Ear Projection Research Articles

302 A Classification System and Surgical Algorithm for Pediatric Postburn Ear Deformities

Abstract Introduction The outward projection of the external ear makes this anatomically complex appendage susceptible to trauma. Notably, up to 40-60% of facial burns involve the ear, frequently impacting function and aesthetics. Significant postburn sensory deficits and changes to the ear’s intricate architecture can markedly impair physical health, psychosocial functioning, and quality of life. Scar tissue and contracture, traumatized cartilage, and compromised blood supply and surrounding soft tissues all influence the reconstructive plan. The authors describe a new classification system and surgical algorithm for pediatric postburn ear deformities informed by both their extensive operative experience on the traumatized ear and a retrospective study of different reconstructive techniques for more severe burn injuries to the pediatric ear. Methods To develop the classification system and surgical algorithm, three senior surgeons with over 85 years of combined experience reconstructing ears carried out an iterative joint review of their relevant clinical cases and insights, including their personal approach to assessing postburn ear trauma and developing an operative plan. Particular attention was focused on how the type and extent of soft tissue injury affects available reconstructive options. To inform classification of the most complex ear burn cases, a retrospective review was conducted on patients aged 0 to 21 years who underwent cartilage framework reconstruction between January 2004 to January 2021 at a specialized pediatric burn center. Medical records were screened and 54 patients (61 ears) who met study criteria were identified and patient demographics, procedural characteristics, and outcomes were analyzed. Results For postburn ear deformities (Table 1) involving total or near-total preservation of the ear’s anatomical structural elements (Type I and Type II deformities, respectively), scar release, local tissue rearrangement, and/or skin grafting are typically sufficient for optimal reconstruction. For cartilage defects involving less than or more than two-thirds of the helix (Type III and Type IV deformities, respectively), a partial to complete ear scaffold can be successfully reconstructed using a composite graft, conchal transposition flap, costal cartilage graft, or porous polyethylene implant. Conclusions The proposed classification system and surgical algorithm (not shown) for postburn ear deformities facilitate a tailored approach that addresses reconstructive course duration, anticipated aesthetic results, complication potential, and patient goals and expectations. Applicability of Research to Practice The authors provide a new classification system to pediatric postburn ear deformities that, along with a proposed surgical algorithm, can help guide planning for reconstruction.

Ear Stent Fabrication for Pediatric Patient with an Innovative Method for Retention

External ear anomalies can be caused by genetic or acquired disorders such as trauma or cancer. This flaw has a direct influence on the emotional, social, and psychological well-being of the afflicted. The flaws can be repaired in a number of methods, including prosthetic rehabilitation and surgical reconstruction. The two most challenging components of the treatment are preserving the ear projection during the first phases of auricle repair utilizing grafts and flaps, as well as avoiding the postauricular sulcus from re-epithelizing and obliterating the vestibule. Prosthodontists can address this issue by designing stents that retain the projection of a rebuilt auricle. This case study describes the production procedure as well as the method of retention for an ear stent.

Surgery of Severe Cauliflower Ear Deformity

A cauliflower ear is an auricular deformity characterized by thickened soft tissue and cartilage. A subperichondrial hematoma or fluid collection causes this malformation. As a result of being cut off from the perichondrium blood supply, the ear cartilage becomes ischemic, developing scar tissue, fibrous tissue, new cartilage overgrowth, or necrosis beneath the skin, resulting in a permanent alteration in the shape of the external ear resembling that of a cauliflower. To properly fix defects, the surgeon must grasp ear anatomy and be familiar with a variety of reconstructive alternatives. It requires meticulous attention, due to the intricate design of the ear. Simple and complex techniques for treating cauliflower ears have been developed. However, in severe cases, simple techniques are often insufficient. As a result, complex techniques such as replacement with an auricular prosthesis or implant or autogenous costal cartilage framework were developed. We present a case of a 25-year-old man who experienced a severe cauliflower ear as a result of an infection during adolescence. The patient was concerned about the shape of his ear and was depressed. Ear reconstruction was accomplished using the costal cartilage framework engraved according to a three-dimensional cutting guide for surgical planning. Costal cartilage is chosen to provide a framework for reconstruction as it is strong and rigid, and its curved shape is similar to that of the external ear. There were no complications after surgery. The ear projection and shape have performed admirably. The patient was pleased with the outcome and felt more confident after surgery.

Hyaluronic acid injection in the auricular base for the aesthetic correction of lying ears: A retrospective study

BackgroundEars play an important role in facial profiles. Lying ears are not perceived favorably in Asian cultures; therefore, surgical procedures are implemented to adjust this defect. However, surgery has complications and requires recovery time. We introduced a hyaluronic acid (HA) injection technique to aesthetically improve ear prominence. MethodsThis retrospective study examined 25 Chinese patients aged 20–47 years with congenital lying ears who received HA injections in the auricular base at Shanghai Ninth People’s Hospital and Hangzhou Yijie Medical Cosmetology Clinic between November 2019 and December 2022. The average injection volume was 6.32 ​± ​1.22 mL in the auricular base unilaterally, and the follow-up time ranged from 6 to 24 months. Morphological measurement data were recorded. Two-dimensional (2D) and three-dimensional (3D) images were obtained to evaluate the effects. ResultsAll patients showed improvements in ear prominence. The cranioauricular angle (CAA) increased from 22.24° ​± ​4.53° to 65.90° ​± ​5.38° immediately post-injection and was maintained at 49.18° ​± ​4.74° 6 months later. The ear projection (EP) increased from 14.75 ​± ​2.72 mm to 26.26 ​± ​2.94 mm immediately post-injection and was 22.51 ​± ​2.68 mm after 6 months. No serious complications were noted. ConclusionHA injection in the auricular base effectively corrected the lying ears and aesthetically optimized the facial profile. It also had a face-lift effect that made the face look younger and more compact. The injection procedure was minimally invasive and required no recovery period. The effect was maintained for a long time and was satisfactory.

A Study of Prominent Ears Among Undergraduates in Delta State University at Abraka in Nigeria

The goal of this inquiry is to establish the pervasiveness of prominent ears among undergraduates of Delta State University, Abraka in Nigeria.The outcome can act as a guide during correctional surgical measures in congenital or acquired ear defects. This enquiry adopted an observational cross-sectional study plan. The study sample comprised of both male and female undergraduates of Delta State University, Abraka aged between 16-30 years. Exactly 384 individuals (184 males and 200 females) were sampled and the cluster sampling procedure was practiced. Data was collected with the aid of a sliding vernier caliper, pencil, and a data collection sheet. Every subject’s head was kept in Frankfort’s horizontal plane and dimensions were taken with a sliding caliper. Ear projection greater than 21mm was defined as ear prominence. Totality of 36 (9.38%) had small right ear while 28 (7.29%) had small left ear. Prominent ear was more prevalent on the right region (n=44, 11.45%) than on the left (n=19, 4.95%). Entirety of 63 (16.4%) had prominent ears with more males affected compared to the females. The gender disparity in the occurrence of prominent ears is not remarkable (p>0.05). The relationship between age and the occurrence of prominent ears was remarkable (p=.000). Indubitably prominent ear is not widespread among the considered undergraduates.

A Study of Prominent ears among Undergraduates in Delta State University at Abraka in Nigeria.

The goal of this inquiry is to establish the pervasiveness of prominent ears among undergraduates of Delta State University, Abraka in Nigeria.The outcome can act as a guide during correctional surgical measures in congenital or acquired ear defects. This enquiry adopted an observational cross-sectional study plan. The study sample comprised of both male and female undergraduates of Delta State University, Abraka aged between 16-30 years. Exactly 384 individuals (184 males and 200 females) were sampled and the cluster sampling procedure was practiced. Data was collected with the aid of a sliding vernier caliper, pencil, and a data collection sheet. Every subject’s head was kept in Frankfort’s horizontal plane and dimensions were taken with a sliding caliper. Ear projection greater than 21mm was defined as ear prominence. Totality of 36 (9.38%) had small right ear while 28 (7.29%) had small left ear. Prominent ear was more prevalent on the right region (n=44, 11.45%) than on the left (n=19, 4.95%). Entirety of 63 (16.4%) had prominent ears with more males affected compared to the females. The gender disparity in the occurrence of prominent ears is not remarkable (p>0.05). The relationship between age and the occurrence of prominent ears was remarkable (p=.000). Indubitably prominent ear is not widespread among the considered undergraduates.

Anthropometric Study of Human Ear: A Baseline Data for Ear Reconstruction.

Creation of an auricular framework plays the main role on first stage of microtia reconstruction. The size of framework is determined based on the size of the contralateral healthy ear and customized with Nagata theory. The height of rib that added behind the previous framework is the same with the projection of the normal ear. But the height of rib needed and framework in bilateral cases is unknown. A population based auricular framework pattern and projection are urgently needed. This study aimed at determining the mean values of normal anthropometric measurement of external ear and projection of human ear in males and females and their comparison on either sides and in either sex. Measurements are taken from 524 subjects (96 men and 428 women) aged 17 to 35 years using a Vernier caliper. The parameters measured were total ear height, ear width, lobular height, lobular width, upper pole, middle upper pole, middle pole, lower middle pole, lower pole, each subject's right and left ears. Comparisons between gender were performed by independent t test and paired t test for comparison between right and the left ear. All dimensions were significantly different between male and female ( P < 0.05) except the right lobular height ( P > 0.05). There was no significant difference both side among groups (P < 0.05) except total ear height on female group (P > 0.05). All projection dimensions were significantly different between male and female. There was no significant difference of auricular projection of right and left auricular on the male (P < 0.05) groups except the projection of lower pole. There were significant between auricular projection of right and left ears on the female groups (P > 0.05). These findings suggest that the normal anthropometric study will have implication in the ear reconstruction especially on bilateral cases as a baseline for reconstruction.

A Rare Case of Infantile Hemangioma Requiring Ear Reconstruction

A Rare Case of Infantile Hemangioma Requiring Ear Reconstruction

A modified crescent cartilage block for improving the retroauricular contour of the reconstructed ear: A retrospective cohort study

The use of a semilunar cartilage block to elevate a reconstructed ear does not always achieve a well-defined auriculocephalic sulcus. Herein, we modified the conventional crescent cartilage block through sculpting a concavity at its posterior surface, with the aim of improving the retroauricular contour. The study aimed to verify the effectiveness and reliability of this modified cartilage block through a retrospective cohort study. A retrospective review of patients who underwent Nagata microtia reconstruction between October 2017 and November 2018 were conducted. The esthetic outcomes of auricular projection and cranioauricular sulcus in patients who accepted the modified semilunar block were compared with those of patients who underwent the same procedure using the traditional crescent pad. A total of 163 (84 of the modified group and 79 of the traditional group) patients were included. The mean (median) esthetic scores for ear projection in the modification and traditional groups were 3.13 (3) and 3.06 (3), respectively. The rate of favorable ear projection in the modification group (83.3%) was similar with that in the traditional group (78.5%) (p = 0.550). The mean (median) esthetic scores for cranioauricular sulcus in the modification and traditional groups were 2.51 (3) and 2.90 (3), respectively. The rate of favorable retroauricular sulcus in the modification group was 75.9%, whereas that in the traditional group was 51.2%, with the differences reaching statistical significance (p = 0.001). The concave crescent-shaped block can improve the contour of the auriculocephalic sulcus under the premise of ensuring the ear projection.

Evaluation of effectiveness of three-dimensional printed ear splint therapy following ear elevation surgery in microtia patients: A randomized controlled trial

AimThis study aimed to compare the effectiveness of a 3D-printed ear splint with that of a conventional thermoplastic ear splint after microtia reconstruction. MethodsPatients who underwent ear elevation surgery with postauricular fascia coverage between October 2017 and October 2018 were included. They were randomly divided into the experimental group (3D-printed ear splint) and the control group (thermoplastic ear splint) and underwent routine postoperative rehabilitation and antiscar therapy. Splint therapy was initiated 4 weeks postoperatively and continued until 24 weeks postoperatively. The evaluated indices were the Vancouver scar scale score (VSS score), cranioauricular distance, patient compliance, complications (dermatitis, skin ulcers, skin necrosis), and patient satisfaction. A two-group t-test was carried out to compare all variables except patient satisfaction, which was compared using the Mann–Whitney U-test; p < 0.05 was considered significant. ResultsTwenty patients were included in each group. At 4 weeks postoperatively, the VSS score (p = 0.748) and cranioauricular distance (p = 0.647) showed no significant differences between the groups. At 24 weeks postoperatively, the mean VSS scores were 4.85 ± 1.46 and 6.25 ± 1.74 (p = 0.009), the mean cranioauricular distances were 15.80 ± 1.82 mm and 13.95 ± 1.93 mm (p = 0.004), and the patient satisfaction scores were 4.5 ± 0.51 and 3.7 ± 0.47 (p < 0.001) in the experimental group and the control group, respectively, all showing significant differences. Two patients in each group exhibited skin irritation or skin ulcers, which resolved after 6 months of follow-up. ConclusionThe application of 3D-printed ear splints provides better inhibition of scar contracture, better maintenance of ear projection and higher patient satisfaction than conventional ear splints following ear elevation surgery in microtia patients. Therefore, 3D-printed ear splints should be preferred over conventional ear splints whenever possible.

Role of posterior auricular muscle to prevent protruding ear after retroauricular ear surgery

ObjectiveThe posterior auricular muscle (PAM) functions in ear projection in normal position and is severed during the retroauricular approach, and some patients complain of a protruding ear postoperatively. This study was designed to determine whether suturing of the severed PAM reduces pinna projection after the retroauricular approach. MethodsIn a prospective controlled study, we enrolled 91 patients with chronic otitis media, all of who underwent canal wall up mastoidectomy with tympanoplasty via retroauricular approach. They were randomly assigned to the PAM-sutured (n=45) or PAM-non-sutured (n=46) group. Helical-mastoid distance and concho-mastoid angle were measured serially. ResultsIn both groups, helical-mastoid distance was significantly longer than preoperatively until 1 month postoperatively but was similar to preoperatively by 6 months. Concho-mastoid angle increased significantly until 1 month after surgery in the PAM-non-sutured group but returned to the preoperative value at 6 months postoperatively. In the PAM-sutured group, concho-mastoid angle increased significantly at 3 days postoperatively, was similar to preoperatively at 1 month after surgery, and became narrower than preoperatively at 6 months postoperatively. In both groups, there were significant effects of time on the changes in helical-mastoid distance or concho-mastoid angle. Group assignment did not significantly affect these time-related changes. ConclusionPAM suturing did not affect helical-mastoid distance by 6 months postoperatively, but it did reduce the concho-mastoid angle to below the preoperative value at 6 months. We recommend that PAM be left severed to maintain concho-mastoid angle in the long term when using the retroauricular approach.

(Y)ears of Freedom? Customized Splints in Microtia Reconstruction to Maintain Cephloauricular Angle.

Background Maintaining ear projection and preservation of cephaloauricular sulcus from obliteration following graft contracture is a challenge following staged microtia reconstruction. Authors have designed simple, effective, and easy-to-use splints to ensure improved aesthetic outcomes and patient compliance. Materials and Methods This is a prospective study over 3 years including 8 patients of both sexes aged 6 to 12 years. Custom-made ear splints were designed separately for females and males and used to maintain ear projection. Projection of the ear was measured postoperatively and at follow-up using goniometer and photographic records. Outcome was assessed in terms of cephaloauricular angle, conchal depth, pain, cost-effectiveness, splint retention period, and aesthetics. Results and Conclusion Maximal follow-up was 2 years. The splint effectively maintained ear projection of more than 30 degrees. Patient compliance was optimal, and no major complications were associated with its prolonged use.

Ethnic differences in the morphology of the pinna

Metric features of the ear are important for diagnosis of congenital malformations, pre-operative planning and design of hearing devices. Non-metric features including earlobe attachment is a marker of population genetics. Although these features vary with sex and populations, it’s unclear whether they show ethnic variations. This study describes ethnic differences in the morphology of the pinna. Both ears of one hundred and forty-eight (148) medical students (80males and 68 females) [recruited from four ethnic groups: Kenyan Indian, Kenyan Arab, Kikuyu and Luhya] were studied. Ear projection, heights and widths of ear, earlobe and concha were measured. For the Kenyan Indians, Arabs, Kikuyus and Luhyas respectively, proportion of free earlobes was 70.1%, 48.6%, 37.8%, 43.2%, attached lobes was 21.6% 27.1%, 42.9%, 32.4%. Mean earlobe height was 18.2mm, 16.7mm, 15.8mm, 15.8mm (p=0.001), ear projection at mid-tragus was 14.5mm, 13.5mm, 12.5mm, 12.6mm (p=0.035). Ethnic differences are present in earlobe height, attachment type and ear projection at mid-tragus. Earlobe height among indigenous Kenyans is significantly smaller compared to Kenyan Indians and Arabs. The attached earlobe is most prevalent among Kenyan indigenous while the free earlobe is most prevalent among Kenyan Indians. These features ought to be considered in aesthetic reconstruction of ear during earlobe rejuvenation and correction of projected ears.Keywords: Pinna morphology, Ethnic difference, Variations

A Simple Modified Flip-Flop Flap for the Reconstruction of Antihelix and Triangular Fossa Defects.

A Simple Modified Flip-Flop Flap for the Reconstruction of Antihelix and Triangular Fossa Defects.

Prominent ears: Anthropometric study of the external ear of primary school children of Harare, Zimbabwe.

BackgroundProminent ear is the most common congenital ear deformity affecting 5% of children in the Western world and has profound psychosocial effects on the bearer. It is important to know the prevalence in the local population to have a better appreciation of the local burden of the abnormality as well as to know the parameters of ear morphology locally. These parameters can be useful in the diagnosis and evaluation of ear anomalies and may help reconstructive surgeons in reproducing an anatomically correct ear of an African/Zimbabwean child.ObjectivesTo evaluate the frequency of prominent ears in black school going children in Zimbabwe and to establish morphometric properties of the ear.DesignProspective observational, cross sectional study.SettingThree Primary schools in Harare. Two in a high density area and one in a low density area.Materials and methodsThree Primary schools in Harare were selected at random. The following measurements were taken: ear lengths, ear projection and face height using a sliding caliper. Three hundred and five healthy pupils of the age range 9–13 years of both sexes were included in the study, whilst children with congenital anomalies, ear tumours and history of ear trauma were excluded.ResultsThe mean ear height across the cohort was 56.95 ± 5.00 (right ear) and 56.86 ± 4.92 (left ear). Ear projection was 19.52 ± 2.14 (right ear) and 19.59 ± 2.09 (left ear). Gender related differences were noted. Mean ear height was significantly higher in males (p-value = 0.000). Ear projection was higher in males compared to females. A total of 6.89% had prominent ears. Among males, 7.69% had prominent ears whilst 6.17% of females had prominent ears.ConclusionThe prevalence of prominent ear among black African children in the studied population is comparable to that of Caucasians. The study provides a set of biometric data of auricular dimensions for normal black African children aged 9–13 years.

Sensory afferent segregation in three-eared frogs resemble the dominance columns observed in three-eyed frogs.

The formation of proper sensory afferent connections during development is essential for brain function. Activity-based competition is believed to drive ocular dominance columns (ODC) in mammals and in experimentally-generated three-eyed frogs. ODC formation is thus a compromise of activity differences between two eyes and similar molecular cues. To gauge the generality of graphical map formation in the brain, we investigated the inner ear projection, known for its well-defined and early segregation of afferents from vestibular and auditory endorgans. In analogy to three eyed-frogs, we generated three-eared frogs to assess to what extent vestibular afferents from two adjacent ears could segregate. Donor ears were transplanted either in the native orientation or rotated by 90 degrees. These manipulations should result in either similar or different induced activity between both ears, respectively. Three-eared frogs with normal orientation showed normal swimming whereas those with a rotated third ear showed aberrant behaviors. Projection studies revealed that only afferents from the rotated ears segregated from those from the native ear within the vestibular nucleus, resembling the ocular dominance columns formed in three-eyed frogs. Vestibular segregation suggests that mechanisms comparable to those operating in the ODC formation of the visual system may act on vestibular projection refinements.

A simple ear splint for microtia patients.

Microtia is a congenital anomaly of the ear can occur as an isolated birth defect or as part of a spectrum of anomalies or as a syndrome. Microtia is often associated with impaired hearing and or total loss of hearing. Such patients typically require treatment for surgical ear reconstruction and for hearing impairment. Maintenance of ear projection and post auricular sulcus in staged ear reconstruction in microtia is a trying problem. So also is the maintenance of the patency of the external auditory meatus following recanalization and meatoplasty.This case report describes a simple effective way of fabrication of ear splint prosthesis.

Maintaining Ear Aesthetics in Helical Rim Reconstruction

Wedge resections of the helical rim may result in a significant deformity of the ear with the ear not only smaller but cupped and prominent too. Our technique involves resection of the wedge in the scaphal area without extending into the concha followed by advancement of the helical rim into the defect. This technique is most suitable for peripheral defects of the helical rim, in the middle third. Our modified surgical technique was applied to reconstruction of the pinna after resection of the tumor in 12 patients. Free cartilaginous helical rim, length of helical rim to be resected, and projection of the ear from the mastoid was measured. This was then compared with measurements after the operation, and the patient satisfaction assessed with a visual analog scale. The free cartilaginous rim was 91.67 ± 5.61 mm. Of this, 21.92 ± 3.78 mm was resected, which amounted to 23.84% ± 3.35% of the rim. Although this resulted in a mean increase in ear projection of 6.42 ± 1.68 mm, the aesthetic outcome was good (visual analog scale, 9.08 ± 0.9). This technique reduces cupping and does not make the ear as prominent as it may do after a conventional wedge resection and results in high patient satisfaction.

Dental impression compound as an effective splint for maintenance of ear elevation in microtia reconstruction

Ear projection is an important goal to be achieved after stage two (ear elevation) in cases of microtia. This is a retrospective study conducted on patients with microtia who underwent staged reconstruction for the same. This study has been carried out over a period of 10 years with 211 patients. Dental impression compound was used as a splint after ear elevation and split skin grafting to maintain the projection of the ear. Projection of the ear was measured both pre- and post-procedure and at every follow-up using goniometer and photographic documentation was simultaneously done. Statistical analysis was performed using t-test. Patients were reviewed every month and splint was continued until 6 months post-surgery. The splint was very effective in maintaining the ear projection of more than 20° even after prolonged follow-up of upto 2 years. There were no complications associated with the splint application or prolonged use.

Implementation of Competencies for Anatomy in the First Year of Medical Training

To assess the outcome of students that underwent the exercises to implement certain competencies at the beginning level.It is quite a challenge to develop teaching and evaluation strategies for the implementation of competencies in a traditional medical school that accepts 1200 students yearly, used to the traditional systems, and grouped in classes of 40 students each with teacher having limited experience in competence based learning.We established three experimental and three control groups. We used three different exercises for a particular theme and tested before and after; compared the results of the experimental and control groups with T Student and Chi Square. The first strategy was to use a case history of cranial fracture, skulls to study in small groups, group discussion and evaluate written communication in a composition. The second strategy was to use body painting to identify the cervical triangles and their content. The third strategy was a case history of deafness and the study of an on line presentation of the ear, group discussion and the projection of ear implant techniques. The fourth strategy was a case history of rheumatic fever, the study of heart anatomy, group discussion.Results showed a marked improvement in grades achieved on all quizzes and examinations of the experimental groups.