Autogenous Costal Cartilage Research Articles

Refinements in autologous ear reconstruction: descriptive surgical technique and experience of 400 consecutive cases at a tertiary referral center in the UK

Ear reconstruction for microtia is a great challenge in plastic surgery. Autogenous costal cartilage has remained the material of choice for framework fabrication. We describe our preferred technique and provide several refinements which have been developed over years to improve the outcome and minimize complications, based on experience with 406 cases. Esthetic outcome scoring was performed by evaluating all subunits of the reconstructed ears as well as the overall integration of the ear with the face (15 esthetic parameters). These were graded, using a 5-point ordinal scale from 1 (very poor) to 5 (very good). The course of improvement of the overall esthetic score was assessed using one-way ANOVA test with Bonferroni post hoc analysis. The overall complication rate was 15%. Wire extrusion was the most common (12.8%). The rate of revision procedures was 11.8%. The helix and concha had the highest esthetic score (3.4 each). The overall esthetic score was 3.2 on average. The overall score showed statistically significant improvement after the first 50 cases (p = 0.02) and another increase after performing 250 cases. The difference between the esthetic score of the first and the last subgroup of cases is highly significant (p < 0.001). Autologous ear reconstruction is a complex surgery with inevitable learning curve. Undertaking an adequate training is advised to achieve pleasing results. Having a regular high volume case load is essential to achieve significant improvement in outcomes. The goal of having nationally designated ear reconstruction units is highly recommended. Level of evidence: Level IV, therapeutic study.

Classification of the concha-type microtia and their new suitable treatment strategies without autogenous costal cartilage grafting

ObjectiveNumerous corrective methods have been successfully applied in concha-type microtia reconstruction over the past several decades, and autogenous rib cartilage grafting has become a routine technique in a two or three-stage operation. However, it still remains a challenge due to the effective use of the large volume of the remnant cartilage and skin involved. The objective of this study was to clarify how this remnant cartilage and skin could be manipulated for new suitable treatment strategies without autogenous costal cartilage grafting. MethodsA total of 424 patients with concha-type microtia operated at our Center from January of 2012 to June of 2019 have been reviewed and analyzed cases. At the same time, a classification system for grading the severity of concha-type microtia was created on the basis of anatomical findings and ear size. ResultsA total of 436 ear cases (involving 424 patients), showing concha-type microtia, were included in our study and reviewed through medical records, photographs, analysis of surgical methods, and postoperative outcomes. The concha-type microtia were classified into four graded types: Grade I (n = 151), Grade II (n = 101), Grade III (n = 93), and Grade IV (n = 79). A total of 352 ears in 345 patients with Grade I to III concha-type microtia were followed up for 1 month to 7 years (average, 14.7 months). 329 patients (95.4%) were satisfied with the aesthetic outcomes of the corrected ear. ConclusionsIndividual corrective methods and aesthetic outcomes for patients with Grade I to III of deformity were described in this study. The authors present new suitable approaches according to a progressive classification system which provide conservative and individualized methods of treatment in early stages of life.

Application of costicartilage in rhinoplasty repair surgery

Objective To investigate the clinical application and effect of autogenous costal cartilage in rhinoplasty repair surgery. Methods From July 2015 to June 2018, 112 cosmetic patients were treated with costal cartilage nasal tip prosthesis in the Department of Cosmetic Surgery, Shanghai Yixing Medical and Beauty Hospital. By using the straight part of the ribs, the nasal columella was made with mortise groove and then septal expanded graft prepared by using two pieces of expanded grafts. The cap-like, shield-like cartilage and perichondrium were combined for completing nasal tip prosthesis. Results A total of 112 patients were treated after rhinoplasty repair surgery. After 6-24 months of follow-up, 100 (accounting for 89.3%) cosmetic seekers were satisfied with the shape of the nasal tip, 5 (accounting for 4.5%) of those patients were not being satisfied due to unexpected nasal tip point, 3 (accounting for 2.7%) surgical infection cases after rhinoplasty and underwent prosthesis removal, 2 (accounting for 1.8%) had slight deviation of nasal tip and 2 had partial necrosis of nasal septum mucosa. No pneumothorax or chest wall deformities were found. Conclusions Rib cartilage is an excellent material for nasal tip formation in rhinoplasty. The use of autogenous costal cartilage to repair aesthetic defects in the lower nose can achieve a more effective, safe and lasting effect. Key words: Costal cartilage; Transplantation, autologous; Rhinoplasty; Reconstructive surgical procedures; Mortise alveolar cartilage

Different Methods of Fabricating Cartilaginous Ear Framework in Children With Microtia According to the Length of the Eighth Costal Cartilage Intraoperatively.

There is controversy over the optimal timing of microtia reconstruction. The eighth costal cartilage, which is used to shape the helix framework, can be one of the key factors determining surgical timing of microtia reconstruction. Nevertheless, it is difficult to predict the length of the eighth costal cartilage preoperatively. The aim of the present study was to discuss different methods of fabricating cartilaginous ear framework in children with microtia according to different lengths of the eighth costal cartilage. Based on the actual length of the eighth costal cartilage in microtia children, there are 2 methods to fabricate auricular framework. In method I, the eighth costal cartilage was divided into 2 parts. Part A was used to fashion the helix, while part B was used to protrude the antihelix, superior, and inferior crus. The seventh rib was used to form the main body and the sixth rib was used to form the base of the framework. In method II, the seventh costal cartilage was used to fashion the helix and extrude the antihelix, superior, and inferior crus as method I did. The sixth rib was used to form the main body and the eighth rib was used to form the base of the framework. A total of 68 microtia children underwent auricular reconstruction adopting the modified techniques between 2015 and 2016. The great majority of patients (66 patients) were satisfied with the reconstructed ears. Two patients were relatively satisfied with the reconstructed ears. Three cases have been selected to illustrate the favorable result achieved. They revealed that the helix, antihelix, superior crus, and inferior crus all appeared distinct and presented a favorable result of the contour of the reconstructed auricle. Based on different lengths of eighth costal cartilage in children, different methods of fabricating ear framework make full use of the autogenous costal cartilage and elevate anatomical details, demonstrating that personalized treatment is necessary.

Single centre review of the use of costal cartilage for reconstruction of the nasal dorsum

Reconstruction of the nasal skeleton aims to allow optimal air passage as well as a cosmetically pleasing appearance. Autogenous graft materials are the gold standard due to low extrusion and infection rates. A larger source of cartilage is required for complex secondary nasal reconstruction which makes costal cartilage an ideal source of autogenous material. We performed a retrospective review of all patients undergoing nasal reconstruction with autogenous costal cartilage between the years 2005 to 2016. All procedures were performed by a single surgeon across two hospital sites. Patient charts were reviewed to determine aetiology, indication for surgery, referral source, post-operative complications, need for revision surgery and the length of follow-up. There was a total of 28 patients, 68% male with an average age of 37 years. The majority were referred from ENT (50%) followed by plastic or maxillofacial surgeons (21%). The commonest indication for surgery was previous nasal trauma (53%), and 88% of patients with trauma as the aetiology had previous nasal surgery prior to costal cartilage reconstruction. The commonest complication was warping of the costal cartilage graft; this occurred in 18% of patients; a slipped costal cartilage graft occurred in 4%. The revision rate was 32%. There were no cases of pneumothorax, pleural tear and post-operative infection. Despite the availability of alternative cartilage sources and the risk of cartilage warping, autogenous costal cartilage is still the ideal cartilage source for complex nasal reconstruction. It is readily available, durable and versatile. Several recent studies have reported alterations in surgical technique to reduce warping. This will subsequently reduce rates of revision surgery and ensure this versatile cartilage source continues to be utilised by surgeons in future. Level of Evidence: Level IV, therapeutic study

Effectiveness of autologous costal cartilage transplantation in repair of Binder's syndrome

To investigate the technical points and effectiveness of autogenous costal cartilage transplantation in repair of Binder's syndrome. Between June 2012 and June 2017, 8 cases of Binder's syndrome were admitted. There were 3 males and 5 females, aged 16-31 years (mean, 22 years). All patients were conformed to the typical manifestations of Binder's syndrome. The autogenous costal cartilage was harvested and carved into the nasal dorsum graft, nasal column graft, and nasal basement graft. Before and after operation, standard pictures of the anterior view, lateral view, and base view were taken to measure facial related parameters of nasal dorsum length, nasal columella-lobule ratio, nasofrontal angle, nasal columella-upper lip angle, nasal tip projection rate, and nasion projection. Then the effectiveness of this surgical procedure for Binder's syndrome was evaluated. All incisions healed by first intention without acute infections. All patients were followed up 6-36 months, with an average of 18 months. The foreign body sensation in upper lip and scar hyperplasia in thoracic incision occurred in 1 case, respectively. The nasal morphology improved significantly and the coordinated relationships of the nose with the upper lip and face were restored postoperatively. Postoperative parameter measurements were taken in 6 cases. The nasal dorsum length, nasal columella-lobule ratio, nasofrontal angle, nasal columella-upper lip angle, nasal tip projection rate, and nasion projection at preoperation were significantly improved when compared with the values at 6 months after operation ( P<0.05). The difference in nasal dorsum length, nasal tip projection rate, and nasion projection between actual values at 6 months after operation and normal values was no significant ( P<0.05). There was significant difference in nasal columella-lobule ratio between actual value at 6 months after operation and normal value ( P>0.05). Autogenous costal cartilage transplantation in repair of Binder's syndrome can obviously improve patients' appearance of the external nose and middle face, and obtain the persistent effectiveness.

Application of costal cartilage in oriental secondary rhinoplasty

Objective To introduce the experience of using costal cartilage in oriental secondary rhinoplasty. Methods From January 2012 to December 2016, we used costal cartilage grafts to obtain a functional and aesthetic reconstruction, in which silicone was used in 34 previous cases and e-PTFE was used in 5 cases. Results The mean duration of follow-up was 1.5 years, 43 (86%) patients showed high satisfaction with the shape of nose. 1 case of infection and 2 cases of costal cartilage warping occurred. 1 case was somewhat dissatisfactied with outcome. There was no case of chest wall deformity and pneumothorax, but scar on the chest wall at the donor site was observed in 2 cases. Conclusions We have obtained good aesthetic results using costal cartilage grafts which could display sufficient and stable support for the scaffold of nose. We can conclude that costal cartilage is a good material in secondary rhinoplasty, and can be used to reconstruct an aesthetic nose. Key words: Autogenous costal cartilage; Secondary rhinoplasty; Satisfaction

Modified Methods of Fabricating Helix and Antihelix in Total Auricular Reconstruction Based on Different Length of Eighth Costal Cartilage

Attaining an ideal appearance of the reconstructed ear depends primarily on the fabricated cartilaginous ear framework. Despite the role of eighth costal cartilage, the length of the eighth rib cartilage is difficult to anticipate, and growth of the eighth cartilage is variable. The authors discussed modified methods of fabricating helix and antihelix based on different length of eighth costal cartilage. Based on the actual length of the eighth costal cartilage, patients were divided into group A and group B. In group A, the eighth costal cartilage was divided into 2 parts. Part I was used to fashion the helix, whereas part II was used to fabricate the antihelix and superior crus. In group B, the seventh costal cartilage was cut into 3 parts. Part I and part II were used to fashion the helix, antihelix, and superior crus as group A did. Part III was assembled to the lateral part of the framework to form the inferior crus. A total of 56 patients underwent auricular reconstruction adopting the modified techniques between 2015 and 2016. Three cases have been selected to illustrate the favorable result achieved. They revealed that the helix, antihelix, superior crus, and inferior crus all appeared distinct and presented a favorable result of the contour of the reconstructed auricle. Based on different length of eighth costal cartilage, modified methods of fabricating helix and antihelix make full use of the autogenous costal cartilage, elevate anatomical details, and enhance the overall aesthetics of reconstructed ear. The great majority of patients have satisfactory surgical outcomes, demonstrating that personalized treatment is necessary.

A New Classification of Helix Fabrication Methods with Autogenous Costal Cartilage in Microtia Reconstruction.

Recreating the complex architecture of the auricle poses one of the most demanding challenges for the plastic surgeon. The fabrication of the prominent helix is crucial to the final contour of the constructed ear. The success of helix carving depends greatly on the complicated characteristics of the cartilage used, which is commonly the eighth costal cartilage. The authors elaborate on the relevant details for helix sculpting based on different qualities of cartilage. A series of 415 microtia patients underwent autogenous costal cartilage auricular reconstruction between 2012 and 2015. Because the cartilage used for helix reconstruction is always imperfect or insufficient for the fabrication of anatomical structures, they have devised perfect helix duplication by using individualized eighth rib cartilage with different cartilage lengths, widths, and flexibilities. Four possible scenarios in helix fabrication have been elaborated, and the corresponding methods were introduced. Selective methods for different scenarios in helix fabrication have been shown to produce favorable results. The results reveal that a harmonious helix was achieved and provide a cohesive framework for the integrity of a reconstructed ear. A new classification of helix fabrication methods with autogenous costal cartilage is elaborated, and a favorable framework with harmonious proportions is achieved by precise carving using corresponding measures for different cartilage characteristics. This approach enhances helix aesthetics and helps attain a satisfactory contour of the auricle. Therapeutic, IV.

Three-dimensional autologous cartilage framework fabrication assisted by new additive manufactured ear-shaped templates for microtia reconstruction

During microtia reconstruction, the intraoperative design of the cartilage framework is important for the appearance and symmetry of the bilateral auricles. Templates (traditionally, the X-ray film template) are usually utilized to complete the task, which can provide cues regarding size, cranioauricular angle and positioning to the surgeons. With a combination of three-dimensional (3D) scanning and additive manufacturing (AM) techniques, we utilized two different ear-shaped templates (sheet moulding and 3D templates) during the fabrication of 3D-customized autologous cartilage frameworks for auricle reconstruction. Forty unilateral microtia patients were included in the study. All the patients underwent auricle reconstruction using the tissue-expanding technique assisted by the new AM templates. Images were processed using computer-aided design software and exported to print two different AM ear-shaped templates: sheet moulding and 3D. Both templates were assisted by the 3D framework fabrication. The 3D images of each patient's head were captured preoperatively using a 3D scanner. X-ray film templates were also made for the patients. The lengths and widths of the contralateral auricles, X-ray film and sheet moulding templates were measured in triplicate. The error of the template and the contralateral auricle were used to compare the accuracy between the two templates. Between January and May 2014, 40 unilateral microtia patients aged 6-29 years were included in this study. All patients underwent auricle reconstruction using autogenous costal cartilage. The sterilized AM templates were used to assist in the framework fabrication. The operative time was decreased by an average of 15min compared with the method assisted by the X-ray film template. Postoperative appearance evaluation (based on five indexes: symmetry, length, width, cranioauricular angle and the substructure of the reconstructed ear) was performed by both the doctors and the patients (or their parents). Follow-up (ranging from 9 to 18 months) showed that all of the patients obtained satisfactory results with life-like 3D configuration and symmetric cranioauricular angle. The follow-up showed that no surgery-related complications occurred. Comparing the accuracy of the X-ray film and sheet moulding templates, the average errors of length were 1.8mm±1.44mm and 0.39mm±0.35mm, respectively, and the average width errors were 1.32mm±0.88mm and 0.3mm±0.47mm, respectively. The new sheet moulding template was more accurate than the X-ray template. The new sheet-moulding template is much more accurate than the traditional X-ray film template. Framework fabrication assisted by accurate 3D and informative AM templates contributed to individualized cartilage framework fabrication and satisfactory results.

3D CT Image Processing for 3D Printed Auricular Reconstruction of Unilateral Microtia Patient

Purpose Microtia is congenital anomaly of external ear and the reconstruction method for the external ear of microtia patient was based on autogenous costal cartilage framework. The application of 3D printing technique in medical science has made more possibility of human tissue restoration, and we tried to apply this technique in auricular reconstruction field. Materials and Methods As for unilateral microtia patient, the contralateral side ear is normal and reconstructive surgeon tried to mimic it for reconstruction of affected ear. So, we obtained facial CT scan of microtia patient and made mirror image of normal side ear. Moreover, to make the 3D scaffold based on the mirror image of normal ear and to apply this scaffold for the auricular reconstruction surgery, we included auriculocephalic sulcus and anterior fixation part. Results We could successfully obtain mirror image of normal ear, auriculocephalic sulcus and anterior fixation part for 3D scaffold printing. Conclusions Using this CT image processing and 3D printing technique, we will be able to make the scaffold for auricular reconstruction of unilateral microtia patient, and perform auricular reconstruction in near future.

Application of mastoid flap for correction of moderate or severe cup ear

Objective To propose a practical method for moderate-to-server cup-ear correction.Methods Auricular reconstruction was performed in a manner of two-stage approach with mastoid flap and costal cartilage support.In the first stage,the autogenous costal cartilage framework was inserted under the retroauricular mastoid skin flap.The corrected ear was raised in the second operation and wound was closed with grafting skin.Results Satisfaction of appearance was achieved for totally 18 cases except one case of partly necrosis of cartilage.They were followed-up for 3-26 months.Conclusions This integrative two-stage approach of mastoid flap combining three dimensional costal cartilage is safe and effctive for moderate to severe cup-ear correction,which brings about good appearances and symmetry.The complications are in control. Key words: Cup ear; Skin flap; Deformity

Reconstructive rhinoplasty: operative revision of patients with previous autologous costal cartilage grafts.

Costal cartilage grafts are used more frequently in secondary rhinoplasty. However, these procedures result in patients that require further revision operations that are not trivial. The purpose of this study was to assess the outcomes of reconstructive rhinoplasty performed on patients with a history of prior secondary or tertiary rhinoplasty using autogenous costal cartilage grafts. A retrospective review was conducted of tertiary rhinoplasty procedures. Outcomes of interest included the indications for the revision operation; revision rate following the tertiary costal cartilage revision; whether or not the use of costal cartilage grafts for the reconstructive rhinoplasty was a planned event; and perioperative incidents such as infection, structural collapse, and scarring requiring further surgery. Forty-six patients met inclusionary criteria. The revision rate following tertiary rhinoplasty performed by the primary author was found to be 24 percent (11 of 46). The reasons for these revision operations were nasal airway obstruction (n = 6), aesthetic dissatisfaction (n = 4), and infection (n = 1). Outcomes of the revisions were satisfactory, with no adverse complications requiring further surgery. Reconstructive rhinoplasty may be required in patients who have undergone previous costal cartilage grafting for secondary rhinoplasty. These revision operations can be performed successfully to help patients achieve both improved function and aesthetic results but have a higher than usual revision rate themselves. The revisions of these operations can be managed with standard revision operations that result in satisfactory outcomes. Therapeutic, IV.

Precision carving of costal cartilage graft for contour fill in aesthetic and reconstructive rhinoplasty.

Background:Autogenous costal cartilage is a good option for large volume requirements in rhinoplasty, when septal or conchal cartilages do not suffice. Reluctance to use costal cartilage is due to apprehension of warping. However, warping can be avoided if we follow the principle of balanced section as advocated by Gibson and Davis. “Warping” can also be utilized to change the curvature of the graft.Materials and Methods:We have used 69 costal cartilage grafts as a solid piece for contour fill in rhinoplasty in 31 patients over the last 10 years. Principle of balanced section as advocated by Gibson and Davis was adhered to while carving the grafts, however some grafts were allowed to warp to get different sizes and shapes.Results:All the procedures were uneventful. Aesthetic appearance of all patients was satisfactory and acceptable to all the patients. In two cases, the dorsal graft minimally shifted to one side, but remained straight. In one patient, there was late appearance of distortion.Conclusion:The mode of cartilage warping is predictable and it can be used to advantage. Apprehension to use costal cartilage graft is unjustified, as with precision carving a desired shape can be obtained.

Assessment of limited stage reconstruction of auricular deformities using autogenous costal cartilage

ObjectiveTo evaluate the results of ear reconstructions in cases of auricular dysplasia utilizing autogenous costal cartilage graft, using two-stage versus three-stage technique of auricular reconstruction.BackgroundTotal reconstruction of the absent auricle because of congenital microtia is a complex topic that can be carried out either by alloplastic material or by autogenous material such as costal cartilage.Patients and methodsThis prospective study evaluated 22 patients with auricular deformities who were presented to ENT and Plastic Surgery Departments. Patients are assessed preoperatively by history, general and local examination. Esthetic assessment, photo documentation, audiological and radiologic evaluation were carried out. The patients were divided into two groups according to the stages of reconstruction: two-stage (using temporalis fascia and skin graft) and three-stage (using tissue expander) reconstruction. Patients were assessed postoperatively according to doctor and patient satisfaction. The latter was measured by Glasgow benefit inventory questionnaire.ResultsThe surgical outcome was good to fair for the majority of the patients in terms of size, texture and shape of the ear, according to doctor satisfaction, with no significant difference between the two techniques (P > 0.05). Regarding patient satisfaction, there were no significant differences between both the techniques (P > 0.05). There was a significant difference between the two techniques regarding postoperative skin texture and the rate of development of postoperative complications in favor of group II, using tissue expander (P = 0.002).ConclusionThe microtic ear can be satisfactorily reconstructed using autogenous costal cartilage graft either by two-stage technique (using temporalis fascia flap and skin graft) or three-stage technique (using tissue expander), with no significant difference between the two techniques regarding doctor and patient satisfaction.

Larengotrakeal rekonstrüksiyonda kosta kıkırdağıyla Dacron® greftin karşılaştırması: Deneysel çalışma

Amac: Larenks rekonstruksiyonunda Dacron® implant kullanimini degerlendirmek ve bu materyalin bas-boyun cerrahilerinde potansiyel endikasyonlarini tartismak. Yontem: Her biri 12 Wistar albino sicandan ibaret uc grup olusturuldu. Grup 1 kontrol grubu olup bu gruptaki sicanlarda krikoit kikirdaktan 5. trakea halkasina kadar 6 mm uzunlugunda kesi yapilarak elde edilen 5¥5¥5 mm'lik otolog kosta kikirdagi transplantasyonu yoluyla anterior larengotrakeal rekonstruksiyon gerceklestirildi. Grup 2'de, Grup 1'de oldugu gibi trakea esit uzunluklarda bolumlere ayrildi ve ayni buyuklukte homolog kikirdak nakliyle anterior larengotrakeal rekonstruksiyon gerceklestirildi. Grup 3'de trakea, Grup 1'e esit bolumlere ayrildi ve ayni buyuklukte bir Dacron® greftiyle rekonstruksiyon yapildi. Implantasyondan sonraki 12. haftada sicanlar sakrifiye edildi ve hasta gruplar trakea kesit alani, parsiyel oksijen basinci, epitelizasyon, neovaskularizasyon, enflamatuar hucre infiltrasyonu ve yeni kondrosit olusumu acisindan karsilastirildi. Bulgular: Grup 1'de postoperatif 2. gunde pnomotoraks ve Grup 3'de ise 8. gunde granulasyon ve krutlanma nedeniyle birer deney hayvani kaybedildi. Trakea enine kesit alani ve parsiyel oksijen basinci acisindan gruplar arasinda herhangi bir istatistiksel farklilik yoktu. Grup 2 ve Grup 3 arasinda epitel gelisimi ve neovaskularizasyon acisindan istatistiksel bir farklilik yoktu ancak Grup 1, diger iki gruptan anlamli derecede daha iyi idi. Greft reddinde lenfosit infiltrasyonu onemli bir parametre olup gruplar arasinda onemli bir farklilik vardi. Grup 1, diger 2 gruptan daha iyi oldugu gibi Grup 3'un, Grup 2'den hatiri sayilir derecede farkli oldugu belirlendi. Yeni kondrosit gelisimi acisindan Grup 1. ile Grup 2 arasinda anlamli bir farklilik vardi. Sonuc: Epitel, neovaskularizasyon ve kondrosit gelisim skorlari daha iyi oldugu icin otojen kosta kikirdagi trakea ve larenks icin ideal greft materyalidir. Dacron®'un kullanildigi grupta stenoz, enfeksiyon ve rejeksiyon olmadigi, tum deney hayvanlarinda epitel gelisimi ve neovaskularizasyon tatminkâr derecede olustugu icin larenks rekonstruksiyonunda Dacron® implantlari guvenle kullanilabilmektedir.

Anthropometric Measurements in 126 Microtia Reconstructions

Due to its complex, three-dimensional morphology, auricular reconstruction remains one of the most challenging procedures in reconstructive surgery. A subject that remains controversial, however, is the question of the growth potential of the cartilaginous framework. This study explored the anthropometric changes of the reconstructed auricle and the contralateral normal ear in a series of Asian patients. The records of 126 unilateral microtia patients in three age groups who underwent autogenous costal cartilage auricular reconstruction between 2007 and 2010 were reviewed. The average age was 14 years, and the average follow-up was 2.5 years. The auricular height was measured as the distance from the supra-auricle to the subauricle, and the width was measured as the distance from preauricle to the postauricle. Measurements of the height and width of the reconstructed auricle and the contralateral normal side were taken at implantation and at the final follow-up. Comparisons between the three age groups were performed using a paired Student t test to examine the mean auricular heights and widths for significant interval changes in size. The measurements showed average width increases of 1.24 mm (3.68%) and 1.35 mm (3.91%) in the reconstructed auricles of children and adolescents, respectively, but we did not find obvious changes in the adult group. No significant differences were found in the height measurement of the reconstructed auricle in the three groups. The mature size of the normal ear was reached by age 12, with slowing as patients entered adolescence and adulthood. Comparison of the reconstructed auricle and the contralateral normal ear revealed a very similar growth rate in the adult group. There were average height decreases of 0.77 mm (1.3%) and 1.3 mm (2.09%) in the reconstructed auricles of children and adolescents compared with the normal side. The results showed an average width increase of 1.13 mm (3.15%) in the adolescent group but not in the child or adult groups. The results of this study have generated some useful parameters for the study of growth of the reconstructed auricle and contralateral normal ear. This information serves to clarify the issue of auricular framework fabrication in terms of proper size, especially for Asian patients. Further investigation and analysis are necessary to provide further proof of the graft change.

A 2-year Follow-Up of Irradiated Homologous Costal Cartilage Used as a Septal Extension Graft for the Correction of Contracted Nose in Asians

Septal extension graft is a useful method for the correction of contracted nose. When septal or costal cartilage is not available, irradiated homologous costal cartilage (IHCC) may be an alternative choice. This preliminary study is focused on noninfective absorption and other complications and postoperative changes of nasal length after septal extension graft using IHCC. Thirty patients who could be observed for more than 2 years postoperatively were assessed. All patients had contracted nose deformities with a history of an inflammatory contracture after previous aesthetic surgical procedures. The IHCC was used only as a septal extension graft in each patient. Nasal length was analyzed by comparing preoperative and 2-year postoperative photographs. There was no noticeable graft warping or infective IHCC absorption. However, 3 patients underwent revision: 2 cases of graft avulsion fracture and 1 case of minimal nasal obstruction. Nasal length, which had increased an average of 8.5% after the procedure, was maintained at follow-up 2 years postoperatively. The IHCC has the advantages of avoiding donor-site scars, and also provides the same benefits as autogenous costal cartilage. It can therefore be a reliable alternative material for rhinoplasty. A longer follow-up may be necessary to confirm the structural stability of the IHCC graft in the lengthened caudal septum.

CT 3D Reformatting Technique to Aid Microtia Reconstruction Procedure Planning

This 8 year-old girl presented to a tertiary surgical centre with a history from birth of an absent left and a malformed right pinna, and associated bilateral hearing impairment.&#x0D; On clinical examination, the left pinna was absent and the right dysplastic. No penetrable external auditory meati were evident. Bilateral hearing impairment, more pronounced on the left, was confirmed with auditory testing.&#x0D; Prior to surgery high resolution CT imaging of the temporal bones was performed. In addition a CT of the lower thoracic cavity was undertaken to assess the costal cartilage for surgical planning.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Discussion&#x0D; Microtia is a congenital deformity of the pinna, with a wide spectrum of abnormalities ranging from complete absence (anotia) to a relatively, well formed, but dysplastic pinna (Figure 2). It occurs in 1 in every 6,000 births, with a higher preponderance in select racial groups, such as the Japanese.1 &#x0D; For decades surgical procedures have been performed and evolved for the treatment of microtia. In contemporary practice theses may either be autogenous, using costal cartilage or alloplastic, using the likes of porous high density polyethylene (Medpor).2 The key autogenous surgical techniques in common practice are those described by the Brent and Nagata.3,4&#x0D; Autogenous costal cartilage is utilised in one of the key stages in reconstructing the pinna to fabricate the auricular framework. The age at which the procedure is performed is typically in childhood (8 – 10 years of age), when costal cartilage is believed to be well formed and fusion may have occurred at the mid-lower ribs levels (7th – 9th). Traditionally no pre-operative imaging has been undertaken given the difficulties with visualising cartilage at this age. On standard CT chest with traditional viewing methods the costal cartilage is poorly if at all seen in children. However, utilising some of the more advanced 3D software algorithms on contemporary CT scanners, accurate assessment to aid the surgeon prior to scheduling a procedure can be performed (Figure 1). The configuration of costal cartilage may be reviewed and if adequate fusion has occurred. A potential framework can then be outlined (Figure3a). In addition selective dimensions can be recorded to the nearest millimeter (Figure 3b). This post-processing work is undertaken with the reporting radiologist and surgical lead for the procedures.&#x0D; *Images in our institutions were acquired on Siemens Somatom 64 slice scanner with radiographic parameters of kV 120, Mas 46, slice thickness 0.6mm and DLP of 68 without the use of intravenous contrast. Coronal 3D reconstructions were performed using the InSpace software, using an arterial algorithm (Figures 1 and 3a). Alternatives employed include the use of soft tissue algorithm (Figure 3b).

The Oblique Split Method

Autogenous rib cartilage is widely used in the septorhinoplasty cases with major structural grafting requirements. However, there is a risk of warping over time. To introduce a novel method for carving costal cartilage grafts to obtain straight grafts of varying thicknesses and to eliminate the risk of warping. Between 2007 and 2011, a total of 43 consecutive patients underwent septorhinoplasty using autogenous costal cartilage grafts carved by the oblique split method (OSM). The Ankara Training and Research Referral Hospital, Ankara, Turkey. The study included 43 patients with saddle nose deformity and revisional rhinoplasty with a depleted source. All patients were followed-up for a period ranging from 12 to 37 months (mean, 19.2 months) after surgery. All patients underwent open or closed septorhinoplasty. Autogenous costal cartilage was carved with the OSM to obtain grafts suitable for use as columellar strut, dorsal onlay, L-strut, lateral crural strut, caudal extension, and tip or speader grafts in selected cases. Patients were evaluated by inspection, palpation, and photographic documentation before surgery. Inspection, palpation, and photographic documentation were carried out every 6 months and 12 months after surgery and once a year thereafter. Patient satisfaction in terms of form and function was achieved in 41 patients (95%). Two patients required reoperation for further tip projection (n=1) and alar batten graft displacement (n=1). No complication was observed as a result of graft warping, resorption, or fracture. The OSM provides straight costal cartilage grafts of varying thicknesses without the risk of warping. Because they strictly preserve their straight form, the grafts may safely be modified into rectangular shape or carved asymmetrically and/or have their edges beveled. Current data from this study suggest that the OSM offers a flexible and reliable reconstructive option for the rhinoplasty surgeon. 4.