Otoplasty

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Otoplasty (Greek, oÃÆ'Â »s ," ear "???????? plÃÆ'¡ssein ," for the form ") indicates surgical and non-surgical procedures for correcting deformities and defects in the pinna (outer ear), and for reconstructing damaged or defective, or absent external ears due to congenital conditions (eg microtia, anotia, etc. ).) and trauma (blunt, penetrating, or explosive). Otoplastic surgeons repair defects or deformities by creating external ears that have natural proportions, contours and appearance, usually achieved by reshaping, moving, and adding to the cartilage support framework of pinna. In addition, the occurrence of congenital ear abnormalities sometimes overlaps with other medical conditions (eg Treacher Collins syndrome and microsomia hemifacial).

Video Otoplasty

Histori

Antiquity

Otoplasty (ear surgery) was developed in ancient India, in the 5th century BC, by ayurvedic doctors Sushruta (around 800 BC), which he described in medical summary, Sushruta samhita . Moreover, two centuries later, contemporary autoplastic praxis, slightly modified, derives from techniques and procedures developed and erected in antiquity, by Indian ayurvedic doctors Sushruta.

Nineteenth Century

In Operational Surgery (1845), Johann Friedrich Dieffenbach (1794-1847) reports the first surgical approach for corrective prominent ears - a combination of otoplasty procedures that exhibit simple excision ( cutting) of the troubled cartilage excess from the posterior (ear plug) backbone, and subsequent affixing, with stitches, from the corrected bella to the mastoid periosteum, the membrane covering the mastoid process beneath the mastoid portion of the temporal bone , behind the head.

the 20th and 21st centuries

In 1920, Harold D. Gillies (1882-1960) first reproduced the pinna by burying the ear-external support frame, made of autologous cartilage, under the skin of the mastoid area of ​​the head, which reconstructed the pinna he then separated from the skin of the mastoid area by means of a flap cervix. In 1937, Dr. Gillies also tried to reconstruct a child's ear as with a pinna support frame made with mother's cartilage. The autoplasty correction technique proved inadequate, due to the inherent problem of biochemical cleavage and elimination (resorption) of cartilage tissue by the patient's body.

In 1964, Radford C. Tanzer (1921-2004) reiterated the use of autologous cartilage as the most reliable organic material to resolve microtia, abnormal ear, due to its large histologic viability, resistance to shrinkage, and softening resistance. , and lower resorption incidence.

Development of plastic surgery procedures, such as refinement of J.F. ear surgery techniques Dieffenbach, has established more than 170 cutting procedures for correcting prominent ears, and for correcting defects and pinch defects; thus, otoplasty correction exists in three groups of surgical techniques:

Group I - Techniques that leave the framework of the entire ear cartilage, and reconfigure the pinna projection distance and angle of the head, only by stitching, as in permanent stitches. -Overthe technique of Mustardà ©  © Merck's stitching method and the Fritsch autoplasty without incisions to create an anti-helical fold:

a) Mustard technique Å ©: An open invasive method, in which retroauricular cartilage is extensively exposed, part of skin is cut, and mattress sutures are inserted.

b) Merck suture method: minimally invasive method, in which the ears are no longer cut open and cartilage is left intact completely. The mattress suture is inserted into the ear through 2 to 3 small puncture incisions at the back of the ear.

c) Otoplasty Fritsch without incision: This is a combination of minimally invasive techniques and Stenström technique, where the cartilage in the front of the ear is assessed by a shallow incision.

Group II - A technique that resolves (cuts and discards) the associated excess cartilage from the pinna support framework, which then makes it easy to reshape, reconfigure, and attach to the head on the distance-and-angle projection normal ear characteristics; Relevant procedures are converse cartilage-cutting techniques and Chongchet-Stenströ¶m techniques for prominent anterior ear correction.

Group III - Techniques that combine cartilage excision of the pinna support frame, to reduce the projection level and distance from the outer ear of the head.

Maps Otoplasty

Anatomy of external ear surgery

Pinna The external ear (pinna) is a surgically challenged anatomy consisting of a delicate, intricately constructed cartilage complex, visible on its visible surface, with thin, firm, and hairless skin. Although the area is small, the anatomy of the outer ear surface is complex, consisting of pinna (earlobes) and external hearing meat (auditory canal). The outer frame of the pinna consists of the edges of the helices, which appear from the front and from the bottom (anterior and inferior), from the crank (shank) that extends horizontally over the auditory canal. The helix fuses downward (inferiorly) into the cauda helices (the tail of the helix), and connects to the lobule (earlobe). The area between the crura (shanks) antihelix is ​​the triangular fossa (depression), while the scapha (longitudinal depression) lies between the helix and the antihelix. Antihelix borders midway (medial) to the edge of concha (shell) and precise concha, consisting of superior conchal cymba and inferior conchal cavity, separated by helical crus, and met antihelix in antihelical ream. Tragus (lobule of the auditory channel) and antitragus (counter lobule) are separated by an intertragal groove; the auditory lobes do not contain cartilage, and display a variety of morphological forms and attachments to adjacent cheeks and scalps.

The supply of blood and innervation of the superficial and superficial temporalisuricularuric artery maintains an external ear arterial blood supply. Sensory innervation involves the front and back (anterior and posterior) branches of the larger auricular nerve, and is amplified by temporal and less auricularis occipital nerves. The vagus nerve auricular branch supplies part of the posterior wall of the external auditory canal.

Otoplastic Praxis The supporting framework of reconstructing pinna should be more rigid than the natural cartilage framework of a normal ear, in order to remain at its natural size, proportion, and contour. If the reconstructed pinna frame has a fragile structure such as the cartilage frame of the natural pinna, its anatomical verisimisnya as the ear will be gradually eroded by a combination of pressure from tight skin-envelopes in the temporal region of the head, and the pressure of progressive contracture of the surgical scar (s).

Prominent ears In the practice of otoplasty, the term prominent ears depicts the external ears (pinnae), regardless of size, protruding from the sides of the head. Abnormal appearance exceeds normal head-to-ear size, where the external ear is less than 2.0 cm, and at an angle of less than 25 degrees, from the side of the head. The ear, distance and angle configuration, which exceeds the normal size, stands out when a man or woman is seen from the front or back. In the occurrence of prominent ears, a common cause of anatomical defects, deformities, and abnormalities may occur individually or in combination; they:

(i) Undeveloped antihelic folds This anatomical deformity results from inadequate antihelix folding, which causes scapha and helical edges. The defect is manifested by the superiority of scapha (the longitudinal depression that separates the helix and antihelix) and the upper third of the ear; and sometimes from the middle third of the ear.

(ii) Prominent Concha This deformity is caused by too deep concha, or by too wide concha-mastoid angles (& lt; 25 degrees). Both anatomical abnormalities may occur in combination, and produce prominent konka (the largest, deepest concave of the pinna), which then causes the protrusion of the middle third of the external ear.

(iii) Leaves of prominent ears This ear-leaf defect causes prominence of the lower third of the pinna. Although the most prominent ear is anatomically normal, morphological defects, defromities, and abnormalities occur, such as:

• Unlimited ears displaying abnormal small pinna, and protruding from the head due to the insufficient development of the circumference of the helical circle, which, in turn, causes the pinna to collapse to continue, and forms a cup ear .
• crypto ear hidden by the side of the head. The hidden ear condition is produced when the developed helical pinna is contained under the scalp skin in the temporal region. (see Cryptotia)
• Makrotik ear , a prominent outer ear showing a large pinna, but its morphologically normal. (see Macrotia)
• Ear-question mark represents the ear that displays the deformity of the supralobular region (the upper region of the pinna), and has a question mark (? ) display.
• Stahl's ear deformity describes the presence of a third crus (shank) on the pinna, which produces a pointed elf . The third craft is the addition to two crura (shanks) of the ordinary triangle fossa (depression), which crosses the skapha (the longitudinal depression separating the helix and the antihelix).

Ear angles

Cephaloauricular and scaphoconchal angle

The degree of angle between head and ear, and the degree of angle between scapha and concha, determines the prominent ear concept . Research, Comparing Cephaloauricular and Scaphaconchal Angles in Leading Ear Patients and Controls Subjects (2008) reported comparisons from head-to-ear and scapaha angles. -to-concha angles of a group of 15 patients with prominent ears, with analogue ear angles from a 15-person control group, determined that the mean head-to-ear angle was 47.7 degrees for study groups, and 31.1 degrees for the control group; and that the mean scapha-to-concha angle was 132.6 degrees for the study group, and 106.7 degrees for the control group.

Antihelix

Antihelix usually forms a symmetrical Y-shaped structure where the gentle (folded) leaping of the antihelix root peak continues upward as the superior crus, and the inferior crus branch forward, from the root, as the folded ridge. The root of the inferior crucible of the antihelix sharply defines the edge of the concha. In addition, the inferior crus also forms a wall separating the concha from the triangular fossa. The root and crus superior antihelix form the anterior wall of the scaphoid fossa, and the helix forms the posterior wall. Fossa dips triangle in the Y arm of the superior and inferior crura. The wavy contours of the oval and the auricular valley provide a pillar (support) effect that stabilizes the pinna. Conical vertical cup walls translate to semi-horizontal plane when konka fused with folded antihelix peaks. The scapha-helix is almost parallel to the temporal surface area of ​​the head. If the antihelix coil and its emblem are erased and flat, rather than rolled or folded, the sharp curvature of the konka wall continues into the antihelix and the unformed scapha and ends in the helix, with little disturbance. The planar orientation places a complex of scapha-helix that is almost perpendicular to the temporal plane of the head - because it appears prominent, so that the ear also does not have the stability provided by the pillar effect, and thus allows the superior auricular pole. to stand out. In the literature, the thinning (deficiency) of antihelic folds is the main subject of most prominent ear discussions, since this is a deformity that manifests as a spectrum of defects and defects - ranging from an indistinguishable antihelix (with a confluent concave, from antihelix to scapha and helical rims projected forward and forwards) to lose the only definition of the superior antihelix (with the superiority of the pole over the ears).

Concha

Concha from the ear is an irregular hemispheric bowl with a clear rim. The normal scapha-helix surrounds the posterior portion of the bowl (such as the inverted tops of the cap around the crown). Pitch in which the scapha-helix project of the cup cup is determined: (i) by the sharpness of the antihelix peak fold, (ii) by the posterior wall height of the konka bowl, and ( iii) by the completeness of the hemisphere formed by the concha. If the posterior wall of the concha is too high, and the concha is too round, then there are excess angles and distances between the scapha-helix plane and the temporal surface area of ​​the head. Such projection is usually distributed evenly around the posterior wall of the shell, however, the cephalad portion of the concha may stand out disproportionately, another cause for prominent upper poles. Similarly, the tail section of the concha may proportionally project, and cause a prominent lower auricular pole, therefore, this deformation feature requires special attention in the operating room.

In addition, regarding the shape and projection of the ear, the importance of concha should be considered in relation to the configuration of a three-tier auricular cartilage framework, since the finer antihelix and helical complexes are fitted to stronger concha; therefore, changes in size and shape of the horn greatly affect the level above it, it is very rare to see the superiority of the ear that does not have conical elements. Concha affects triple ear benefits: (i) the entire encha enlargement projecting the ears away from the mastoid surface; (ii) the extension of the helical crus throughout the concha creates a strong cartilage rod that pushes the ear out; (iii) the angulation effect of cartilage, at the junction between concha cavum; and sweep of cartilage until prominent antitragally, affect the position and superiority of the lobule (earlobes) and the lower third of the ear.

Understanding the element of the first deformation is well known, and, although attention is limited to the second element, once visible, it is easy to understand. Therefore, understanding the third element leads to an understanding of the surgical-technical approach to improve the superiority of the lower pole and isolated lobules. The peculiarity of shellfish, though not the only cause of lobular excellence, seems to play a key role. When the cartilage angle, between the concha cavum and the antitragus, becomes more acute (ie, as the antitragic end is closer to the concha), this support structure leads beyond the lobule and the lower third of the ear. This feature has a greater influence on the lobe position than the usual helical tail is portrayed.

Antihelix stands out and a prominent oba combined

The combined effects of the deep antihelix and concha also contribute to a severe auricular bulge, the very prominent ears.

Prominent mastoid process

Auricular Privileges

The occurrence of a protruding mastoid process tends to push the concha forward, which extends the pinna (external ear) away from the side of the head. The external ear is attached to the underlying bone of the underlying temporal bone, therefore, the anomaly and asymmetry of the skeletal form can cause pinna, or both pinnae, to be prominent. With respect to prominent mastoid processes, the most recognizable skeletal anomalies are position changes and pinna projection, associated with non-syndotic plagiocephaly (horizontal side position of head, not due to inaccurate binding of two bones). Therefore, in the occurrence of the skull leveling (deformation of the parallelogram of the skull dome), the side of the head suffered with occlusal plagiocephaly presents prominent ears. In delicate cases, prominent ears may be more readily seen in older patients, whose ears are positioned asymmetrically, the residual occipital occipital excuses (occipital plagiocephay), and mild facial asymmetry, are not seen at first sight. This effect, from the shape of the patient's head, to the outer and elongated position is primarily shown in a 19th century illustration depicting Ely's autoplasty technique [1881].

Microsomia hemifacial

The development of one side of a person's face, showing the effect of skeletal development on the external ear position on the head, caused by the morphological development of temporal bone deficiency, and by the medial position of the temporomandibular joint, the synovial joint between the temporal bone and the mandibular (maxilla). In addition, in severe cases of hemifacial microsialia, without the occurrence of microtia (small ears), the normal external ear may appear to have been cut off from the head, since the top half of the pinna projects out, and, at the midpoint, the lower portion of the pinna is inclined to in, toward the hypoplastic and underdeveloped side of the patient's body. The same type of asymmetrical head and face development has a relatively wide head, narrow face, and narrow jaws; when observed from a future perspective, the person's head and face display a triangular configuration. Such wide-to-narrow skeletal slopes, from head to face, can create a bony canopy overhead and from there projecting the upper anatomy of the pinna, which is otherwise an external ear with normal proportions, sizes, and contours.

Striking cauda helicis

The cauda helicis (the helical tail) are attached to the fibrofatty tissue of the earlobe by the connective tissue tissue. The helix tail (cauda helicis), which is projecting out of the concha, carries the earlobe with it, causing it to stand out, whose physical condition contributes to the polar superiority of the pinna, the external ear.

Leaves of prominent ears

Given the morphological diversity of the earlings found among men, women, and children, some large ears, some pendulous earlobes, and some large and pendulous earlobes, but some are prominent because of the structure and shape of the dense fabric and interlacing tissue fibers that form the anatomy of the earlobe independent of the helical tail (cauda helicis).

Soft-tissue

Functionally, the external ear is served by three (3) ear muscles, posterior auricularis (behind-the-muscle), superior auricularis (upper-muscle), and anterior auricularis (front of the ear-muscle), the most important is muscle posterior auricularis, which serves to pull the ears back, therefore superficially attached to the ponticulus (bridge) of the konka cartilage, and to the posterior auricular ligaments (ear ligament behind). The posterior ear muscle consists of 2-3 facies (skeletal muscle fibers contained in the perimysium connective tissue), derived from the mastoid process of the temporal bone and inserted into the underside of the skull of the concha, where it is surrounded by fibroareolar tissues deep within the temporal fascia. The posterior auricular artery flows through the ear tissue with the arteries of the small arteries (hemp). Likewise, the back of the ear muscle is innervated with the fine flax of the posterior auricular nerve, which is the branch of the facial nerve. Deep within the muscular structure and ligaments are located the mastoid fascia and the origin of the sternomastoid muscle tendon.

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Autoplasty operation

The corrective purpose of otoplasty is to rearrange the ear so that they appear naturally proportioned and contoured, as they are harmonically rearranged, with no evidence or indication of surgical correction. Therefore, when the corrected ear is seen, they should look normal, from:

(i) The front perspective. When the ear (pinna) is seen from the front, the helical rim should be visible, but not set so far (flattened) hidden beneath the antihelical folds.

(ii) Rear perspective. When the pinna is seen from the rear, the helical rim is straight, not bent, as if the "C-letter" (medium to third), or crooked, as if a hockey stick "(the ear is not flat enough). the helical rim is straight, its harmonic decline; that is, the top, middle, and bottom-third pinna will be proportionally backwards with respect to each other.

(iii) A side perspective. The ear contours should be soft and natural, not sharp and artificial.

Autoplastic time correction Corrected ear deformities determine the favorable time of otoplasty, for example, in children with very prominent ears, 4 years of age is of a reasonable age. In the case of Macrotia associated with prominent ears, the child's age may be 2 years, however, it is advantageous to limit further growth of deformed ears. In addition, regardless of the patient's age, the otoplasty procedure requires that the patient be under general anesthesia.

Ear reconstruction. Generally, to reconstruct the entire ear, or part of the cartilage cartilage, the surgeon first harvests the costal cartilage graft from the patient's rib, which is then carved into a auricular skeleton superimposed under the patient's temporal skin, so that the skin envelope includes a cartilage frame, ear. Once emplaced and anchored with stitches, the surgeon then creates a pinna (outer ear) of natural proportions, contours, and appearance. In subsequent months, in advanced surgery, the surgeon then creates an earlobe, and also separates the reconstructed pinna from the side of the head (approximately 15-18 mm), to create a small, round, projection trunk located before the external entrance to the ear canal.

In the case of a patient burdened with some ear defects or who have sufficient autologous cartilage for harvest, it may not be feasible for corrective effects with rib cartilage grafts. In such a case, the antia-Buch helical reconstruction technique may apply; move the tissue from behind the rim of the ear, and then around and forward to fix the damaged front of the rim of the ear. To perform Antia-Buch helical advancement , with ink, the first surgeon designs an incision inside the helical circle and surrounds the crank (shank) of the helix. Then cut the skin and cartilage - but it does not penetrate the posterior skin of the ear. The helical rim is then advanced to allow suture (closure), and a dog-shaped leather earplug is removed from behind the ear. Closing the sutures advance the helical crus into the helical circle.

Indication

Defects or deformities that need to be fixed determine the techniques and procedures of otoplasty to be applied, so that the torn earlobe can be repaired only by sutures; slight damage to the edge of the pinna (outer ear) can be repaired with autologous skin grafts harvested from the scalp, but conversely, proper ear reconstruction may require some surgery. In correction of infantile ear deformities and deformities, otoplasty is usually performed when he is about six years old, because, at that age, healthy ears are almost mature, and thus can serve plastic surgeons as a template correction for auricular reconstruction.

Autoplastic surgery may be performed in patients under local anesthesia, local anesthesia with sedation, or general anesthesia (usually for children). To correct the lop ear with a small helix (the outer edge of the cartilage supported from the pinna), an incision to one side of the flat cartilage piece leaves an unchallenged elastic force on the opposite side, allowing the evolution of the ear contours; thus, a small incision on one side of the lop-ear cartilage, along the new anti-helix fold, can be a technical element of corrective ear surgery. However, when performed without an incision, this procedure is considered an uncomplicated autopsy, in which the surgeon places the needle through the skin, to model the cartilage and to loosen the retention stitch that will attach the antihelix and conchal. bowl area.

surgical otoplasty technique

Depending on the auricular (pinna), deformity, or reconstruction defect required, the surgeon applies these three otoplastic techniques, either individually or in combination to achieve ear-generating results with natural proportions, contours and appearance:

me. Anti-Ultralip Manipulation

a) Sewing cartilage. The surgeon provides a seam stitch at the back of the ear, which is fastened with sufficient tension to enhance the definition of the antihelic fold, thereby reinstalling the helical rim. Cartilage not treated. This is a technique of Mustardà ©  © and Merck. But there is a difference between the two methods. Whereas the MustardÃÆ' © method is an open invasive method, in which the cartilage in the back of the ear is widely exposed and the skin area is cut, the Merck method is a minimally invasive minimized procedure, in which the cartilage is not exposed anywhere. and the skin is also not removed.

b) Anterior abrasion stenstration technique. Abrasion (rough or scoring) from the anterior surface (front) of the anti-helix fold cartilage causes the cartilage to bend away from the irradiated side (per Gibson Principle), toward the whole perichondrium side, fibrous connective tissue membrane.

c) Full thickness incision. One slice full of thickness along the desired curvature of the antihelix allows folding it with little force, thus creating an antihelical crease (as in the Luckett procedure). However, because the folds are so sharp and unnatural in appearance, the technique is modified as a Converse-Wood-Smith technique, in which two incisions are made, running parallel to the desired antihelical folds, and emplaced tubing sutures to make it clearer. contour folds and natural appearance.

II. Alchura changes

(a) Stitching. The surgeon lowers the angle (-25 degrees) between the concha and the mastoid process of the head with the seam attached between the conical and mastoid fascia.

(b) Checking konka. From the anterior or posterior approach, the surgeon removes the full-thickness of the cartilage from the posterior wall of the concha (making sure it does not violate or damage the antihelic folds), thus reducing the height of konka. In addition, to avoid producing a clear operation in concha, the surgeon closely closes the cone defect with stitches. The design of the sickle-cartilage excision means to produce a cover incision located at the konka floor intersection and the posterior shell wall - where it is at least visible, and causes minimal distortion of the normal ear contours.

(b) The combination of Konka suture and excision. Surgeons apply corrective techniques that incorporate technical aspects of Furnas suture techniques and Konka excision techniques.

d) Medialisation from the Antihelix konka section. With this method, the antihelix is ​​moved toward the ear canal with the fingers and remains in this position with the seams of the mattress. Thus, large cavical conchae decreases without excision of cartilage and the ears move towards the head to the desired level.

I, I, I. Ear Elevation Correction

Reposition of the earlobes is the most difficult part of otoplasty, because when the pinna (outer ear) has been repositioned in its upper two thirds, and which still retains the protruding lobule (earlobes) it will appear disproportionately and malposition to the head - as it happens in the original deformity, which is not corrected. The most effective otoplastic technique for lobular repositioning is the Gosain technique (or variant), in which the surgeon cuts the skin on the medial surface of the earlobe, and, in sewing it closed, takes a concave subsurface bite to pull the earlobe toward the head.

Another ear-ear-tone correction technique is the tailing of the helix-cartilage tail to the concha; however, since the helical tail does not extend into the lobule, adjusting it can not reliably fix the back of the right earlobe; Other techniques involve skin excision and stitching, between fibrofatty tissue of the lobules and neck tissue.

IV. Position change of auricular position

Depending on the level of pre-surgical superiority of the upper third of the pinna, the formation of antihelic fold surgery may be inadequate to completely improve the position of the helical rim, near the helical root.

Autoplastic correction type

• Enlarged ears , handles Microtia (pinna less developed) and Anotia (pinna absent) involves adding structural elements to replace missing structures. Cartilage tissue graft for extensive reconstruction is usually harvested either from the ear (cartilage auricularis) or from the ribs (cartilage costa).
Ear pinback - An otopexy that "flattens" the enlarged ear against the head (approximately 15-18 mm), where the surgeon makes an incision into the natural folds at back (retroauricular sulcus) of the external ear, and cut a small tunnel along the antihelix front that is folded badly. After the cartilage is relaxed, the concha is moved closer to the head, after removing excess skin and cartilage from the rim of the ear, and sewn to form antihelis folds, to balance the ear lobe (lobule) with the proportion of pinna. The corrected ear is then coated and stitched closer to the head. Surgical ear earbacks may be performed in an anesthetized patient (local or general anesthesia), and are usually performed as an outpatient procedure that allows the patient to recover at home. Bruising and postoperative swelling usually subside within two weeks, and narrow surgical scars are hidden in the posterior skin creases of the ears; but the results are not fully visible until the swelling and bruises disappear. Historically, the autopection dates from 1881, when Edward Talbott Ely first performed a pinback ear plastic surgery at Eye, Ear, and Throat Hospital, Manhattan, New York City.
• Ear reduction , handles Macrotia, may involve the reduction of one or more of the ear components that are too large; incisions are usually hidden in, or near, the pinna's front folds.

Post-operative recovery

Internal sutures are usually permanent, but surgical or wound wounds can be sutured with absorbable sutures or with non-absorbable sutures that plastic surgeons can remove when the surgical wound has healed. Depending on the abnormality to be corrected, otoplasty may be performed either as an outpatient operation or in a hospital; while operating room time (OR) varies between 1.5 and 5.0 hours.

For a few days after surgery, the autoplasty patient wears an uncompressed gauze on the corrected ear, during the healing period, he should avoid excessive pressure on the ear, not causing pain and increasing swelling. , which can cause abrasion (rubbing), or even to ear necrosis of the ear. After removing the sauce, the patient then wears a loose headband during sleep, for a period of 3-6 weeks; it should be comfortable, not tight, because its purpose prevents the corrected ear from being pulled forward, when the sleeping patient moves while asleep. Therefore, a tight headband can erode and erode the surface of the ear, possibly creating an open wound. Dressing should not be worn if someone is operated with a stitching method.

Complications

• Hematoma. This autoplasti complication is promptly handled when the patient complains of excessive pain, or when the surgical wound is bleeding. Dressing is immediately removed from the ear to ensure a hematoma, which is then evacuated immediately. If the surgical wound is infected, antibiotic therapy helps avoid abscesses or perichondritis (inflammation).
• Infection. Cellulitis is rare after otoplasty, but is treated aggressively, with antibiotics to avoid chondritis - which may require debridement, and damage the ears permanently.
• Sewing Complications. The most common otoplastic complications are extrusion of sutures in the retroauricular sulcus, (groove behind the ear). Such extruded sutures are easily released, but extrusion events may be associated with granulomas, which are painful and unattractive. This complication may be avoided by using absorbable sutures; where the effect, monofilament stitches are more likely to be prominent, but have a lower incidence rate of granulomas; whereas braided stitches are unlikely to be prominent, but have a greater incidence rate of granulomas.
• Overcorrection and unnatural contours. The most common, but significant, complication of an autopsy is overcorrection, which can be minimized by the surgeons' detailed attention to the functional principles of the surgical technique used. Therefore, the function of the form must minimize the creation of unnatural contour characteristics of "perfect technical ears".

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Non-surgical Otoplasty

Indication

The incidence of ear deformities Approximately 20-30 percent of newborns are born with external ear deformities (pinna) that may occur either inside the cervix (congenital) or in the birth canal (acquired). Possible defects and deformities include prominent ears ("bat ears"); sharp ears ("fairy ears"); helical rim deformity, where the superior part of the ear has no curvature; cauliflower ears, which look like crushed; ear lop, where the top of the pinna is folded into itself; and others. Such deformities usually self-correct, but, if at the age of 1 week, deformities of the child's external ear have not been corrected, then surgical correction (otoplasty about 5-6 years) or non-surgical correction. network printing) is required to reach the ear with normal proportions, contours and appearance.

Tissue Molding

(I) Taping, (ii) designed physician splints, (iii) EarWell, (iv) Ear Buddies and (v) earFold In the early weeks of infancy, infantile pinna cartilage is very easily formed, because the remaining maternal estrogen in circulation child organisms. During special biochemical periods, prominent ears, and related defects, can be corrected permanently by forming pinnae (ear) in the correct shape, either by traditional recording methods, with ribbons and soft dental compounds (eg gutta gums percha), or simply with ribbons; or with non-surgical tissue molding equipment, such as custom-made, splint-specific defects designed by physicians; and EarWell and Ear Buddies devices, which are technical variants of the mechanical ear-splint-and-tape correction method; each method requires tightening to the baby's head with an adhesive tape. Therapeutically, the splint-and-adhesive-tape treatment regimen lasts months, and continues to achieve the desired results, or until there is no further improvement in pinna contour, as well as with specialized and commercial network-printing devices..

Adult

At or above, the age of 7 years, a child or adult can treat their prominent ears with minimally invasive techniques using an earFold implant to remold cartilage in their ears in a simple procedure that can be performed under local anesthesia.

Recording

The traditional, non-surgical correction of the prominent ear is by recording it to the child's head, to "flatten" them into a normal configuration. Doctors of this effect are direct correction to take advantage of estrogen-induced mother flexibility from the infantile ear cartilage during the first 6 weeks of life. The taping approach may involve adhesive tapes and splinting materials, or just adhesive tapes; Specific deformities determine the method of correction. This period of non-surgical correction is limited, since the maternal estrogen that remains in the child's organism is reduced in 6-8 weeks; after that, the ear cartilage stiffens, so, recording the ears is only effective for correcting the "ear of the bat" (protruding ear), and not a serious disorder requiring surgical resection of the pinna (outer ear) to produce normal ear sizes, contours, and proportions. Furthermore, ear correction with splints and ribbons requires the replacement of splints and regular bands, and a primary concern on the head of the child for all types of skin erosion, due to the cumulative effect of mechanical stresses of the appropriate splint and binder tape.

Splints designed by doctors

Default ear deformity is defined as malformation (microtia, cryptotia) or deformation, in which the term "ear deformation" implies a normal chondrocutaneous component with abnormal auricular architecture. Conditions are categorized as restricted ears, Stahl's ear deformities, and prominent ears, derived from a variety of causes, such as abnormal development and function of intrinsic and extrinsic ear muscles, which may produce damaging forces of the aura (pinna); and external forces as a result of head malpositioning during the prenatal and neonatal periods of the child's life. Research, Early Post Reproductive Orth (2005), reported the efficacy of ear splinting in a child during the initial neonatal period as a safe and effective non-surgical treatment to correct congenital ear abnormalities.

The applied splint is a core-wire segment, in a 6-French silica tube, affixed with an adhesive leaf closing strip; device applied 3-4 weeks without anesthesia; three (3) cases indicate the efficacy of non-surgical correction by means of splints for re-forming infantile ear defects:

• Case 1: narrowed ears - Although there is no family history of this congenital defect, a boy in the full term presents a bilateral limited ears marked by a finite edge with the appearance of strings closed wallet. Splint-correction treatment begins at 3-days postpartum, for a 1-month treatment regimen. At 10-days, the upper pole of the earlobe (ear) has expanded; at a 6-month follow-up check, the ear corrections remain extended.
• Case 2: Stahl's Ear - A full-time boy presents a Stahl ear deformity characterized by a helical rim with a third crusher (calf), flat helix, and defective scaphoid fossa. Correction begins at 3-days post-partum, for a 3-week treatment regimen; on 10-day correction seen with the loss of a third crus (calf), and the formation of a normal helical circle; corrections remain effective at 6 months post-procedure.
• Case 3: prominent ears - A full-time girl presents a bilateral protruding ear marked with a high altitude of a conical wall, and a wide conchoscaphal angle (<90 degrees). Correction begins on 3-day postpartum, for a 4-week treatment regimen, where splinting reduces the initially wide ( 90 degree) angle of the conchascaphal to a closer, more natural (& lt; 90 degree) position./li>

Corrected ear deformities with splints designed and manufactured by a doctor are configured with such materials

1. The core wire segment in 6-French silastic tube - Splints are superimposed in a groove between helix and antihelix, and affixed with 3-5 strips of skin tape-closing bands.
2. Self-attached foam - Intended to prevent splints from damaging childlike skin; foam is applied at the bottom of the auricular folds, and in the exact conjunctional fossa.
3. Suspension - Dental materials (eg gutta percha gum) are applied to press and correct the abnormal folding of the anterolateral surface and the posteromedial surface; it is taped to a strip of adhesive leather closing tape.
4. Tooth wax - Dental compounds and dental implants prepared with heat and water, and then molded to desired auricular contours; it is taped to a strip of adhesive leather closing tape.
5. Thermoplastic materials - Hard and elastic soft compounds at room temperature, but which soften at temperatures less than 60 ° C (140 ° F), applied to the ear to provide light pressure from the side anterior and posterior side of the pinna, after which it hardened in a matter of minutes.
6. Commercial ear-splint devices - proportional-scale cassettes and splints for ear-to-ear correction applications, e.g. EarWell and Ear Buddies devices.

EarWell baby ear correction system

Mechanical correction-a mold of infantile ear deformities, made possible by estrogen-induced flexibility of the pinna cartilage (ear), allows the application of EarWell devices to reshape ear defects to the ear with normal proportions, contours and appearance. Among the non-surgical corrected deformities with EarWell devices are prominent ears ("bat ears"), Stahl ear defects ("fairy ears"), ear lop with small helices (rims of outer cartilage), upper part closure of helix, helical compression, crus conchal, cryptotia, characterized by ear, the upper part of the scalp, and Tanzer II's less severe ear malformations.

EarWell ear ear correction system is a network printing device in four parts: (i) a posterior shell (cradle), superimposed on and around the ear for correction; it is attached to the scalp; (ii) retractors to form pinch edges; (Iii) the former konka to form concha, the central hole of the ear; and (iv) a suitable anterior shell above, affixing the interior, and locking into the holder, to cover and protect the ear. After initiation of treatment with this tool, the physician monitors the progress of the correction within 2 weeks after the emplacement to influence the adjustment of the appliance and observe the progress of the defect correction; Regular treatment regimen is 6-8 weeks.

When treatment begins in the first week of infant life, tissue correction may produce non-surgical autoplasty results that are comparable to otoplasty surgery. Research, Earring Molding on Newborns with Auricular Deformity (2010), reported the efficacy of EarWell devices in fixing the antihelix deformity, triangular fossa, helical rim, and over-prominent conchal angle -mastoid, in 831 ear-defects, at 488 newborns featuring: (i) prominent ears, (ear cup): 373 ears (45%); (ii) ear lop: 224 ears (27%); mixed ear deformity: 83 ears (10%) all with associated conchal crus; Ear Stahl: ear 66 (8.0%); helical rim deformity: 58 ears (7.0%); crus konka: 25 ears (3.0%); and cryptotia: 2 ears (0.2%). Bilateral deformities (both ears) occur in 340 patients (70%); unilateral deformity occurred in 148 patients (30%); and 58 infant ears (34 patients) were corrected with the EarWell system, with a successful 90 percent correction rate. The application of a tissue-printing device 1 week after childbirth proves most efficacious in achieving successful correction, because, when the correction begins at 3-weeks from birth, reduced flexibility of the cartilage and ear tissue is reduced. the level of successful defect correction up to 50 percent.

Ear Buddies

Ear Buddies pitch is attached to the ear canal and affixed with a narrow adhesive tape, thus forming a networking tool that corrects (re-form) deformity. Splint pressure on the ear cartilage suppresses the tendency of the ear to protrude, while maintaining the exact contours of the entire ear. Splints are curved and supple, and may be formed specifically for the proportion of the patient's ears, as required by certain defects or defects to be managed. This device is only effective when applied as it is, when both elements (splint and fastener tape) are jointly applied to deformed ears, therefore, simply by attaching the ear to the head, without splint, ineffectively therapeutically, and possibly at risk good landscape. or make a helical circle.

The corrective splint is superimposed by inserting it into the edge of the defective ear cleft, then rolling the tip of the ear into a splint, and tightening it with a tape. After that, the inserted ear is attached to the side of the head with a tape. In the case of non-gutter ears, helix (rim), or antihelix (common characteristic of the ear), the splint is attached slightly away from the edge-ear, which is then rolled onto the splint to be formed into the right helix (rim), and also to facilitate the formation return antihelix. In the case of Stahl's ear deformity (characterized by either a bulge or cramped crease), the splint is firmly attached to the defect or defect, mounted in place, and affixed to the side of the head.

Therefore, to achieve successful, nonoperative ear correction results, the infant uses Ear Buddies 24 hours daily during the recommended splotting period; which is so determined, if he is split at:

• was born, 2 weeks splintage.
• Age of 1 month, 1 month splash.
• Age 2 months, 2 months splash.
• Age 3 months, 2.5 months splash.
• 4-6 months, at least 3 months splash.
• more than 6 months, 4 months splash.

The success of the Ear Buddies device function (splint and fastener tape) requires that the baby's ears become dry and cleaned of dead skin and natural oils, so that the adhesive of the fastening tape does not fail to attach each splint to the ear, and the clogged ear to the side of the head. Furthermore, in the splice correction program, it is important to monitor that the binding tape is not too tightly attached, lest it not allow the skin to breathe, which can lead to skin erosion which then interferes with the successful reprint of infantile pinna (outer ear) into the ear with normal size, contour, and proportion.

See also

• Ear form
• Plastic surgery
• Maxillofacial operation
• Otolaryngology

src: exploreplasticsurgery.com

Note

src: onlyfaces.com

References

• Thorne, Charles, ed. (2007). Plastic Surgery Grabb and Smith (6th ed.).
• Rinzler, CA (2009). Encyclopedia of Cosmetic and Plastic Surgery . New York City: Facts in File.

src: www.drhodgkinson.com.au

External links

• Flash Otoplasty Animation

Source of the article : Wikipedia