Cartilage Sparing Research Articles

Complications of Cartilage Sparing Otoplasty: A Systematic Review and Meta-Analysis.

To study the prevalence of complications in patients who have undergone cartilage sparing otoplasty. On December 26, 2021, the authors searched 8 databases using the search term "(otoplasty) AND (cartilage sparing OR cartilage sparing)" for collecting the most appropriate studies. The authors used R software version 4.1.2 for conducting the meta-analysis. Of the 414 records screened, the authors included 14 studies. Recurrence/reoperation was the most common reported complication with a prevalence of 4.27% (95% CI: 2.93-6.22), followed by suture erosion 2.46% (95% CI: 0.86-7.07) and hematoma/hemorrhage 1.34% (95% CI: 0.79-2.27). The authors did not find any significant difference between cartilage sparing and cartilage scoring in terms of recurrence/reoperation [odds ratio (OR): 0.92; 95% CI: 0.53-1.60; P = 0.766], hematoma/hemorrhage (OR: 1.39; 95% CI: 0.28-7.01; P = 0.688), and wound infection (OR: 0.37; 95% CI: 0.06-2.24; P = 0.279). Various complications have been reported, including recurrence and reoperation, hematoma, wound infections, suture erosions, keloid formation, and skin necrosis. However, the prevalence of these events is not high, although significant heterogeneity was reported for some outcomes. Therefore, it can be concluded that cartilage sparing otoplasty is a safe and reproducible technique.

Pediatric Functional Rhinoplasty.

Surgery on the growing pediatric nose poses many questions regarding the indications and proper timing. Historically, surgeries on the pediatric nose led to facial growth alterations so many urged caution and waiting until skeletal maturity at the age of 18. However, animal studies showed some promise that facial growth may not be affected. Investigations into effects of pediatric sinus surgery and septal surgery on facial growth showed no issues. The external nose is somewhat different in that minor variations potentially can grow to a cosmetic deformity. However, numerous studies on facial growth show, to date, that it is not affected, and that surgery is safe. The caveat that one uses is the techniques of cartilage sparing and preservation, which have been studied and shown to be safe. There are ways to measure the effectiveness of surgery in relieving nasal airway obstruction both objectively and, more recently, subjectively. It is essential to treat pediatric nasal airway obstruction to avoid other facial growth problems, such as mouth breathing, snoring, malocclusion, and obstructive sleep apnea.

Benefits of medially based perichondrio-adipo-dermal flap in cartilage sparing prominent ear surgery

BackgroundCartilage-cutting and cartilage-sparing techniques are the two types of otoplasty procedures. Because of the significant risk of haematoma, skin necrosis, and ear deformity, cartilage-cutting techniques have been questioned. As a result; suture-based cartilage-sparing procedures such as Mustarde and Furnas suture procedures have grown in popularity. However, these techniques have a tendency for deformity recurrence due to cartilage memory and suture fatigue, as well as the possibility of suture extrusion and pinpricking sensation of the sutures. MethodsIn this study, we used a medially based adipo-dermal flap including perichondrium which is elevated from the back of the auricle to cover and support a cartilage-sparing otoplasty, thirty-four patients (14 female and 20 male) were operated using this technique. The medially based perichondrio-adipo-dermal flap is advanced anteriorly and fixed to the helical rim under cover of the distal skin flap. This procedure sought to cover the suture line preventing suture extrusion and support in the repair of the deformity preventing its recurrence. ResultsThe average operative time was 80min, ranging from 65 to 110min. The patients passed the early postoperative period uneventfully except for 2 patients; one patient (2.9%) developed haematoma, and the other patient developed a small area of necrosis on the new antihelical fold. In late the postoperative period recurrence of the deformity developed in one patient. No patients developed suture extrusion or granuloma. ConclusionThe treatment to repair prominent ears is easy and safe, with benefits such as a natural-looking antihelical fold and minimal tissue stress. The medially or proximally based adipo-dermal flap may help to lower recurrence rates and suture extrusion.

Benefits of medially based perichondrio-adipo-dermal flap in cartilage sparing prominent ear surgery

BackgroundCartilage-cutting and cartilage-sparing techniques are the two types of otoplasty procedures. Because of the significant risk of haematoma, skin necrosis, and ear deformity, cartilage-cutting techniques have been questioned. As a result; suture-based cartilage-sparing procedures such as Mustarde and Furnas suture procedures have grown in popularity. However, these techniques have a tendency for deformity recurrence due to cartilage memory and suture fatigue, as well as the possibility of suture extrusion and pinpricking sensation of the sutures. MethodsIn this study, we used a medially based adipo-dermal flap including perichondrium which is elevated from the back of the auricle to cover and support a cartilage-sparing otoplasty, thirty-four patients (14 female and 20 male) were operated using this technique. The medially based perichondrio-adipo-dermal flap is advanced anteriorly and fixed to the helical rim under cover of the distal skin flap. This procedure sought to cover the suture line preventing suture extrusion and support in the repair of the deformity preventing its recurrence. ResultsThe average operative time was 80min, ranging from 65 to 110min. The patients passed the early postoperative period uneventfully except for 2 patients; one patient (2.9%) developed haematoma, and the other patient developed a small area of necrosis on the new antihelical fold. In late the postoperative period recurrence of the deformity developed in one patient. No patients developed suture extrusion or granuloma. ConclusionThe treatment to repair prominent ears is easy and safe, with benefits such as a natural-looking antihelical fold and minimal tissue stress. The medially or proximally based adipo-dermal flap may help to lower recurrence rates and suture extrusion.

Cartilage Sparing Septal Perforation Repair using Rotation Flaps and a Collagen Interposition Graft: A Case Series.

Septal Perforations may be asymptomatic or can cause significant problems including nasal obstruction, crusting, bleeding, whistling and in severe cases a change in nasal shape and even pain. The author would like to present a single surgeon case series of septal perforation repairs, managed using an endo-nasal technique, with no external scars. There were 54 consecutive cases between 2011 and 2017. The repair was carried out using mucosal rotation flaps with an interposition graft of porcine collagen matrix. Patients were grouped according to the size of the perforation as measured at the time of the surgery. The patients were then clinically followed up for 1 year, and the recorded outcome measures were: the success of the surgical repair and the patient reported symptoms. Surgical success was 70% up to 1 cm diameter, 77% from 1 to 2 cm and 82% in perforations from 2 to 3 cm in diameter. No perforation over 3 cm in diameter was successfully closed. Patients were rendered asymptomatic even if the perforation was not closed in between 81% and 91% of patients up to perforations 3 cm in size. Over 3 cm in size 50% of patients reported being asymptomatic. This technique is an effective and low morbidity option for patients with small to medium sized septal perforations. For perforations over 3 cm in diameter other options may be more suitable.

Otoplasty Using Dermoperichondrial Flap as an Adjunct to Mustarde Suture Technique

Prominent ears are congenital deformities that are challenging to correct due to the risk of postoperative recurrence. While they have been traditionally reconstructed with cartilage excision or scoring and with cartilaginous sutures, flap techniques have been developed over the last 2 decades to improve the structural integrity of these repairs. The addition of a local flap helps to sustain long standing operative correction while maintaining optimal cosmetic outcomes that have been reported, particularly after cartilage sparing techniques. The authors describe a lateral dermoperichondrial flap on the posterior ear as an adjunct to the use of Mustarde sutures and contextualize its use in the landscape of existing otoplasty techniques.

Modified Cartilage Sparing Tip Plasty Technique for Extra Projection: Hemitransdomal Suture With Submucosal Dissection: A New Approach to Nasal Tip Dynamics.

The nasal tip projection and rotation to be obtained with tip plasty play a key role in achieving successful results. Cartilage sparing techniques provide extra ease to reshape the cartilage in revision rhinoplasty. Freed dome cartilage eliminates the restricting forces of mucosa. The authors recommend to free the dome cartilage from mucosa during the tip plasty which ensures the desired dome shape and extra projection. A total of 218 patients who were operated between the dates of January 2017 and August 2018 were included in this study. About 3 mm parts of the marked domes toward medial and lateral crurae were dissected from the mucosa. New domes were created with bilateral hemitransdomal sutures. The outcome of the operation was asked to the patients verbally and answers were recorded. Of 218 patients who were included in the study, 182 were females and 36 were males. Patients had a mean age of 26.5 years. The length of follow-up was 11.8 months. About 205 patients had primary rhinoplasty while 12 patients had secondary rhinoplasty and 1 patient had revision rhinoplasty. Of the patients, 89.9% (196/218) were very satisfied with the result and 7.4% (16/218) were satisfied, whereas 2.7% (6/218) were dissatisfied. Only 5 patients who were dissatisfied with the result underwent revision rhinoplasty operation. The combination of the modified free dome suture with the mucosal dissection in dome area provides achieving the desired tip projection and symmetry.

Helix free otoplasty for correction of prominent ear

Prominent or bat ear is not uncommon deformity as it affecting 5% of population. Plenty of procedures were reported for its correction. Being plenty means it is still a subject of research. The current procedures could be summarized as cartilage sparing and cartilage splitting ones. During a period of 35 months a total of 31 patients were presented with bilateral prominent ears so the included a total of 62 ears. Their average age was 8 years (ranging from five to 18 years). All deformities were corrected using helix free otoplasty technique which included skin paddle excision, separation of helical cartilage (hence the name helix free), anterior scoring, backward folding, mattress and simple suturing of the folded cartilage, proper definition of antitragus and earlobe and concha-mastoid sutures. Outcomes including patient's and/or guardians' satisfaction were determined. The postoperative period was uneventful except two cases that developed early postoperative hematomas, one case shows late postoperative antihelical fold irregularity in one ear and other case developed ill defined superior helix in one ear. The average follow up period of two years shows no recurrences. Almost all patients (96.85%) and their guardians were satisfied with the aesthetic results while only one (3.2%) was dissatisfied. Helical free otoplasty technique addresses the deformity through a posterior approach with under vision correction. It has very low incidence of complications, high patient's satisfactions, no visible scars and no recurrences. It is a simple, short duration procedure, reliable and good option for correction of prominent ear.

Lateral Crural Tensioning for Refinement of the Nasal Tip and Increasing Alar Stability: A Case Series.

AbstractThe objective of this study was to discuss the technical details and our experiences with lateral crural tensioning (LCT) in both functional and aesthetic rhinoplasties. A retrospective medical review was completed for all patients who underwent rhinoplasty with LCT from the years 2011 to 2014. The indications for LCT included correction of lateral crural convexity, boxy tip geometry, and dynamic collapse of the external nasal valve. The details of the rhinoplasty procedure and complications were evaluated. A total of 114 LCT rhinoplasty cases were included in this series. The most common adjunctive maneuvers included placement of spreader grafts (92% of cases) and alar rim grafts (78% of cases). Conventional classic cephalic trim was not performed in any subjects and conservative paradomal cephalic trim was performed in 48% of cases. As experience with the technique progressed, the use of onlay tip grafts decreased and the use of articulated rim grafts increased. Indications for revision were dissatisfaction with cosmetic outcome (4.4% of cases) and nasal obstruction (0.9% of cases). LCT combines traditional lateral crural steal with the use of a caudal septal extension graft to refine the broad tip and increase stability of the alar lobule. This maneuver is essentially cartilage sparing and does not rely on extensive grafting maneuvers that can reduce airway area.

Pinnaplasty: improved access to the antihelical fold.

Prominent ears affect a significant proportion of the population with some studies quoting rates of 5%. (1) Many techniques have been described over the years including, cartilage sparing, cartilage cutting, cartilage scoring and suturing.(2) Some of the more recent techniques describe the efficacy of incisionless pinnaplasty in selected cases. (2) Each technique has advantages and disadvantages with no overall consensus on the optimal technique. Pinnaplasty has several recognised complications including haematoma, infection, skin or cartilage necrosis, re-protrusion, asymmetry, suture expulsion and keloid scarring. (3) This article is protected by copyright. All rights reserved.

Abstract: 15.30 The Wifi Otoplasty -An Entirely Posterior Approach To Setback Otoplasty

INTRODUCTION: Prominent ears are by far the most common congenital ear deformity. Many techniques have been described using one or a combination of 3 basic methods: cartilage cutting, cartilage weakening and cartilage sparing techniques. The ideal otoplasty technique should yield a natural correction of the deformity, with low recurrence rates and with little risk of complications. MATERIALS AND METHODS: A new cartilage weakening technique using closing wedge concentric microchondrectomies through an entirely posterior approach is presented. Between 2006 and 2015, 196 bilateral otoplasties using this ‘WiFi’ technique were performed. This entirely posterior technique is based on the excision of concentric partial thickness cartilage wedges designed in the pattern of the WiFi symbol. RESULTS: There were no major complications such as anterior skin necrosis and no returns to theatre for infections or haematomas. 3 patients (1,5%) had complete recurrence of the deformity and 10 patients (5,1%) had to undergo a minor revision for recurrence at the upper pole. 5 patients have had exposure of the end of the permanent upper pole schapho-temporal suture more than 3 months after surgery requiring simple outpatient suture trimming/removal without any recurrence of results. Palpable or bridging sutures were present upon clinical examination in 10 patients (5,1%) but did not require revision surgery. CONCLUSIONS: Here, we describe a fast, safe and reliable technique for otoplasty with no need for extensive dissection, which is applicable to various degrees of deformity. In contrast to the Stenstr_m principle, we describe a technique that makes cartilage warp towards the injured side, allowing for an entirely posterior technique. 16.10–16.40 Keynote Lecture 2 THE BIONIC MAN: NOT THAT FAR AWAY Paul CEDERNA Ann Arbor, USA 16.40–18.10 Session 5 – OUTCOME/CLINICAL, PART 1 Moderators Bill KUZON Andrew HART

Intake of Pomegranate Prevents the Onset of Osteoarthritis : Molecular Evidences

Intake of Pomegranate Prevents the Onset of Osteoarthritis : Molecular Evidences

Dynamometric Analysis of Normative Auricular Stiffness and Comparison With Operated Prominent Ears

Stiffness of the auricular cartilage is the main determining factor for the choice of operative technique of the prominent ear deformity. The aim of this study is to evaluate the stiffness of normal appearing ears objectively and quantitatively, compare the results with the operated prominent ear patients, and present prospective short-term dynamometric evaluation of the operated prominent ear patients. A total of 190 volunteers without ear deformities were recruited and 9 age groups were formed: group (5-9), group (10-14), group (15-19), group (20-24), group (25-29), group (30-34), group (35-39), group (40-49), and group (50+). Total 28 ears (14 patients) with otoplasty were included in the study as group (operated 5-9) and group (operated 10-14). In addition, 3 patients with prominent ear deformity were prospectively followed for dynamometric changes that occur with otoplasty operation. The auriculocephalic angle (ACA) was measured once and auricle to scalp distance was measured at 4 different standardized levels. Ear stiffness was measured on each ear individually at 4 different points over the antihelix using digital computer-aided dynamometry. Each ear was compared in terms of ACA, distance, and dynamometric values. Dynamometric values tend to increase with age, which increase and peak around 35 years of age and declines after 40 years of age. Measurements of the first 2 age groups were statistically different compared with the other groups. Postoperative dynamometric measurements (DNM) of group (operated 5-9) were similar with normative values of group (5-9) and postoperative satisfaction visual analogue scale (VAS) score was 92.8%. Postoperative DNM of group (operated 10-14) were higher compared with normative values of group (10-14) for each different measuring level and the postoperative satisfaction VAS score was 75.3. A total of 3 patients with prominent ears had lower dynamometric values preoperatively; these values approached closer to normative values of their age group postoperatively. Results show that auricular cartilage stiffens and malleability decreases with increased age. This stiffness peaks in the 35-39 age group and declines after 40 years of age. Dynamometric values increase, at all levels, suggesting increased cartilage stiffness is related to age. In the scope of these results, cartilage sparing techniques are more suitable for 5 to 14 years of age and cartilage-cutting techniques are more suitable for older patients.

Clinical and biochemical study of the comparative efficacy of topical versus oral glucosamine/chondroitin sulfate on osteoarthritis of the knee

Aim of the workThe aim of this study was to detect and compare the efficacy of topical and oral glucosamine/chondroitin sulfate on knee OA (OAK), and to prove their efficacy on sparing the articular cartilage among the Egyptian patients. Patients and methods180 patients with OAK were included and randomly divided into 2 groups, each of 90 patients. One group took 1500mg oral glucosamine/chondroitin sulfate and the other group used topical glucosamine/chondroitin sulfate for 3months. The diagnosis was based on the American College of Rheumatology (ACR) criteria for OAK. Age, duration of OA, and body mass index (BMI) of the patients were recorded. Knee radiographs were assessed with the Kellgren–Lawrence scale. The severity of knee pain, stiffness, and disability were measured using the visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The serum C-reactive protein (CRP) and Cartilage oligomeric matrix protein changes (COMP) were measured. ResultsNo statistical difference was found between the 2 groups regarding age, sex, duration of OA, and Kellgren–Lawrence grading scale. Both VAS and WOMAC subscores showed significant equal relief of pain and joint function between the 2 groups regardless of the severity or duration of knee OA. Topical glucosamine was superior to the oral route in improving stiffness and function. ConclusionTopical and oral glucosamine/chondroitin sulfate are safe and equally effective on improving knee pain, stiffness and function. Glucosamine/chondroitin sulfate is beneficial as a symptomatic treatment and not as a cartilage sparing drug in the treatment of OAK.

Comparison of Cartilage Scoring and Cartilage Sparing Techniques in Unilateral Otoplasty

We identified the optimal operative technique of unilateral otoplasty among cartilage-scoring or posterior-suturing methods. All unilateral otoplasties repaired in South East Scotland in 10 years were analyzed. Using visual analog scale, outcomes were scored by blinded professional panel and by patients. Case notes were interrogated for postoperative complications. Of 81 patients, 40 with full photographic records were included in the study. Cosmetic outcomes and symmetry scores in patients who underwent posterior suturing with fascial flap were significantly better than cartilage scoring and posterior suturing without fascial flap. Early complications were significantly more common in cartilage-scoring and posterior-suturing techniques without fascial flap than posterior suturing with fascial flap. In conclusion, posterior suturing with fascial flap represents cosmetically superior technique in unilateral otoplasty. It allows for intraoperative adjustment of posterior sutures, resulting in symmetric ears. The technique seems to be associated with fewer short-term complications, often responsible for pediatric patient distress.

Cartilage Splitting Without Stitches

Otoplasty procedures usually involve cartilage sparing, with stitches or cartilage scoring. These techniques have been widely reviewed in the literature. The technique reported in this study requires neither stitches nor rasping but rather a complete separation of the helix and antihelix, with nontransfixing incisions to break the cartilaginous springs. To evaluate the technical details, aesthetic results, and complications in a series of otoplasty procedures involving cartilage splitting without stitches. We conducted a retrospective review of patients who underwent otoplasty procedures between January 2004 and September 2010, by the same senior surgeon. File data on complications, recurrences, and revision rates were collected. An aesthetic evaluation of the postoperative results was conducted by a panel of 3 plastic surgeons and 3 lay observers. Our series included 58 patients, with a mean age of 16 years. No recurrences were reported. Six patients (10%) experienced minor complications. No revisions were needed. No chondritis or skin necrosis was noted. The aesthetic results were very good for 36 patients (62%) by the plastic surgeons and 39 patients (68%) by lay observers. The remaining aesthetic results were judged as good. The Jost otoplasty procedure described herein requires no nonabsorbable sutures to bend the cartilage, avoiding many complications. The technique is safe, reliable, and reproducible, with predictable and permanent outcomes. It is also useful for secondary otoplasty after failed Stenström or Mustarde otoplasty. 4.

Otoplasty with Combined and Cartilage Sparing Techniques

Описаните в литературата техники за хирургично лечение на отоклизиса могат да се разглеждат в две главни категории: съхраняващи хрущяла и отслабващи хрущяла чрез надрязване или изпиляване. Стремежът и при двете групи е корекция на антихеликса и издадената конха. Съчетаването на елементи от двата метода цели да се избегнат недостатъците на всеки един от тях. Настоящата статия представя опита ни от приложението на комбинирана и съхраняваща хрущяла техники за корекция на проминиращи уши при 72 пациенти на възраст от 6 до 45 години. Билатерална отопластика е извършена при 67 от случаите и унилатерална в 5 случая. Техника, съхраняваща хрущяла, е приложена при 48 от пациентите. Комбиниран метод е използван при 24 пациенти. Разпределението на получените резултати е както следва: отлични – 67 (93.05%) от случаите, много добри – 2 (2.78%) и незадоволителен – 3 (4.17%) пациенти. Обсъждат се постигнатите резултати и се дискутират предимствата и недостатъците на различните методи. The techniques described in literature for the surgical treatment of otoclysis can be considered in two main categories: cartilage sparing and cartilage weakening by snipping or rasping. The aim in both groups is the antihelix and the protruding concha correction. The purpose of combining elements of both methods is to avoid the disadvantages of each procedure. This article presents our experience with the application of cartilage sparing and combined technique for correction of protruding ears in 72 patients aged 6 to 45 years. Otoplasty is performed bilaterally in 67 cases and unilaterally in 5 cases. Preserving cartilage technique was applied in 48 patients.Combined method was used in 24 patients. The distribution of the results is as follows: excellent – 67 (93.05%) of the cases, very good – 2 (2.78%) and unsatisfactory – 3 (4.17%) patients. The obtained results and the advantages and disadvantages of different methods are being discussed.

Pediatric otoplasty

Pediatric otoplasty

Open Rhinoplasty

Obtaining predictable cosmetic results in rhinoplasty can be challenging. Three main surgical approaches are used to perform this operation: the closed technique, the open technique and the combination of a closed/open technique. The literature is full of discussion claiming the superiority of one technique over another. Proper treatment planning and being able to execute that plan in a reproducible fashion is critical to success. Utilizing an open technique the surgeon can obtain maximum visualization of the structures requiring modification. Tip modification using cartilage sparing suture techniques or more aggressive cartilage excision and grafting procedures are more easily performed with enhanced visualization. Respect for tissue planes during dissection and proper closure does not prolong recovery. The resultant scars are well tolerated by patients. A practical review of the technical details to achieve success using an open approach will be discussed.

Otoplasty with Mustarde Suture, Cartilage Rasping, and Scratching

Many techniques have been developed for the treatment of protruding ears. However, the best technique is one that is reproducible, simple, and versatile. Modern otoplasty techniques consist of two main surgical categories, cartilage sparing and cartilage cutting, along with many variations. A retrospective review of 58 patients who underwent otoplasty was conducted. Mustarde suturing and cartilage softening were applied for the treatment of protruding ear. The authors use 4-0 braided white polyesther suture. For four patients, a secondary revision was performed for recurrence. The remaining patients were satisfied with their outcome.