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DOI: 10.1055/s-2003-39129
Surgery of the Auricle
Publication History
Publication Date:
09 May 2003 (online)
ABSTRACT
Auricular reconstruction is a unique area of facial plastic surgery where a wide array of reconstructive options often must be considered. The external ear is unique in its aesthetic role where the normal auricle often goes unnoticed; yet even a small irregularity can stand out and become conspicuous. The reconstruction of large or total auricular defects is a combination of science and art. Two forms of auricular reconstruction are discussed: (1) those for a congenitally abnormal shape but no acquired tissue deficiency, that is, otoplasty, and (2) repairs requiring a reconstruction of discrete loss of tissue. A general algorithm is presented that can assist with flap selection and covers the techniques for grafts, framework repair, local and pedicled flaps, temporoparietal facial flaps, and auricular prostheses.
KEYWORDS
Auricular defects - auricular reconstruction - prominent ears - otoplasty - microtia - auricular prosthesis
REFERENCES
- 1 Aguilar F E. Auricular reconstruction of congenital microtia (grade III). Laryngoscope . 1996; 106(12) 1-26
- 2 Kurihara K. Congenital deformities of the external ear. In: Cohen M, ed. Mastery of Plastic and Reconstructive Surgery, 1st ed Boston, MA: Little, Brown 1994: 770-799
- 3 Quatela V C, Goldman N D. Microtia repair. Facial Plast Surg . 1995; 11(4) 257-273
- 4 Farkas L G. Anthropometry of the normal and defective ear. Clin Plast Surg . 1990; 17(2) 213-221
- 5 Adamson P A. Otoplasty techniques. Facial Plast Surg . 1995; 11(4) 284-300
- 6 Davis J E. Anatomy of the ear. In: Stark RB, ed. Plastic Surgery of the Head and Neck New York: Churchill Livingstone 1987: 445-462
- 7 Colin K S, Donald A J. Embryology and anomalies of the external ear. Facial Plast Surg . 1995; 11(4) 251-256
- 8 Roger B O. Developmental defects of the ear. In: Stark RB, ed. Plastic Surgery of the Head and Neck New York: Churchill Livingstone 1987: 467-471
- 9 Gosain A K, Moore F O. Embryology of the head and neck. In: Aston SJ, Beasley RW, Thorne CHM, eds. Grabb and Smith's Plastic Surgery, 5th ed Philadelphia, PA: Lippincott-Raven 1997: 223-236
- 10 Tolleth H. A hierarchy of values in the design and reconstruction of the ear. Clin Plast Surg . 1990; 17(2) 103-197
- 11 Issing P R, Ohmayer T, Heermann R. et al . Axillary metastasis of oropharyngeal carcinoma after pectoralis major flap. Hals-, Nasen-, und Ohrenheikunde (HNO) . 1997; 45 153
- 12 Hosal N, Turan E, Aras T. Lymphoscintigraphy in pectoralis major myocutaneous flaps. Arch Otolaryngol Head Neck Surg . 1994; 120 656
- 13 Adamson J E, Horton C E, Crawford H H. The growth pattern of the external ear. Plast Reconstr Surg . 1965; 36 466-470
- 14 Furnas D W. Otoplasty for protruding ears, cryptotia, or Stahl's ear. In: Evans GR, ed. Operative Plastic Surgery New York: McGraw-Hill 2000: 417-448
- 15 Emery B E. Otoplasty. Facial Plast Surg Clin North Am . 2001; 9(1) 147-157
- 16 Caouette-Laberge L, Guay N, Bortoluzzi P, Belleville C. Otoplasty: anterior scoring technique and results in 500 cases. Plast Reconstr Surg . 2000; 105(2) 504-515
- 17 Mustardé J C. The reconstruction of prominent ears using simple mattress sutures. Br J Plast Surg . 1963; 16 170
- 18 Aguilar E A. Congenital auricular malformation. In: Bailey BJ, ed. Head and Neck Surgery-Otolaryngology, 2nd ed Philadelphia, PA: Lippincott-Raven 1998: 2735-2767
- 19 Cheney M L. Otoplasty. In: Cheney ML, ed. Facial Surgery Plastic and Reconstruction Baltimore, MD: Williams & Wilkins 1997: 581-590
- 20 Luckett W H. A new operation for prominent ears based on the anatomy of the deformity. Surg Gynecol Obstet . 1910; 10 635
- 21 Chongchet V A. A method of antihelix reconstruction. Br J Plast Surg . 1963; 16 268
- 22 Tamerine J A, Mirehouse O. Reconstruction of the antihelix and scapha in selected cases of protruding ears. Arch Otolaryngol Head Neck Surg . 1959; 70 597
- 22a Gibson T, Davis W B. The distortion of autogenous cartilage grafts: its cause and prevention. Br J Plast Surg . 1958; 10 257
-
23 Farrior R. In: Romo T III ed. Aesthetic Facial Plastic Surgery New York: Thieme 2000: 427-443
- 24 Furnas D. Correction of prominent ears by conchamastoid sutures. Plast Reconstr Surg . 1968; 42 189-193
- 25 Spira M, Stal S. The conchal flap: an adjunct in otoplasty. Ann Plast Surg . 1983; 11 291
- 26 Brent B. Auricular repair with autogenous rib cartilage grafts: two decades of experience with 600 cases. Plast Reconstr Surg . 1992; 90 355-374
- 27 Brent B. Technical advances in ear reconstruction with autogenous rib cartilage grafts: personal experiences with 1200 cases. Plast Reconstr Surg . 1999; 104 319-334
- 28 Lucente F E. Malformation. In: Lucente FE, Lawson W, Novic NL, eds. The External Ear Philadelphia, PA: WB Saunders 1995: 302-313
- 29 Megerian C A, McKenna M J, Nadol J B. Otologic considerations in microtia/atresia. In: Cheney ML, ed. Facial Surgery Plastic and Reconstruction Baltimore, MD: Williams & Wilkins 1997: 573-580
- 30 Weerda H. Classification of congenital deformities of the auricle. Facial Plast Surg . 1988; 5 385-388
- 31 Park S S, Hood R J. Auricular reconstruction. Otolaryngol Clin North Am . 2001; 34(30) 713-738
- 32 Lawson W. Management of acute trauma. In: Lucente FE, Lawson W, Novic NL, eds. The External Ear Philadelphia, PA: WB Saunders 1995: 174-188
- 33 Antia N H, Buch V I. Chondrocutaneous advancement flap for the marginal defect of the ear. Plast Reconstr Surg . 1967; 39 472-477
- 34 Lawson W. Surgical repair of the auricle following tumor excision and trauma. In: Lucente FE, Lawson W, Novic NL, eds. The External Ear Philadelphia, PA: WB Saunders 1995: 243-286
- 35 Argamaso R, Lewin M L. Repair of partial ear loss with local composite flap. Plast Reconstr Surg . 1968; 42 437-441
- 36 Cheney M L. Local flaps for facial reconstruction. In: Cheney ML, ed. Facial Plastic Surgery and Reconstruction Baltimore, MD: Williams & Wilkins 1997: 373-457
- 37 Cronin T D. One stage reconstruction of the helix: two improved methods. Plast Reconstr Surg . 1952; 9 547-556
- 38 Converse J M, Brent B. Acquired deformities of the auricle. In: Converse JM, ed. Plastic Reconstructive Surgery, 3rd ed Philadelphia, PA: WB Saunders 1977: 1724-1773
- 39 Lewin M L. Formation of the helix with a postauricular flap. Plast Reconstr Surg . 1959; 5 432-440
- 40 Renard A. Postauricular flap based on a dermal pedicle for ear reconstruction. Plast Reconstr Surg . 1981; 68 159-165
- 41 Schramm V L, Meyers R N. Reconstruction of the conchal defects. Laryngoscope . 1978; 88 1868-1870
- 42 Fox J W, Edgerton M T. The fan flap: an adjunct to ear reconstruction. Plast Reconstr Surg . 1976; 58 663-667
- 43 Park S S, Wang T D. Temporoparietal fascial flap in auricular reconstruction. Facial Plast Surg . 1995; 11 330-337
- 44 Kim J C, Hadlock T, Varvares M A, Cheney M L. Hair-bearing temporoparietal fascial flap reconstruction of upper lip and scalp defects. Arch Facial Plast Surg . 2001; 3 170-177
- 45 Cheney M L, Varvares M A, Nadol Jr B J. The temporoparietal fascial flap in head and neck reconstruction. Arch Otolaryngol Head Neck Surg . 1993; 119 618-623
- 46 Park C, Lew D H, Yoo W M. An analysis of 123 temporoparietal fascial flaps: anatomic and clinical considerations in total auricular reconstruction. Plast Reconstr Surg . 1999; 104 1295-1306
- 47 Yotsuyanagi T, Nihei Y, Sadawa Y. Reconstruction of defects involving the upper one-third of the auricle. Plast Reconstr Surg . 1998; 102 988-992
- 48 Converse J M. Reconstruction of the auricle. Part 1. Plast Reconstr Surg . 1958; 22 150-163
- 49 Cheney M. Management of auricular injuries. In: Cheney ML, ed. Facial Plastic Surgery and Reconstruction Baltimore, MD: Williams & Wilkins 1997: 547-555
- 50 Lawson W. Management of auricular trauma. In: Lucente FE, Lawson W, Novic NL, eds. The External Ear Philadelphia, PA: WB Saunders 1995: 174-188
- 51 Mladick R A, Horton C E, Adamson J E, Cohen B I. The pocket principle: a new technique for reattachment of a severed ear part. Plast Reconstr Surg . 1971; 48 218-223
- 52 Mladick R A, Carraway J H. Ear rattachment by the modified pocket principle. Plast Reconstr Surg . 1973; 51 584-587
- 53 Baudet J, Traumond P, Goumain A. A propos d'un procede originale de reimplantation d'un pavillon de l'oreille totalemant separe. Ann Chir Plast . 1972; 17 67-72
- 54 Jenkins A M, Finucan T. Primary nonmicrosurgical reconstruction of the auricle following ear avulsion using the temporoparietal fascial island flap. Plast Reconstr Surg . 1989; 83 148-152
- 55 Tanzer R C. Total reconstruction of the auricle: a 10-year report. Plast Reconstr Surg. 196; 40 547-550
- 56 Tanzer R C. The correction of microtia. In: Brent B, ed. The Artistry of Reconstructive Surgery St. Louis, MO: Mosby 1987: 93-98
- 57 Jahrdoerfer J A, Kesser B W. Issues on aural atresia for the facial plastic surgeon. Facial Plast Surg . 1995; 11 274-277
- 58 Ohara K, Nakamura K, Ohta E. Chest wall deformities and thoracic scoliosis after costal cartilage graft harvesting. Plast Reconstr Surg . 1997; 99 1030-1036
- 59 Thomson H G, Kim T Y, Ein S H. Residual problems in chest donor sites after microtia reconstruction: a long term study. Plast Reconstr Surg . 1995; 95 961-968
- 60 Cronin T D, Ascough B M. Silastic ear reconstruction. Clin Plast Surg . 1978; 5 367
- 61 Thorne C H, Lawrence E, Bradley J P, Levine J P, Hammerschlag P, Longaker M T. Auricular reconstruction: indications for autogeneous and prosthetic techniques. Plast Reconstr Surg . 2001; 107 1241-1251
- 62 Britt J C, Park S S. Autogenous tissue-engineered cartilage. Evaluation as an implant. Arch Otolaryngol Head Neck Surg . 1998; 124 671-677
- 63 Butler D F, Gion G G, Rapini R P. Silicone auricular prosthesis. J Am Acad Dermatol . 2000; 43 687-690
- 64 Westin T, Tjellstrom A, Hammerlid E, Bergstrom K, Rangert B. Long-term study of quality and safety of osseointegration for the retention of auricular prostheses.Otolaryngol Head Neck Surg . 1999; 121 133-143
- 65 Woofaard J F, Wilkes G H, Parel S M, Tjellstrom A. Craniofacial osseointegration: the Canadian experience. Int J Oral Maxillofacial Implants . 1993; 8 197-204
- 66 Tjellstrom A. Osteointegrated implant for replacement of absent or defective ears. Clin Plast Surg . 1990; 17 355-366
- 67 Wilkes G H, Wolfaardt J F. Osseointegrated alloplastic versus autogenous ear reconstruction: criteria for treatment selection. Plast Reconstr Surg . 1994; 93 967-979