Conchal Wall Research Articles

A New and Practical Instrument for Antihelix Scoring: Gillies Skin Hook

Prominent ears are relatively common, with an incidence in whites of about five percent¹. It is inherited as an autosomal dominant trait and is commonly caused by a combination of two defects: (1) underdevelopment of antihelical folding and (2) overdevelopment of the conchal wall. Many techniques have been described to correct the antihelical fold. In 1958 after Gibson and Davis2 showed the ability of injured cartilage to bend away from the side of injury, Stenstrom described scoring of the anterior auricular cartilage to create an antihelical fold, Chongchet’s technique used sharp scoring of the lateral scaphal cartilage to form an antihelix with a scalpel.2-4 Stenstrom, in contrast, used a rasp to blindly score the antihelix.3 Many different instruments have been used for scoring, including scalpels, rasps, abraders, diamond burr drills, Adson-Brown forceps, hypodermic needles and bipolar cautery.5 We present in this paper, a new instrument which can be used for scoring,a fine skin hook.

Use of 3D Printing for Auricular Template Molds in First Stage Microtia

BACKGROUND: Three-dimensional printing provides a quick and inexpensive way to create model replicas. We sought to investigate its use in creating an inverse replicate of the normal ear for a template in first stage microtia surgery. METHODS: Photographs were obtained of the normal ear to create a negative mold of a patient’s microtic ear using rapid prototyping (RP) with polylactic acid (Figure 1). The three-dimensional mirror image of these images was created using computer aided design (CAD) software (123D Catch, Autodesk- San Rafael, CA). The negative image of the lateral contours of the ear including, the conchal floor, conchal wall, antihelix-schapa complex and helix, were created by subtraction of the patient’s anatomy from a virtual disk whose boundaries were at least 5mm from any boundary of the ear (Figure 2).Figure 1: Preoperative lateral photo of 7 year-old girl with microtia of right ear.Figure 2: 3D printed polylactic acid right ear mold based upon photographs of the patient’s normal left ear. All photographs were processed with a free, open-source iPhone application- 123D Catch (Autodesk- San Rafael, CA).RESULTS: The 3D molding process took 90 minutes to complete. The mold was then sterilized to be used intraoperatively as a template to create an autologous costo-chondral implant in its likeness. The total cost of disposables for the printing process was $0.57. CONCLUSIONS: The resulting mold provided a normal, sterilizable impression of the patient’s affected ear that can be used to mold and design the cartilaginous framework from harvested costal cartilage. This process may improve accuracy and decrease operative times by eliminating the need to mold intraoperative templates.

Antihelical shaping of prominent ears using conchal cartilage‐grafting adhesion

No specific otoplasty method has been considered as the absolute standard in patients with prominent ears showing thick and strong auricular cartilage. Retrospective case series study. The authors reviewed the chart and preoperative and postoperative photos of patients (N = 66) who underwent otoplasty consecutively with a new antihelical shaping technique using conchal cartilage-grafting adhesion between 2003 and 2010. Three mattress sutures between the posterior scapha and concha wall were performed to create an antihelical tubing. A piece of conchal cartilage with an intact perichondrium was inserted through the posterior tubing gap and fixed to the posterior scapha and conchal wall, which induced permanent cartilage adhesion. Thirty-nine patients were female and 27 were male. The average age was 23.7 years. Prominent ears were bilateral in 24 patients and unilateral in 42 patients. All patients were observed for a postoperative duration of between 4 months and 24 months. Operative wounds in all patients healed uneventfully. Asymmetric ear projections due to undercorrection were observed in two patients, and mild irregularities or prominences on the postauricular surfaces were observed in three patients. Twenty-two patients (27 corrected ears) were interviewed by telephone to evaluate their long-term satisfaction (an average of 5.2 years after surgery). All except one reported their corrected ears as good. The conchal cartilage-grafting adhesion technique creates a naturally shaped smooth antihelix, allowing the prominent ear to predictably and permanently set back. We believe that the method is indicated in adult patients showing thick and strong auricular cartilage.

A New Corrective Method for the Tanzerʼs Group IIB Constricted Ear: Helical Expansion Using a Free-Floating Costal Cartilage

The group IIB constricted ear, as defined by Tanzer, shows a short helical length and an accompanying deficiency of the upper antihelix or scapha, and a cup or tubular form. The author proposes in this article a new corrective method for the deformity. Ten ears in eight patients were corrected with the author's new method. Three small transverse skin incisions were made along the helix, and a subcutaneous helical tunnel was prepared through the skin incision sites. A piece of split eighth or ninth costal cartilage was inserted into the tunnel. In each case, two to four auxiliary procedures were performed to make an effective helical expansion, as follows: (1) the fasciocutaneous Grotting flap was transposed on an intentionally induced gap at the incision site of the otobasion superius; (2) a marginally based scapha skin flap was elevated and advanced toward the inserted helical cartilage; (3) to prevent an excessive widening of the inserted helical cartilage, an additional costal cartilage bar was inserted through the postantihelical tunnel and connected between points on the ascending and descending helices of the inserted cartilage; (4) to correct ear prominence, a 4-0 nylon mattress suture was placed between the descending helix and the conchal wall. All reconstructed ears showed well-expanded helices. The reconstructed ears in unilateral cases showed the same shape and size as their opposite normal ears on follow-up views. The presented method was relatively simple and safe, and offered consistently effective results.

How to harvest the maximal amount of conchal cartilage grafts

Using the conchal cartilage as a graft has been widely accepted, but the deformities that can result have been underestimated. The deformities range from a visible scar to the total collapse of the ear framework. A simplified technique of harvesting the maximal amount of the conchal cartilage graft is suggested, based on the results of 16 consecutive cases. The technique involved (1) using a postauricular incision to minimise visible scars, (2) harvesting the entire cymba concha and cavum concha separately, with at least 5mm of the helical crus, leaving a lateral extension as a strut between them, as well as a 2mm outer rim along the conchal wall, and (3) by using a tie-over bolster dressing that can serve as a mould for the conchal bowl. This technique has been used on 16 patients with neither contour irregularity nor any deformity, from a case of a step deformity to the total collapse of the ear.

Antihelix Plasty Without Modeling Sutures

Many techniques have been described for the surgical correction of protruding ears. A novel modification of a cartilage-sparing otoplastic technique is provided herein. In this modification, a diamond-coated file is used to abrade the anterior surface of the antihelical cartilage to create biomechanical remodeling with resultant formation of a new antihelix. A case series of 302 ears, operated on over a 3 1/2-year period, is presented in support of this technique. This procedure is appropriate for patients having firm or soft auricular cartilage, an underdeveloped antihelical ridge, and a prominent or moderate hypertrophic conchal wall.

Minimal invasive Otoplastik

We have further developed a method, first published in 1967 by Kaye but not widely used later, to correct protruding ears. To our knowledge, clinical experience with a closed otoplasty technique based on a large number of patients has not yet been published. Of 442 ears in 4.5 years, 385 (200 patients, 15 one sided) were corrected using the minimally invasive technique. The key part of this technique to such otoplasty is the creation of a naturally appearing antihelix by combining permanent buried sutures and a conservative cartilage-breaking technique, both applied without extensive skin incisions and excisions. A total of 154 of the patients (i.e., with six one sided corrections, 302 ears) could be examined at least 3 months after surgery. Complications were revisions for either a partial recurrence or a still insufficient correction in the opinion of the patient (30/302, 9.9%), reactions to the suture material (26/302, 9.3%), early infections (2/385, 0.7%), prolonged sensitivity (2/302, 0.7%) and one hypertrophic scar in the lobule (1/302, 0.3%). There was no bleeding, hematoma, hypesthesia, sensitivity to temperature or skin reactions in the auricle. Minimally invasive otoplasty is a surgical technique that allows the correction of most protruding ears. Very strong cartilage or a very high lateral conchal wall set the limits to such an approach. We found the cosmetic results and complication rates to match those of open methods. Since patient comfort seems to be higher, the method is better accepted.

Surgical correction of prominent ear using modified tube technique and posterior approach.

In patients with a prominent ear, the most common deformities are a poorly developed antihelical fold and the formation of excessive conchal cartilage, particularly in the posterior conchal wall. As such, the main goal for surgical correction of a prominent ear is to narrow the conchoscaphal angle by folding the antihelix and reducing the concha. In the current study, cartilage-sparing tubing otoplasty is refined by the addition of a minimal dissection of the edge of the conchal and scaphal cartilages, and horizontal mattress sutures between the two edges. Nine patients with 13 cases were operated on between 1999 and 2001. Of the nine patients, four had bilateral procedures, and five had unilateral surgery. The age distribution was 11 to 22 years. The follow-up periods ranged from 6 months to 2 years. No hematomas or skin necrosis occurred. A mild recurrence of the upper antihelical fold was experienced in one case, and the patient required further surgery. Suture extrusions developed in two cases. In conclusion, the proposed technique is a simple and safe procedure with reliable results and no anterior scarring.

Chongchet's otoplasty: not only a method of anthelix reconstruction

The cause of prominent ear deformity may be anthelix deficiency or a high conchal wall [2]. Chongchet's otoplasty [3] is an old method described for correction of anthelix deficiency via anterior scoring. The aim of this study is to show the use of Chongchet's otoplasty in conchal wall reduction and the use of auricular cartilage tension lines in surgical correction of prominent ear deformity. In 24 prominent ear cases with different causes anterior scoring was performed along the auricular cartilage tension lines. Conchal reduction as well as antihelical reconstruction was easily achieved by folding the cartilage; excess conchal wall cartilage was excised laterally. Long-term results show pleasing contours without any recurrence. In conclusion, Chongchet's otoplasty which permits conchal wall reduction and anterior scoring according to auricular cartilage tension lines facilitates conchal and antihelical folding.

Correction of the prominent ear with cartilage abrasion and concha-mastoid sutures

Robert M. Oneal, MD, Ann Arbor, MI, is a board-certified plastic surgeon and an ASAPS member. The pathologic genesis of the protruding ear is a combination of the antihelix's failure to fold and some form of conchal protrusion, in which either the whole ear is tilted laterally or conchal hypertrophy exists. The corrective procedure should address both of these factors. I use a combination of techniques, including lateral cartilage surface abrasion, as originally described by Sten Stenstrom, MD, and posterior sutures, as described by John Mustarde, MD, to create the antihelix. Rather than resect the posterior conchal wall, I prefer to remove the soft tissue from the posterior area of the concha down to the mastoid fascia and then remove a …

Otoplasty techniques.

Otoplasty has undergone a number of important developments over the course of the past 150 years. While cartilage-incision techniques were favored earlier in the century, suture-only techniques are now favored. Prominauris, a condition that affects 5% of the Caucasian population, is inherited as an autosomal dominant trait. Protruding ears commonly are due to a combination of two defects: under-development of antihelical folding, and overdevelopment of the conchal wall. Utilizing a graduated approach, consistently superior results can be obtained. Our approach includes: fusiform skin excision; concha-mastoid sutures; scapha-conchal sutures; and refinement of the scapha, helix, and lobe. The aesthetic results are well retained and significant complications are rare.

Mastoid Skin Island Flap: A Simple Technique for Conchal Defect Reconstruction

O Antonyshyn. Mastoid skin island flap: A simple technique for conchal defect reconstruction. Can J Plast Surg 1993; 1(3): 137-140. Conchal defects resulting from tumour excision can pose a difficult reconstructive problem. These defects generally involve the entire concha and occasionally extend to the external auditory canal. Under these circumstances, skin graft reconstruction is unsuitable. A simple technique of conchal reconstruction using a mastoid skin island flap is described. The flap provides a reliable one-stage reconstruction of the concha and posterior conchal wall.

A Single-Stage Two-Flap Method of Total Ear Reconstruction

A single-stage two-flap method of total ear reconstruction in congenital microtia is reported. This method was derived from the one-stage reconstruction described by Song and Song. Two flaps defined by vascular basis were elevated on the mastoid area: the superficial skin flap supplied mainly by subcutaneous pedicled arteriole perforators from the posterior auricular artery and the deeper axial-pattern fascial flap including the posterior auricular artery itself. The ear framework, exaggeratedly carved using autologous rib cartilage, could be inserted easily between the two flaps, simultaneously producing the auriculocephalic angle and the conchal wall. Intraoperative expansion of the skin flap and postoperative external ear molding also were performed to create aesthetically pleasing ears.

Otoplasty for lop ears.

The classification of malformations of the auricle is reviewed. Hinderer's technique is described. It is based on long oblique skin and cartilage flaps of the upper pole of the ear, taken in opposite directions for expansion of the helical arch, thus preventing a later visible notching at the helical rim. The remaining scapha is straightened and the superior crus and antihelical fold are formed by scratching and sandpaper abrasion of the lateral surface. A deep concha is treated by a cartilage strip expansion from the posterior conchal wall.

Double antihelix: Its significance in the correction of prominent ears

In performing otoplasty for correction of prominent ears, the aesthetic plastic surgeon may be faced with the existence of two antihelical folds especially if the conchal wall is too high. Thinning of the cartilage opposite and in between these two folds transforms them into a gently curved single fold that leads to a good aesthetic result.

Otoplasty goals and principles.

In the surgical correction of protruding ears one should strive for normal-appearing and esthetically pleasing auricular contour and also to simplify surgical techniques so the residents and less experienced surgeons can also consistently achieve such end results. I describe an eclectic suture-only technique which achieves both goals. (A wrongly placed suture can be removed and replaced until it is in the right position without jeopardizing the final result. Conchal protrusion is corrected by suturing the lateral conchal wall to the mastoid periosteum via a low postauricular incision. If there is additional antihelix deformity, the skin is elevated on both sides of the antihelix; the lateral surface is gridded to weaken the cartilage spring. The antihelix is then correctly contoured with buried nonabsorbable mattress sutures tied posteriorly. The placement of these sutures is aided by external black silk guide sutures which are placed under direct vision while the ear is held in the corrected position.