The perichondrium-a natural fibrous membrane encasing cartilage-plays a pivotal role in nutrient delivery and matrix regulation; however, it is often overlooked in engineered constructs. This study aimed to fabricate a perichondrium-mimicking three-dimensional (3D) bioprinted auricular cartilage construct utilizing a hybrid bioink and to assess the effects of adipose-derived stem cell (ADSC) outer layers on cartilage matrix formation, vascularization, and construct stability. Chondrocyte spheroids and ADSCs were isolated from New Zealand white rabbits and embedded in bioinks composed of either alginate alone or alginate/GelMA composites. A dual-mode printing strategy facilitated the fabrication of constructs with 3 and 10 layers. ADSCs were printed as outer "perichondrium-mimicking" layers in designated groups (G2, G4, and G6). Constructs were implanted subcutaneously in nude mice for 6weeks. Histological analyses, immunohistochemical assessments (CD31), and image-based quantitative analyses were conducted. The inclusion of ADSC layers significantly enhanced cartilage matrix synthesis and decreased calcification, particularly in constructs containing GelMA. Group G4 exhibited the highest levels of glycosaminoglycan and collagen content, as well as the lowest calcium deposition. Ten-layer constructs (G6) preserved structural integrity and supported neovascularization; however, the final cartilage thickness did not proportionally scale with the initial print height. The incorporation of ADSC-laden perichondrium-mimicking layers in conjunction with a hybrid alginate/GelMA bioink synergistically enhances cartilage formation, matrix quality, and vascular integration in large constructs. This biomimetic approach is a promising platform for developing clinically relevant cartilage grafts for auricular reconstruction and other cartilage repair applications.

Preserving auricular cartilage can have satisfactory aesthetic outcomes and retain the functional integrity of the ear. Limited research exists on the oncological sequelae of preserving or removing cartilage when excising auricular melanoma. This systematic review compares outcomes between cartilage-sparing and cartilage-removing techniques in the treatment of auricular melanoma. A systematic literature search of PubMed, Scopus, and MEDLINE acquired 23 studies; following independent screening using a PICOT framework-guided inclusion and exclusion criteria and subsequent quality assessment, 6 retrospective studies were included in the final review. The literature suggests that there is a difference in recurrence rates and disease-specific mortality between cartilage-sparing and cartilage-removing excisions. Recurrence and disease-specific mortality appeared to be higher in studies that excised cartilage. However, these findings are inconclusive and undermined by several critical limitations. The explanation, direction, and magnitude of this difference remain unclear, and further long-term randomised control trials are required to confirm the differences in oncological outcome between cartilage-sparing and cartilage-removing excisions of auricular melanoma.

To evaluate the safety and efficacy of auricular cartilage expansion for conchal-type microtia in the high-altitude setting of Xizang. Fourteen children (10mo-6y) with unilateral conchal-type microtia underwent single-stage cartilage expansion between October 2024 and February 2025. Procedures included helical cartilage release, antitragal cartilage grafting, conchal expansion, and local flap resurfacing. Outcomes were assessed at 6 months. All reconstructions survived completely. Mean operative time was 92±12 minutes. Auricular height improved 7.8±1.3mm and projection 5.5±1.1mm. Sutures were removed at 9.1±0.9 days. Parental satisfaction was 100%. No infections, exposures, or hypertrophic scars occurred. Cartilage expansion is a safe, culturally acceptable alternative to rib-cartilage methods for conchal-type microtia in Xizang. It avoids rib cartilage donor-site morbidity, shortens recovery, and expands access to specialized care in remote, high-altitude regions.

Traumatic auricular amputations present a unique surgical challenge, particularly in cases where microsurgical anastomosis is not feasible due to vessel damage or absence. Traditional reconstruction techniques often yield suboptimal aesthetic or functional results. The pocket technique, as described by Sexton and Mladick, has shown promise in such scenarios, particularly in partial auricular amputations. We report a case of a 52-year-old Caucasian male who presented with traumatic amputation of the cranial third of the auricle following a dog bite. The injury was classified as grade III according to the modified Laskin and Donohue grading system. Owing to the absence of suitable vessels for microsurgical repair, a two-stage reconstruction using a novel modification of the pocket technique was performed. In the first stage, under general anesthesia, the skin was carefully dissected from the amputated auricular cartilage, which was then cleaned, debrided, and sutured to the remaining auricle using an "8"-pattern suture technique. A retroauricular advancement flap, adapted from Mladick's method, was utilized to create a vascularized pocket for the cartilage. After 2 months, the auricle was elevated from the mastoid, and a full-thickness skin graft was applied to cover the defect. A galea advancement flap, based on the posterior branches of the superficial temporal artery, was harvested to provide vascular support and refine the auricular contour. This case demonstrates the successful application of a modified pocket technique that synergistically integrates principles from Sexton and Mladick's approaches. The result was a well-perfused, anatomically contoured, and aesthetically pleasing auricular reconstruction without the need for microsurgical anastomosis. This technique represents a viable reconstructive alternative in select cases of partial auricular amputation where vessel quality or availability is compromised.

AimUnderstanding the external ear’s anatomy and the ear nerve blocks (particularly in the external acoustic meatus) is crucial for facilitating effective ear movement and treating clinical cases requiring an ear nerve block. The purpose of this study was to describe the anatomical cartilages and muscular structures of the outer ear and to investigate the appropriate anatomical location of the major nerves supplying the ear in dromedary camels.MethodsThe study was conducted on 12 adult male and female dromedary camel heads of different breeds, obtained from the Buraydah slaughterhouse. The standard dissection technique was employed by placing the samples in a 10% formalin solution before dissecting them using approved dissection tools.ResultsThe findings demonstrated that the auricle of camels has a particular structure. The muscles were organized into four groups: rostral, dorsal, ventral, and caudal. In addition, three cartilages were identified, along with the anatomical location of the auricular nerves. Based on anatomical and ultrasonographic landmarks, the injection sites for the internal and great auricular nerve blocks were determined at the lateral side of the base of the auricular cartilage and at the base of the pinna on its caudal side, respectively.ConclusionThe study provides detailed information about the ear pinna, cartilages, and muscles of the camel, with a particular focus on the auricular nerve block method. These findings can serve as a guide future for clinical and surgical procedures involving the camel’s ear.

Objective. To analyze efficiency and safety of nasal dorsal augmentation techniques in secondary rhinoplasty. Material and methods. We analyzed 102 articles devoted to different methods of dorsal augmentation in secondary rhinoplasty. The PubMed, Google Scholar, Scopus, Cochrane, and RSCI databases were screened using the following keywords: «secondary rhinoplasty», «revision rhinoplasty», «dorsal augmentation costal cartilage», «costal cartilage rhinoplasty», «dorsal augmentation conchal cartilage», «secondary rhinoplasty grafts», «secondary rhinoplasty silicone», «secondary rhinoplasty diced cartilage», «secondary rhinoplasty bone», «rhinoplasty PTFE», «rhinoplasty ADM», «rhinoplasty pHDPE», «rhinoplasty fillers». After reading the abstracts, we reviewed full-text Russian- and English-language articles published until April 2024. Nasal dorsal augmentation with autologous cartilage, autologous and alloplastic grafts was analyzed. When analyzing the articles, we evaluated objective results of dorsal augmentation, intra- and postoperative complications. Results. Nasal dorsum height may be adjusted using various autologous cartilage grafts depending on available septal cartilage after primary surgery, the necessity to restore nasal septal support and necessary dorsal augmentation. These cartilages include septal, costal and auricular ones, as well as combinations with fascial, bone, and diced cartilage. This review also describes dorsal augmentation with the most common alloplastic implants (silicone, expanded polyethylene, high-density polyethylene, and injectable soft tissue fillers). Conclusion. Autologous grafts are optimal for nasal dorsal augmentation due to their biocompatibility and ability to produce natural and long-term results. In redo rhinoplasty, rib cartilage is preferable due to denser nature compared to septal and auricular cartilages. Thus, rib cartilage provides rigid support and resists the forces of scar contracture of skin and soft tissues. Unlike septal and auricular cartilages, rib cartilage provides sufficient quantity not only for septal reconstruction but also for dorsal and radix nasal augmentation. Other biological grafts such as fascia and diced cartilage are successfully used alone for minor dorsal augmentation (<4 mm), or in combination with cartilage autografts.

Rationale:Auricular lacerations are commonly encountered in clinical practice, and such injuries can cause significant damage to both the appearance of the face and the emotional well-being of the individual. This case report presents the clinical experience and key considerations of microreplantation of auricular lacerations in different planes, aiming to provide a reference for clinical treatment.Patient concerns:This study analyzed 6 cases of auricular avulsion microsurgical replantation, all achieving excellent clinical outcomes. After systematically evaluating various anatomical planes, long-term follow-up (up to 6 years), and different surgical techniques (anterograde vs retrograde replantation), we present 2 representative cases. All patients underwent meticulous preoperative assessment of the avulsed auricles followed by successful microsurgical replantation. Postoperative results demonstrated well-survived replanted auricles without significant pigmentation changes, near-complete sensory recovery, and fully preserved auditory function.Diagnoses:Due to various unpredictable causes such as trauma, the auricle can undergo avulsion at different planes, which is diagnosed through physical examination. The examination revealed exposed and fractured auricular cartilage at both the proximal and distal ends, with active bleeding points at the proximal ear and partial contusions at the distal auricle.Interventions:According to the avulsion plane of the auricle, followed by meticulous debridement of both the proximal and distal segments under microscopy, employing a carpet-like excisional technique. Depending on the vascular anatomy and extent of tissue loss, either anterograde or retrograde microvascular replantation was performed. Long-term follow-up was conducted to evaluate outcomes.Outcomes:Both replanted auricles survived completely. Postoperative follow-up ranged from 6 months to 7 years. One patient developed a venous crisis leading to scab detachment and mild auricular collapse. Another case exhibited partial skin loss at the junction of the auricle and earlobe. At 10 weeks postoperatively, the second patient underwent a Z-plasty revision under local infiltration anesthesia to address the defect. At final follow-up, all replanted auricles showed no significant pigmentation, near-normal sensory recovery, and preserved auditory function.Lessons:Intraoperative exploration of vascular integrity based on the level of injury is essential, allowing for precise microvascular anastomosis under microscopy. Adequate vascular anastomosis significantly promotes the survival of the replanted auricle.

Bioengineered bilayered grafts for structural and functional posterior lamellar eyelid reconstruction.

Objective:This study was aimed to evaluate the clinical effectiveness of tympanoplasty using auricular cartilage combined with balloon eustachian tuboplasty for the treatment of adhesive otitis media（adhesive otitis media, AdOM） under endoscopic. Methods:A retrospective analysis was conducted on 60 patients with unilateral adhesive otitis media who visited Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Xiamen University between January 2017 and February 2022. All patients were divided into three groups: ①conservative treatment group;②simple tympanoplasty group; ③tympanoplasty combined with balloon dilation group（BET group）. All patients were regularly assessed for the improvement of tympanic membrane morphology, hearing, and Eustachian tube function, as well as complications, after treatment. Results:There was no significant improvement in eardrum morphology, hearing, or eustachian tube function in the conservative treatment group（P>0.05）; both the simple tympanoplasty group and the BET group showed significant improvements in eardrum morphology and hearing after surgery（P<0.01）; In terms of Eustachian tube function improvement, the BET group showed significantly greater improvements in Eustachian tube manometry（TMM） and Eustachian Tube Dysfunction Questionnaire（ETDQ-7） scores compared to the tympanoplasty alone group（P<0.01）. Conclusion:Tympanoplasty using auricular cartilage combined with balloon eustachian tuboplasty shows good clinical outcomes in the treatment of adhesive otitis media, significantly ameliorating patients' subjective symptoms such as tinnitus and ear congestion after surgery, thereby improving the patient's quality of life.

A subset of chondrocytes in various human cartilage tissues, including neoplastic, regenerative, and normal cartilage, expresses α-smooth muscle actin (α-SMA), a protein typically found in smooth muscle cells. These α-SMA-containing chondrocytes, termed myochondrocytes and myochondroblasts, may play important roles in cartilage physiology, regeneration, and structural integrity, particularly in auricular and articular cartilage. This review synthesizes current knowledge regarding the terminology, distribution, and biological significance of these cells across normal, osteoarthritic, transplanted, and neoplastic cartilage. We summarize key findings from immunohistochemical studies using markers such as S-100, α-SMA, and SOX9, along with ultrastructural confirmation of myofilament bundles via electron microscopy. Current evidence suggests that myochondrocytes exhibit enhanced regenerative potential and contribute to matrix remodeling. Furthermore, their presence reflects the inherent cellular heterogeneity of cartilage, potentially arising from transdifferentiation processes involving fibroblasts, mesenchymal stem cells, or chondroblasts. Finally, TGF-β1 and PDGF-BB are identified as a critical modulator of α-SMA expression and chondrocyte phenotype. A deeper understanding of nature and function of myochondrocytes and myochondroblasts may improve interpretations of cartilage pathology and inform strategies for tissue engineering and cartilage repair. This review highlights the need for further investigation into the molecular regulation and functional roles of these cells in both physiological and pathological contexts.

3D printing of a beehive-inspired tissue-engineered auricular cartilage scaffold for reconstruction of autologous microtia

The body has evolved three types of cartilage: hyaline, elastic, and fibrocartilage. Modern tissue engineering techniques can harvest different types of chondrocytes, expand them in vitro, and use them to repair various cartilage defects. However, the modulatory effect of different cartilaginous niches on the type of regenerated cartilage after the implantation of chondrocytes from different origins remains unknown. In this study, three typical types of cartilage-auricular (elastic cartilage), articular (hyaline cartilage), and meniscus (fibrocartilage)-were investigated. Chondrocytes derived from these cartilages were mixed with Pluronic gel and implanted into three different cartilaginous niches for one month using a goat model. Our results demonstrated that in the articular cartilage environment, regenerated cartilage from auricular chondrocytes lost elastin expression, and cartilage from meniscus chondrocytes lacked a fibrous structure, showing reduced type I collagen and increased type II collagen expression, all resembling a hyaline cartilage-like structure. In the auricular cartilage environment, regenerated cartilage from articular chondrocytes did not express elastin, maintaining a hyaline cartilage-like structure, while fibrocartilage chondrocytes failed to form regenerated cartilage. In the fibrocartilage environment, regenerated cartilage from auricular and meniscus chondrocytes did not exhibit a fibrous structure, with weak type I collagen expression and positive type II collagen expression. Regenerated cartilage from auricular chondrocytes did not express elastin and did not transform into fibrocartilage. This study provides valuable insights into how different cartilaginous niches influence the characteristics of regenerated cartilage, offering potential implications for improving cartilage repair strategies in tissue engineering.

During rhinoplasty, there is often a need to perform camouflage and esthetic augmentation of the nasal dorsum. Some of the most well-studied methods include the use of deep temporal fascia and diced cartilage in fascia. Due to less trauma, taking the rectus abdominis fascia in combination with rib harvesting is becoming widespread. However, in cases where only camouflage or augmentation of the nasal dorsum is required, it is possible to avoid taking the rib and the mentioned fascia, using auricular materials successfully through a single incision. The article described the using of auricular perichondral sleeve for camouflage and dorsal augmentation in empty condition and filled with auricular cartilage in the modeling of diced cartilage auricular perichondral sleeve grafts. For camouflage and augmentation of the nasal dorsum for primary, post-traumatic and secondary cases of rhinoplasty through open and closed approaches, auricular perichondrium wasused in three conditions (1) empty auricular perichondral sleeve, (2) full-length filled with diced auricular cartilage, and (3) partially filled sleeve. The techniques of application of these grafts were described depends on the clinic situation. The authors report their experience with 122 clinical cases from February 2019 to March 2022. The patients were divided into three groups depending on the types of grafts that were used. Autologous auricular perichondrium can be used for camouflage and dorsum augmentation for primary, post-traumatic, and secondary cases. 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 .

To date, it has been a unanimous consent that the conchal cartilage is harvested at subperichondrial plane for the anterior side, and perichondrial level for the posterior dissection. This method has never been challenged, despite the fact that numerous studies already suggested the beneficial validity of preserving perichondrium. The authors address our technique of preserving both sides of the perichondrium during auricular cartilage harvest. Twenty patients, ranging in age from 18 to 33 years, completed the study. In all cases, the conchal cartilage was harvested with bilateral perichondrium preserved. The complications that arose were collected retrospectively. The average time duration for the bilateral perichondrium-preserving was 37.6±4.1 minutes. The size of the conchal cartilage ranged from 3.1×2.4 to 1.8×1.5cm. A case rendered small skin perforation during the harvest, but recovered uneventfully with immediate repair. The technique can be technically challenging and time-consuming. Nevertheless, better tissue integrity, balanced structure, and other potential benefits that ensue vindicate the extra time and effort. This bilaterally perichondrium preserved conchal graft warrants further validations in the long term.

Cryptotia is a common congenital auricular deformity in which the upper ear is constricted and buried beneath the temporoparietal scalp. Various surgical techniques have been reported for the correction of cryptotia, whereas an optimum surgical protocol is still being explored. The aim of this study was to analyze the efficiency and reliability of a new method for cryptotia correction. Twenty-six patients with 32 ears were included in this study. A new method combined with postauricular myofascial flap and skin graft was used for correcting cryptotia. After the curly auricular cartilage release correction, the posterior auricular fascial flap was lifted forward and folded as a support to fix the auricular cartilage, so as to maintain a normal position of the auricle, deepen the cranioauricular groove and correct the Cryptotia. Subsequently, the wound in the mastoid and retroauricular regions was covered with a full-thickness skin graft taken from the groin. All patients exhibited a good response with respect to aesthetic and functional aspects (possibility of wearing glasses and masks). The contour of the corrected auricles was basically the same as that of the contralateral side. Scar hyperplasia occurred in both the groin and postauricular area in one patient. The overall result based on the 4-point Likert scale was good. The method of using a postauricular myofascial flap combined with skin graft has proven to be a simple and reliable technique for correction of cryptotia. All corrections were performed in one stage.

LB1066 Medicare trends in auricular cartilage and composite graft utilization amongst Mohs surgeons and other specialists from 2013 to 2022

IntroductionCongenital microtia is a birth defect characterized by auricular underdevelopment, with unclear pathogenesis and unidentified pathogenic genes.MethodsDifferential expression analysis, weighted co-expression network analysis (WGCNA), protein-protein interaction (PPI) networks and support vector machine recursive feature elimination (SVM-RFE) identified the key biomolecules in microtia. Single-cell and intercellular communication analysis were used to decipher the key intercellular signaling pathway. We extracted primary cells and conducted Immuno precipitation mass spectrometry (IP-MS), co-Immuno precipitation (Co-IP) and RNA-sequencing (RNA-seq) to confirmed the mechanism. The intercellular communication network was confirmed through the cell co-culture system. Organoid and animal models further validated the role of key biomolecules.ResultsWe found that IL-6 may be the key biomolecule in microtia. Normal ear cartilage tissue is mainly composed of chondrocytes, but microtia auricular ear tissue contained chondrocytes and stem cells. IL-6 signaling pathway is the main intercellular communication pathways in microtia. We extracted primary chondrocytes and stem cells, and proved that IL-6 promotes the growth and migration of primary cells. The binding of IL-6 and IL-6R and Glycoprotein 130 (GP130) and the activation of their downstream were confirmed. Furthermore, IL-6 signaling pathway was proved to involve in the intercellular communication of microtia. Cartilage microspheres demonstrated the role of IL-6 in regeneration of ear cartilage. The preventive intervention of adeno-associated virus (AAV) on pregnant mice confirmed the role of IL-6 in vivo.ConclusionIL-6 signaling is the key biomolecule in the development and regeneration of auricular cartilage in microtia. IL-6 is a potential biomarker and preventive and therapeutic target for microtia patients.

This case report examines a rare instance of acquired petrified ear, a condition characterized by calcification or ossification of the auricular cartilage, potentially attributable to chronic mechanical pressure in an occupational setting. The study details the clinical presentation and radiological findings of a 50-year-old market porter who routinely carried heavy loads on their left shoulder, resulting in persistent compression of the left ear. Physical examination revealed a rigid, thickened, and smaller left pinna compared to the right. The patient did not report any associated pain. The patient had no history of trauma or metabolic disorders. There was no hearing impairment. Imaging confirmed that the left pinna was calcified. This case suggests a strong link between chronic occupational mechanical strain and the development of petrified ear.

Introduction: Auricular cartilage calcification, commonly referred to as "petrified ears," is a rare phenomenon characterized by progressive hardening of the auricular cartilage. While this condition is typically associated with endocrinopathies, metabolic disorders, or environmental insults such as frostbite or trauma, chronic actinic damage as a primary etiology has been infrequently reported. We present a case of auricular cartilage calcification in which chronic actinic skin damage was the most likely contributing factor. Case Report: A 54-year-old male with a history of coronary artery disease and hyperlipidemia presented with progressive bilateral auricular induration without associated pain, systemic symptoms, or prior trauma. Examination revealed rigid auricles with overlying scale, consistent with chronic actinic damage. Histopathologic evaluation of a 3 mm punch biopsy demonstrated focal calcium deposition within the auricular cartilage and surrounding dermis, confirmed by Von Kossa staining. Given the absence of systemic symptoms, normal laboratory findings, and a history of bilateral actinic keratoses of the ears, actinic damage was determined to be the most likely etiology. The patient declined further laboratory workup, and no additional intervention was pursued. Discussion: This case highlights an uncommon etiology of auricular cartilage calcification, a rare condition most often associated with systemic disease or mechanical injury. While actinic damage has been proposed as a potential contributing factor in prior reports, few cases have directly implicated chronic sun exposure as the primary mechanism. Recognition of this presentation is essential for accurate diagnosis and appropriate management, particularly in patients without a history of trauma or systemic disease.

Free tarsal grafts, the palatal mucosa, and auricular cartilage are commonly used in the reconstruction of the posterior lamella of the eyelid. However, reports describing the sole use of periosteal flaps are limited. We described the cases of two female patients, aged 72 and 85 years, with sebaceous gland and basal cell carcinomas of the left lower eyelids, respectively, who underwent reconstruction with a long L-shaped periosteal flap. The periosteal flap, measuring approximately 6 × 25 mm, was harvested along the vertical axis over the lateral orbital rim, extending across the frontozygomatic suture with the pivot positioned posteriorly at Whitnall's tubercle. This technique enabled the reconstruction of the posterior lamella of the lower eyelid. At the 1-year follow-up, mild sagging of the reconstructed area was observed in the second case; however, no major complications occurred. Thus, the long L-shaped periosteal flap was useful for reconstructing the lateral lower eyelid.