Auricular Reconstruction

Abstract

The auricle is susceptible to various injuries due to its location and projection from the scalp. The unique contours of the external ear makes reconstruction a challenging endeavor. This chapter provides a comprehensive overview of auricular reconstruction, based on the depth, location, and size of injury. Strategies for reconstructing superficial, composite, and full-thickness injuries are discussed in relation to the location of the defect. Targeted reconstructive options for injuries of the upper, middle, and lower thirds of the auricle are outlined. Methods for total auricular reconstruction and auricular prosthesis are discussed. Options for managing traumatic injuries are reviewed, including avulsion/amputation injuries, burns, electrical injuries, frostbite, and human/animal bites. This chapter provides a practical framework for surgeons faced with complex auricular defects, offering insights to recreate a discreet, harmonious ear.

Keywords

ear - auricular reconstruction - ear reconstruction

Publication History

Accepted Manuscript online:
09 October 2024

Article published online:
29 October 2024

• References

• 1 Horlock N, Vögelin E, Bradbury ET, Grobbelaar AO, Gault DT. Psychosocial outcome of patients after ear reconstruction: a retrospective study of 62 patients. Ann Plast Surg 2005; 54 (05) 517-524
• 2 Jovic TH, Stewart K, Kon M, Whitaker IS. Auricular reconstruction: a sociocultural, surgical and scientific perspective. J Plast Reconstr Aesthet Surg 2020; 73 (08) 1424-1433
• 3 Carniol ET, Adamson PA, Gantous A. Otoplasty. In: Cummings Otolaryngology Head and Neck Surgery. Vol 1. 7th ed.. Elsevier; 2021: 432-438
• 4 Armin BB, Ruder RO, Azizadeh B. Partial auricular reconstruction. Semin Plast Surg 2011; 25 (04) 249-256
• 5 Cheney ML. Local flaps in auricular reconstruction. Facial Plast Surg Clin North Am 1997; 5 (04) 371-393
• 6 Farkas LG. Anthropometry of the normal and defective ear. Clin Plast Surg 1990; 17 (02) 213-221
• 7 Tolleth H. Artistic anatomy, dimensions, and proportions of the external ear. Clin Plast Surg 1978; 5 (03) 337-345
• 8 Hadlock TA, Cheney ML, Quatela VC. Reconstruction of the auricle. In: Local Flaps in Facial Reconstruction; 2022: 583-624.e1
• 9 Shonka Jr DC, Park SS. Ear defects. Facial Plast Surg Clin North Am 2009; 17 (03) 429-443
• 10 Farrior EH, Troiano CA. Otoplasty: anatomy, embryology, and otoplasty technique. In: Bailey's Head and Neck Surgery. 6th ed.. Lippincott Williams & Wilkins; 2022: 3738-3756
• 11 Park SS, Hood RJ. Auricular reconstruction. Otolaryngol Clin North Am 2001; 34 (04) 713-738 , v–vi
• 12 Wong Chung JERE, Chussi DC, van Heerbeek N. External auditory canal stenosis after traumatic auricular amputation. J Craniofac Surg 2017; 28 (01) e87-e89
• 13 Frodel JL. Maxillofacial and soft tissue trauma. In: Facial Plastic Surgery: The Essential Guide. Thieme; 2005: 161-222
• 14 Williams CH, Sternard BT. Complex Ear Lacerations. StatPearls; 2024. . Accessed May 15, 2024 at: http://www.ncbi.nlm.nih.gov/books/NBK525973/
• 15 Hill JD, Stoddard DG, Hamilton GS. Facial trauma: soft tissue lacerations and burns. In: Cummings Otolaryngology Head and Neck Surgery. Vol 1. 7th ed.. Elsevier; 2021: 269-285
• 16 Patel KR, Shaye DA. Chapter 3 - Surgical management of auricular trauma. In: Kozin ED. ed. Otologic and Lateral Skull Base Trauma. Elsevier; 2024: 21-32
• 17 Pool C, Lighthall JG. Reconstruction of lower third auricular defects. Oper Tech Otolaryngol–Head Neck Surg 2017; 28 (02) 119-124
• 18 Nassour N, Watfa W. Outcomes and complications of traumatic ear lobe repair techniques: a systematic review. J Cosmet Dermatol 2022; 21 (03) 910-923
• 19 Yotsuyanagi T, Watanabe Y, Yamashita K, Urushidate S, Yokoi K, Sawada Y. Retroauricular flap: its clinical application and safety. Br J Plast Surg 2001; 54 (01) 12-19
• 20 Sivam SK, Taylor CB, Stallworth CL. Reconstruction of upper third auricular defects. Oper Tech Otolaryngol–Head Neck Surg 2017; 28 (02) 105-113
• 21 Brodland DG. Auricular reconstruction. Dermatol Clin 2005; 23 (01) 23-41 , v
• 22 Lawson VG. Reconstruction of the pinna using pre-auricular flaps. J Otolaryngol 1984; 13 (03) 191-193
• 23 Siegert R, Magritz R. Reconstruction of the auricle. GMS Curr Top Otorhinolaryngol Head Neck Surg 2007; 6: Doc02
• 24 Antia NH, Buch VI. Chondrocutaneous advancement flap for the marginal defect of the ear. Plast Reconstr Surg 1967; 39 (05) 472-477
• 25 Pham TV, Early SV, Park SS. Surgery of the auricle. Facial Plast Surg 2003; 19 (01) 53-74
• 26 Menapace DC, Clark MJ. Management of soft tissue injuries of the face. In: Bailey's Head and Neck Surgery. 6th ed.. Lippincott Williams & Wilkins; 2022: 1158-1182
• 27 Wong K, Wong A, Rousso JJ. Reconstructive options for auricular trauma. Facial Plast Surg 2021; 37 (04) 510-515
• 28 Park SS. Cutaneous lesions and facial reconstruction. In: Facial Plastic Surgery: The Essential Guide. Thieme; 2005: 61-115
• 29 Pickrell BB, Hughes CD, Maricevich RS. Partial ear defects. Semin Plast Surg 2017; 31 (03) 134-140
• 30 Park SS, Wang TD. Temporoparietal fascial flap in auricular reconstruction. Facial Plast Surg 1995; 11 (04) 330-337
• 31 Dresner H, Waselchuk E. Reconstruction of the middle third auricular defects. Oper Tech Otolaryngol–Head Neck Surg 2017; 28 (02) 114-118
• 32 Zhu J, Zhao H, Wu K. et al. Reconstruction of auricular conchal defects with local flaps. Medicine (Baltimore) 2016; 95 (46) e5282
• 33 Converse JM. Reconstruction of the auricle. I. Plast Reconstr Surg Transplant Bull 1958; 22 (02) 150-163
• 34 Gavello P, Zitiert N, Nelaton C. Les autoplasties. Paris G Steinheil; 1907
• 35 Pennington DG, Lai MF, Pelly AD. Successful replantation of a completely avulsed ear by microvascular anastomosis. Plast Reconstr Surg 1980; 65 (06) 820-823
• 36 Mladick RA, Horton CE, Adamson JE, Cohen BI. The pocket principle: a new technique for the reattachment of a severed ear part. Plast Reconstr Surg 1971; 48 (03) 219-223
• 37 Baudet J, Tramond P, Goumain A. [A new technic for the reimplantation of a completely severed auricle]. Ann Chir Plast 1972; 17 (01) 67-72
• 38 Al-Ali MA, Abu-Zidan FM. Auricular avulsion injuries: literature review and management algorithm. Turk J Emerg Med 2022; 22 (02) 59-66
• 39 Gailey AD, Farquhar D, Clark JM, Shockley WW. Auricular avulsion injuries and reattachment techniques: a systematic review. Laryngoscope Investig Otolaryngol 2020; 5 (03) 381-389
• 40 Firmin F, Marchac A. [Reconstruction of the burned ear]. Ann Chir Plast Esthet 2011; 56 (05) 408-416
• 41 Yotsuyanagi T, Yamashita K, Sugai A. et al. New concept for severely burned ear reconstruction: grafting of the frame using banked ear cartilage combined with costal cartilage. Plast Reconstr Surg Glob Open 2021; 9 (02) e3058
• 42 Ebrahimi A, Kazemi A, Rasouli HR, Kazemi M, Kalantar Motamedi MH. Reconstructive surgery of auricular defects: an overview. Trauma Mon 2015; 20 (04) e28202
• 43 Bhandari PS. Total ear reconstruction in postburn deformity. Clin Plast Surg 2002; 29 (02) 213-220 , vi
• 44 Bergstrom L, Neblett LW, Sando I, Hemenway WG, Harrison GD. The lightning-damaged ear. Arch Otolaryngol 1974; 100 (02) 117-121
• 45 Ogren FP, Edmunds AL. Neuro-otologic findings in the lightning-injured patient. Semin Neurol 1995; 15 (03) 256-262
• 46 Bounds EJ, Khan M, Kok SJ. Electrical Burns. StatPearls; 2024. . Accessed May 17, 2024 at: http://www.ncbi.nlm.nih.gov/books/NBK519514/
• 47 Jones DT, Ogren FP, Roh LH, Moore GF. Lightning and its effects on the auditory system. Laryngoscope 1991; 101 (08) 830-834
• 48 Chan TY, Smedley FH. Tetanus complicating frostbite. Injury 1990; 21 (04) 245
• 49 Sessions DG, Stallings JO, Mills Jr WJ, Beal DD. Frostbite of the ear. Laryngoscope 1971; 81 (08) 1223-1232
• 50 Murphy J, Qaisi M. Management of human and animal bites. Oral Maxillofac Surg Clin North Am 2021; 33 (03) 373-380
• 51 Donkor P, Bankas DO. A study of primary closure of human bite injuries to the face. J Oral Maxillofac Surg 1997; 55 (05) 479-481 , discussion 481–482
• 52 Stierman KL, Lloyd KM, De Luca-Pytell DM, Phillips LG, Calhoun KH. Treatment and outcome of human bites in the head and neck. Otolaryngol Head Neck Surg 2003; 128 (06) 795-801
• 53 Horta R, Costa-Ferreira A, Costa J. et al. Ear replantation after human bite avulsion injury. J Craniofac Surg 2011; 22 (04) 1457-1459
• 54 Stevens DL, Bisno AL, Chambers HF. et al; Infectious Diseases Society of America. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59 (02) e10-e52
• 55 Firmin F, Dusseldorp JR, Marchac A. Auricular Reconstruction. Thieme; 2016
• 56 Brent B. Auricular repair with autogenous rib cartilage grafts: two decades of experience with 600 cases. Plast Reconstr Surg 1992; 90 (03) 355-374 , discussion 375–376
• 57 Nagata S. A new method of total reconstruction of the auricle for microtia. Plast Reconstr Surg 1993; 92 (02) 187-201
• 58 Zhou G, Jiang H, Yin Z. et al. In vitro regeneration of patient-specific ear-shaped cartilage and its first clinical application for auricular reconstruction. EBioMedicine 2018; 28: 287-302
• 59 Liao J, Chen Y, Chen J. et al. Auricle shaping using 3D printing and autologous diced cartilage. Laryngoscope 2019; 129 (11) 2467-2474
• 60 Reighard CL, Hollister SJ, Zopf DA. Auricular reconstruction from rib to 3D printing. J 3D Print Med 2018; 2 (01) 35-41
• 61 Humphries S, Joshi A, Webb WR, Kanegaonkar R. Auricular reconstruction: where are we now? A critical literature review. Eur Arch Otorhinolaryngol 2022; 279 (02) 541-556
• 62 Butler DF, Gion GG, Rapini RP. Silicone auricular prosthesis. J Am Acad Dermatol 2000; 43 (04) 687-690
• 63 Nuseir A, Hatamleh M, Watson J, Al-Wahadni AM, Alzoubi F, Murad M. Improved construction of auricular prosthesis by digital technologies. J Craniofac Surg 2015; 26 (06) e502-e505
• 64 Federspil PA. The role of auricular prostheses (epitheses) in ear reconstruction. Facial Plast Surg 2015; 31 (06) 626-632
• 65 Federspil PA. Auricular prostheses. Adv Otorhinolaryngol 2010; 68: 65-80
• 66 Jacobsson M, Tjellström A, Fine L, Jansson K. An evaluation of auricular prosthesis using osseointegrated implants. Clin Otolaryngol Allied Sci 1992; 17 (06) 482-486