total ear reconstruction

Congenital auricular deformity, caused by abnormalities in the development of the first and second zygomatic arches, can be manifested as abnormalities in morphology, location, or size. For example, the upper part of the ear wheel may protrude outwards such as a macacus ear; or the wilderness of the ear wheel (Wildermuth ear), and the upper part of the auricle is downwardly and forwardly curled, called a curl ear or a cup ear. The most common one is the auricle protrusion such as a sail, and the angle with the head is larger than normal, which is called lop ear. In addition, the auricle over-developed is macrotia (macrotia); but the entire auricle over-development is rare, mostly partial earlobe or auricle hypertrophy. The auricle is less developed than the normal one is microtia, often accompanied by external ear canal and middle ear malformation. The earlobe deformity has the absence of the earlobe, the earlobe is too large, the earlobe is stuck, and the earlobe is split. The accessory auricle is located in front of the tragus for the auricle-like structure, and some can be moved to the cheek or neck, which may be accompanied by abnormal cleft palate and tooth dysplasia. The above deformities can be performed on plastic surgery. Judging from the cosmetic point of view whether the shape of the auricle is normal, whether it needs plastic surgery, generally from the following aspects. 1. Factors of social psychology Although some people have mild deformities in their auricles, their spirits are extremely painful and require plastic surgery. 2. Age factor The growth of children in childhood is rapid. At the age of 3, the size of the auricle has reached 85% of the person. After the age of 10, the width of the auricle almost stops growing, and the distance from the ear to the mastoid does not change. The length of the auricle grows with age. The growth of the auricle length of the elderly over 60 years old is more obvious, especially in the cartilage part, and the earlobe part also increases. 3. The auricle is located on both sides of the skull in the position of the skull, and the sides are symmetrical. The upper end is flush with the horizontal line of the eyebrow and the lower end is on the horizontal line through the nasal floor. The normal cranial angle is about 30° to 45°, and the ear and the ear boat are at right angles to each other. The distance from the mastoid to the flange is about 1.8 cm. The long axis of the auricle is not parallel to the bridge of the nose, and the angle of intersection is 15°. 4. The size and shape of the auricle itself is about 6.5cm long, and the width from the tragus to the lobe nodules is about 3.5cm. The auricle is too wide and generally does not need to be corrected. The average depth of the ear is 1.5cm. 5. The shape of the earlobe is about 2 cm from the lower end of the tragus to the earlobe. The shape of the earlobe varies greatly and can be roughly divided into a circle, a flat shape and a triangle shape. The degree of adhesion to the skin of the face is also different. From complete dissociation, partial adhesion, or even complete adhesion, the variation from the angle of the face is also large. As long as it does not affect the wearing of earrings, there is no need to shape. Anatomy of the auricle: The auricle is a body surface organ composed of elastic cartilage as a scaffold and covered with skin, subcutaneous tissue and ligament. The auricle is symmetrical, which is equivalent to the height of the eyebrow and the nose. The horizontal axis is at an angle of 30° to the cranial side wall. It is formed by the development of the first and second arch of the embryo. It consists of yellow elastic cartilage covering the skin, and attaches to the sides of the skull by connective tissue, muscle and skin, and forms an angle of about 30° with it. The back is flat and slightly raised, and the front is uneven. The names of the various departments are shown in Figure 9.1.1.5-0-1. The auricular cartilage consists of a single piece of yellow elastic fiber cartilage plate with a shape similar to that of the auricle. The inner part constitutes the cartilage part of the external auditory canal, and the cartilage is not formed at the bottom of the external auditory canal, forming a gap, which is called the incision between the otoscopes, and the incision is made in the ear, so that the cartilage is not damaged. Statistics have confirmed that there is no standard ear that can be used to determine whether the shape, position and proportion of the auricle are normal. Treatment of diseases: congenital microtia Indication Full auricle reconstruction is available for: 1. Congenital auricle dysplasia caused by small ear malformation. 2. Auricle loss due to trauma, tumor resection, infection, etc. 3. Both sides of the small ear malformation, with external auditory canal atresia, should first consider the external auditory canal formation and tympanic formation, and then consider auricular angioplasty. 4. In the case of small ear malformation with small jaw deformity, auricle reconstruction should be performed after mandibular extension. 5. The age of auricle reconstruction should be around 15 years old. Contraindications Old and infirm are not suitable for surgery, can wear false ears; the surgical area of the skin has acute inflammatory lesions, such as folliculitis, bloated, etc., must be operated after the inflammation has subsided. Preoperative preparation 1. Measure the size and position of the healthy auricle, and prefabricate the film of the auricle shape. After disinfection, use it after surgery. If the patient has a double auricular deformity, the film should be made according to the normal auricle of the parent. 2. Prepare as usual before general anesthesia. 3. Explain the surgical method with the patient or his or her parents, complete in several stages, and the purpose and time required for each operation. Surgical procedure It is divided into two phases. In the first phase, the residual ear is repaired, the earlobe is formed, the deafness skin expander is embedded, and the water is expanded. The second phase of full auricular angioplasty, including rib cartilage, auricle bracket engraving, embedded in the auricle bracket, fascia wrap, auricle erect and posterior ear graft. 1. Stage I surgical earlobe transposition, residual ear repair, water balloon skin dilator embedding. (1) The upper part of the residual ear is cut open, and the ear is turned backward, and the earlobe is formed. (2) Remove the subcutaneous irregular cartilage from the upper part of the residual ear, and trim the skin and suture it. (3) Draw the auricle shape according to the prefabricated ear shape film, and make a semi-arc cut in the posterior upper hairline, about 3.0 to 3.5 cm long, cut the skin and subcutaneous tissue, and make the skin according to the size of the auricle. Separation, which is slightly larger than the line of the contour of the auricle, and a subcutaneous sac is separated behind it for the injection plate of the skin expander. (4) Place the silicone skin expander and suture the incision, and place a vacuum suction tube. 2. Auricular reconstruction (1) First take the costal cartilage and take the skin, and make a fusiform skin incision between the 7th and 8th costal cartilage on the right side. First remove the 3.0cm×5.0cm full thickness skin for use. Then, the full length of the costal cartilage and the anterior fusion portion were separated, and the seventh and eighth costal cartilage were cut out. Be careful not to damage the parietal pleura to prevent the occurrence of pneumothorax. Stitch the chest wall muscles and skin. (2) Carve the cut costal cartilage into auricular cartilage stent, pay attention to the ear wheel to be long enough, engrave the boat-shaped nest, the triangle socket and the pair of ear wheels, and fix them together with steel wire. (3) Remove the ear skin expander (when the incision is followed by the lower edge of the incision), implant the auricular cartilage stent, insert the tail of the ear into the earlobe, and cut the surface of the mastoid along the outer edge of the earring by 3 to 5 mm. The fascia separates the deep fascia of the cartilage scaffold, erects the auricle forward, frees the skin graft after the ear, and packs and wraps after intermittent suture, leaving a drainage tube.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.