Auricular Structure Research Articles

Bilateral Dimorphism of the Auricles in 18–20-year-old Girls

The aim of the study was to identify somatotypological features of linear parameters and bilateral dimorphism of the auricles in 18–20-year-old girls. Material and methods. The study included 140 girls aged 18–20 permanently living on the territory of the Luhansk People's Republic. They were exposed to somatotyping and cephalotyping. During auriculometry, 20 linear dimensions of each auricle were measured. The results obtained were processed using ANOVA and MANOVA and correlation analyses. The index of bilateral dimorphism of auriculometry parameters was determined. Differences in mean values were considered statistically significant at p<0,05. Results. As revealed, the auriculometric parameters of the left auricle exceeded those of the auricle of the contralateral side. Average value of the physiognomic length of the left auricle (n=140) was 61,40 mm, that was 3,55% (p<0,001) bigger than the corresponding parameter of the right auricle. In addition, the maximum index value of bilateral dimorphism (0,069) was registered during the analysis of the height of the tragus. In girls with normosthenic body type (n=69), the morphological width of the left auricle and its height also significantly exceeded the corresponding values of the auricle of the opposite side by 4,12% (p=0,017) and 5,56% (p<0,001), respectively. Variance analysis of the results obtained indicates that the somatotype of women, largely than the cephalotype, affects the variability of the auriculometric parameters. Correlation analysis of the findings allowed identifying predominantly statistically significant positive correlations of varying degrees between the studied parameters. The closest correlation (r>0,90) was determined between the physiognomic length and the length of the cartilaginous part, and between the physiognomic length and height of both the right and left auricles. Conclusion. The data obtained relating the constitutional features of the auricular structure in girls aged 18–20 are of practical significance to study the external ear intravitally, and to optimise surgical options for the auricle shape correction.

Seminars in Plastic Surgery: Pediatric Ear Anomalies and Reconstruction

AbstractCongenital ear anomalies affect 15 to 20% of neonates and can be categorized as either auricular deformations or malformations. Deformations involve a fully developed, albeit abnormally shaped, chondrocutaneous framework, which makes them amenable to correction with ear molding within the first few months of life. Malformations involve hypoplastic or fully absent auricular structures that require augmentation with alloplastic and/or autogenous reconstruction. The goal of this article is to outline the various auricular deformities and malformations, followed by a description of the latest clinical management options, both nonsurgical and surgical, by auricular anomaly.

Nonsurgical Creation of an Auriculocephalic Sulcus in Children With Congenital Auricular Deformities.

Nonsurgical correction of congenital auricular deformity is known to be effective in newborns. In this study, the authors investigated factors influencing the outcome of nonsurgical or surgical correction of the auriculocephalic sulcus, an important auricular structure and one that is necessary for wearing glasses or a mask. A total of 80 ears (63 children) were splinted using a metallic paper clip and thermoplastic resin in our outpatient clinic between October 2010 and September 2019. The ears were divided into a group, in which the auriculocephalic sulcus was formed nonsurgically (n =5 6) and a group, in which surgery was needed (n = 24). The authors compared the clinical characteristics of the deformities, whether cryptotia affected the superior or inferior crus, and whether constricted ears were Tanzer group IIA or IIB between the two study groups by retrospective chart review. There was a significant correlation between the age, at which ear-molding treatment was initiated and outcome ( P < 0.001). The optimal cutoff value for age, before which ear-molding treatment should be initiated was 7 months. Inferior crus-type cryptotia was corrected adequately by splinting, but all Tanzer group IIB constricted ears needed surgical treatment. Earlier initiation of ear-molding treatment is recommended, preferably before 6 months of age. Nonsurgical treatment is an effective intervention for the creation of the auriculocephalic sulcus in ears with cryptotia and Tanzer group IIA constricted ears but cannot correct for an inadequate amount of skin over the auricular margin or a defect in the antihelix.

Two Pre-Expanded Free Flaps Used for Auricular Reconstruction and Ipsilateral Facial Scar Release

Auricular reconstruction is a great challenge for surgeons to achieve good aesthetic outcomes when adjacent tissues were burned. Compared with pedicle flap therapies, there are some advantages of pre-expanded free flaps for ear rebuilding, such as thinner layer tissues for aesthetic requirements of delicate auricular structures and less donor site deformity. In this study, the authors introduced 6 sequential surgical procedures for total auricular reconstruction with severe ipsilateral facial scar. Pre-expanded deltopectoral flap was used to release periauricular contracture and repair facial scar. The injured ear was restored by expanded forearm flap including autologous cartilage framework. The surgical procedures were lasted more than 2 years. An 8 and half year's follow-up was performed from November 2012 to April 2021. The clinical data and surgical techniques were recorded and analyzed. The patient was satisfied with the aesthetic outcomes of the new ear. The skin texture and color of the grafts were approximately matched to the recipient sites. Facial expression was not affected severely. Sensations of the transferred flap and new ear had partially recovered. The donor sites were recovered without severe complication. The pre-expanded free forearm flap is a feasible method for total ear reconstruction when local flap therapies could not be applied. Repair of ipsilateral facial scar is beneficial for auricular procedures.

Management of the partial avulsions of the auricle

Injuries of the auricle can range from simple lacerations to complete avulsions. Many techniques of ear replantation have been described in the literature in addition to the type and extent of the involved auricular structures. A direct reattachment of the amputated pinna without microsurgery is rarely successful due to necrosis of the avulsed fragment. Whereas, reconstructions with pocket methods and their variations might lead to better results. In this article we would like to discuss some of these approaches and demonstrate a two-stage reconstruction technique for subtotal avulsion of the auricle.

Biofabrication of a shape-stable auricular structure for the reconstruction of ear deformities.

Bioengineering of the human auricle remains a significant challenge, where the complex and unique shape, the generation of high-quality neocartilage, and shape preservation are key factors. Future regenerative medicine–based approaches for auricular cartilage reconstruction will benefit from a smart combination of various strategies. Our approach to fabrication of an ear-shaped construct uses hybrid bioprinting techniques, a recently identified progenitor cell population, previously validated biomaterials, and a smart scaffold design. Specifically, we generated a 3D-printed polycaprolactone (PCL) scaffold via fused deposition modeling, photocrosslinked a human auricular cartilage progenitor cell–laden gelatin methacryloyl (gelMA) hydrogel within the scaffold, and cultured the bioengineered structure in vitro in chondrogenic media for 30 days. Our results show that the fabrication process maintains the viability and chondrogenic phenotype of the cells, that the compressive properties of the combined PCL and gelMA hybrid auricular constructs are similar to native auricular cartilage, and that biofabricated hybrid auricular structures exhibit excellent shape fidelity compared with the 3D digital model along with deposition of cartilage-like matrix in both peripheral and central areas of the auricular structure. Our strategy affords an anatomically enhanced auricular structure with appropriate mechanical properties, ensures adequate preservation of the auricular shape during a dynamic in vitro culture period, and enables chondrogenically potent progenitor cells to produce abundant cartilage-like matrix throughout the auricular construct. The combination of smart scaffold design with 3D bioprinting and cartilage progenitor cells holds promise for the development of clinically translatable regenerative medicine strategies for auricular reconstruction.

Fabrication of chondrocytes/chondrocyte-microtissues laden fibrin gel auricular scaffold for microtia reconstruction.

Fibrin gel-based scaffolds have promising potential for microtia reconstruction. Autologous chondrocytes and chondrocyte cell sheets are frequently used seed cell sources for cartilage tissue engineering. However, the aesthetic outcome of chondrocyte-based microtia reconstruction is still not satisfactory. In this study, we aimed to fabricate the chondrocytes/chondrocyte-microtissues laden fibrin gel auricular scaffold for microtia reconstruction. We designed a unique auricular mold that could fabricate a fibrin gel scaffold resembling human auricle anatomy. Primary chondrocytes were harvested from rabbit auricular cartilage, and chondrocyte cell sheets were developed. Chondrocyte-microtissues were prepared from the cell sheets. The mixture of chondrocytes/chondrocyte-microtissues was laden in fibrin gel during the auricular scaffold fabrication. The protrusions and recessed structure in the auricular scaffold surface were still clearly distinguishable. After a one-week in vitro culture, the 3 D structure and auricular anatomy of the scaffold were retained. And followed by eight-week subcutaneous implantation, cartilaginous tissue was regenerated in the artificial auricular structure as indicated by the results of H&E, Toluidine blue, Safranin O, and type II collagen (immunohistochemistry) staining. Protrusions and depressions of the auricular scaffold were slightly deformed, but the overall auricular anatomy was maintained after 8-week in vivo implantation. Extracellular matrix components content were similar in artificial auricular cartilage and rabbit native auricular cartilage. In conclusion, the mixture of chondrocytes/chondrocyte-microtissues laden fibrin gel auricular scaffold showed a promising potential for cartilaginous tissue regeneration, suggesting this as an effective approach for autologous chondrocyte-based microtia reconstruction.

Progenitor cells in auricular cartilage demonstrate cartilage-forming capacity in 3D hydrogel culture

Paramount for the generation of auricular structures of clinically-relevant size is the acquisition of a large number of cells maintaining an elastic cartilage phenotype, which is the key in producing a tissue capable of withstanding forces subjected to the auricle. Current regenerative medicine strategies utilize chondrocytes from various locations or mesenchymal stromal cells (MSCs). However, the quality of neo-tissues resulting from these cell types is inadequate due to inefficient chondrogenic differentiation and endochondral ossification, respectively. Recently, a subpopulation of stem/progenitor cells has been identified within the auricular cartilage tissue, with similarities to MSCs in terms of proliferative capacity and cell surface biomarkers, but their potential for tissue engineering has not yet been explored. This study compared the in vitro cartilage-forming ability of equine auricular cartilage progenitor cells (AuCPCs), bone marrow-derived MSCs and auricular chondrocytes in gelatin methacryloyl (gelMA)-based hydrogels over a period of 56 d, by assessing their ability to undergo chondrogenic differentiation. Neocartilage formation was assessed through gene expression profiling, compression testing, biochemical composition and histology. Similar to MSCs and chondrocytes, AuCPCs displayed a marked ability to generate cartilaginous matrix, although, under the applied culture conditions, MSCs outperformed both cartilage-derived cell types in terms of matrix production and mechanical properties. AuCPCs demonstrated upregulated mRNA expression of elastin, low expression of collagen type X and similar levels of proteoglycan production and mechanical properties as compared to chondrocytes. These results underscored the AuCPCs' tissue-specific differentiation potential, making them an interesting cell source for the next generation of elastic cartilage tissue-engineered constructs.

Abstract: Acute Ear Burns: An Algorithm for Treatment

INTRODUCTION: The exposed position of the external ear on the head, as well as its structure, makes it uniquely susceptible to thermal burns. The goals of treatment of the burned ear are to prevent chondritis, maintain form and function and salvage auricular structure. We propose a classification system and management algorithm for ear burns to better treat these injuries. METHODS: A retrospective chart review was performed on patients who were seen and diagnosed with ear burns at The University of Chicago Medical Center (UCMC) from 2007–2013. Charts were reviewed and searched for key phrases, including “ear” “burn” “chondritis” “cartilage” and “sulfamylon”. Microbiology and pathology data were examined for details regarding infections and chondritis. Patients with ear burns were initially managed similarly with topical sulfamylon, removal of pillows to prevent direct pressure on ears, hydrotherapy, and bedside debridement. They then progressed down the algorithm taking into account the depth of burn and amount of exposed cartilage. RESULTS: From 2007–2013, 109 patients with at least 1 ear burn were treated at UCMC. Of these, 77 (70.6%) were male and 32 (29.4%) were female. Patients ranged from 5 months to 75 years old. 27 patients had operative interventions for their ear burns. All ear burns requiring operative intervention had exposed or burned cartilage. Operative intervention occurred an average of 8.8 days after admission, with a range of 1–42 days. Closure methods included complete or partial primary closure (8 patients), STSG coverage (24 patients), or a combination of these approaches. Most patients required only 1 surgery to treat their ear burns, while one patient required a total of 5 surgeries. The incidence of suppurative chondritis in our patient population was 0. CONCLUSION: Although chondritis is a serious complication of ear burns, our protocol has effectively eliminated chondritis in patients with ear burns admitted to UCMC. Ear burns were classified by depth of injury, presence of viable perichondrium, amount of exposed cartilage, and presence of burned cartilage. Our approach to ear burns involves minimizing pressure to the ear, wound care involving sulfamylon, hydrotherapy treatment for nonoperative debridement and early operative intervention for burns with exposed/burned cartilage, with coverage methods that range from primary closure to local flap closure, depending on the amount of cartilage exposed.

Surgical correction of an accessory auricle, polyotia.

Surgical correction of an accessory auricle, polyotia.

Hair band retained prosthetic reconstruction of bilaterally missing ears: A case of congenital atresia of external auditory canals and pinna

IntroductionAuricular defects present reconstructive challenges, especially if they are bilateral. Surgical reconstruction provides effective results for defects; however for some patients surgical intervention is contraindicated. This case report describes an easy clinical technique to rehabilitate a patient with auricular defects. The prime purpose of this treatment rendered was to restore the lost auricular structure to the patient's satisfaction in an elegant, comfortable and cost effective manner. PatientA thirteen year old female patient, who had bilaterally missing ears, was referred with a chief complaint of discomfort caused due to her existing hair band prosthesis and unsatisfactory esthetics. There was constant formation of ulcers at the site where the prosthesis came in contact with the skin. Considering the patient's age, ease of use and economic status, hair band retained ear prosthesis was selected. Silicone ear prostheses were fabricated on acrylic substructure to ensure fit, esthetics. Beneath the acrylic plates, a thin layer of soft silicone material was attached. The ear prostheses of both sides were connected with a metal hair band to retain. DiscussionThe newly fabricated prosthesis overcame the limitations of the existing one. The patient and her parents were satisfied with the results. ConclusionThe hair band retained silicone ear prosthesis is esthetic, economical and easy to use as a facial prosthesis. The addition of soft liner provided a cushion-like effect, thus reducing the formation of any ulcers due to pressure.

Treatment of Prominent and Constricted Ear Anomalies

Although the physiologic effects of ear deformity are negligible, the aesthetic and psychological impact on the patient can be profound. Significant ear malformations are prevalent in today's society and affect more than 5 percent of the population. Although the prominent ear results from either underdevelopment of the antihelix or an enlarged conchal bowl, the constricted ear is a product of helical down-folding and height deficiency. After a thorough evaluation, surgical management of the prominent ear must be approached in a careful, rational fashion. Although the surgeon may enjoy the wide latitude that hundreds of corrective techniques offer, he or she must always proceed with an algorithmic application of technique best suited to the specific auricular deformity. By using this approach, correction of the prominent ear can go beyond patient satisfaction to predictably maximize outcome in both form and symmetry. From the clinical evaluation and anatomical basis to surgical management of the deformed ear, the true art of otoplasty is in the surgeon's ability to thoroughly understand auricular structure and appropriately apply technique for maximal aesthetic outcome.

Collagen types in the middle ear mucosa.

The distribution of various collagen types--in particular that of type II as the major collagen in cartilage--in normal auricular structures is discussed with reference to a 1994 report by Ovesen describing the presence of collagen type II in normal middle ear mucosa. In contrast to this report, no collagen type II is normally found in the normal mucosa of the middle ear, while multiple structures of the normal middle and inner ear (which mostly consist of cartilage or have at least a cartilaginous origin) contain this unique collagen type. This indicates that the collagen type II staining previously observed in the normal middle ear mucosa is most likely an artifact. Of the at least 18 collagen types now known, interstitial and ubiquitously present types I, III and V can be found in the normal middle ear. The minor cartilage collagen types IX and XI have been found in cartilage of the middle (and inner) ear. The basement membrane collagen type IV is normally present in different microanatomical settings, particularly in the epithelial and endothelial basement membranes. In general, an exclusive morphometric estimation of area changes for collagens, particularly for collagen type IV, regardless of any tissue localization seems to be of minor value, since no attribution can be drawn to any of the histoanatomical structures present in the ear. The presence of further collagen types has not yet been tested in normal auricular structures.

Regression of massive keloid following partial excision and post-operative intralesional administration of triamcinolone

Summary A massive auricular keloid which had rapidly recurred after three previous excisions and a course of radiation therapy was treated effectively by partial excision and intralesional steroid administration. Complete excision would have resulted in considerable deformity in this case because the lesion already encroached significantly on adjacent auricular structures. Almost complete regression of the keloid occurred gradually during steroid therapy, and regrowth of the lesion has not been seen since medication was discontinued one year ago. No systemic or local complications occurred.

Sorghum—Size relationships of seed, embryo, seedling and the first seedling leaves

The seeds of sorghum vary very much in their size. Seed size (length × breadth × thickness) is highly correlated to seed weight. The larger the seed the bigger is its embryo, and the bigger the seedling that grows from it. In six varieties typical of different seed sizes the relationship between seed and seedling leaf measurements have been pursued. The first two seedling leaves are abnormal, in shape, being much wider than long. In these two seedling leaves the width of the seedling is highly correlated with seed size. In the third seedling leaf the length of the leaf is beginning to be influenced by seed size. In this third leaf the midrib and ligular and auricular structures attain their full development.