replaced by an effective conservative treatment. The authors describe their experience using early splinting for congenital auricular deformities. Fifty-two newborn infants with lop, prominent, Stahl's, and constricted ears referred to us by the neonatal department staff were enrolled in this study. Putty Soft, a vinyl polysiloxane impression material, has been used for early molding of the auricles. Surgical tapes were used for the fixation of the mold and to fix the auricle to the scalp. The results were evaluated by one of the parents and by a layperson (medical student) 6 months after completion of the procedure. The above-described early splinting procedure was applied onto 92 auricles of 52 newborn infants aged 1 to 10 days, mostly around day 3. The mean treatment time was 6.8 weeks. All treated auricles were improved, 87 percent were rated as excellent improvement, and there were no complications related to the treatment. The authors conclude that early splinting of deformed auricles should be offered to parents of affected children, and the awareness of this procedure by neonatologists, pediatricians, and nursery staff should be increased.
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Affiliation(s)
- Yehuda Ullmann
- Department of Plastic and Reconstructive Surgery, Rambam Medical Center, Haaliah St. 8, Haifa, Israel.
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Yotsuyanagi T, Yamashita K, Shinmyo Y, Yokoi K, Sawada Y. A new operative method of correcting cryptotia using large Z-plasty. BRITISH JOURNAL OF PLASTIC SURGERY 2001; 54:20-4. [PMID: 11121312 DOI: 10.1054/bjps.2000.3463] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A large Z-plasty on the postauricular surface of the ear has been used for successful reconstruction of cryptotia. This technique provides extensive skin coverage of the posterior auricle without skin grafting. The technique is easy and simple. The natural hairline is not disturbed and the temporoauricular sulcus is emphasised. Almost all of the scar is hidden behind the auricle. It has been performed on 17 patients with no recurrence of the cryptotia. One patient had partial congestion in the cranial-flap tip, which improved within 1 week. There were no other complications.
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Affiliation(s)
- T Yotsuyanagi
- Department of Plastic and Reconstructive Surgery, Hirosaki University School of Medicine, Hirosaki, Japan
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Abstract
This article presents a new surgical method that uses tumbling concha-cartilage flaps to correct lop ears. Through a posterior or anterior auricular skin incision, a rectangular or T-shaped cartilage flap is elevated from the concha and tumbled backward. After passing under the postauricular skin, the flap's tip is fixed to the lidded helix or scapha. The recoiling force of the flap's conchal side enables the lidded portion to be in a normal, erect, anatomic position. The method also increases the vertical height of the ear and creates a normally shaped scapha. Sixteen lop ears were corrected using this procedure, with most of them maintaining natural auricular features. Therefore, this method was considered effective for the correction of moderate lop ear deformity.
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Affiliation(s)
- C Park
- Department of Plastic Surgery, Yonsei University College of Medicine and Yongdong Severance Hospital, Seoul, Korea.
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