Preauricular Scar Research Articles

One-stage operation surgical efficacy observation of congenital preauricular fistula infection and static period of inflammation in children

Objective:To compare the clinical effect of surgical treatment of congenital preauricular fistulas in children during the local infection period and static inflammatory period. Methods:Forty children with congenital preauricular fistula infection treated in our hospital from January 2020 to December 2022 were selected as the experimental group, and 39 children with congenital preauricular fistula inflammation at static period were selected as the control group. The fistula of the two groups of children aged between 1-14 years old was located in front of the foot of the ear wheel or the foot of the ear wheel, and all were unilateral fistulas. The postoperative follow-up was 6 months to 2 years, and the efficacy of the two groups was compared. Results:There was no significant difference in the healing rate of stage Ⅰ and stage Ⅱ between the two groups（P>0.05）. There was no significant difference in fistula recurrence rate and satisfaction with the preauricular scar between the two groups after treatment（P>0.05）. There was no significant difference in postoperative hospital stay between the experimental group and the control group（P>0.05）. Conclusion:The effect of surgical treatment of congenital preauricular fistula in the infected period is similar to that of surgical treatment in the static period of inflammation, and it can reduce the pain of dressing change under local anesthesia in children, avoid the second operation in children, and reduce the economic cost. This treatment method is worthy of clinical promotion. Appropriate incision and resection method were designed according to the fistula and infection sites.

Extended Superolateral Cheek Lift With a Short Preauricular Scar: A Local Anesthesia-based Practicable Technique for the Correction of Moderate-degree Facial Aging Signs.

An ideal technique applicable to middle-aged individuals with a moderate degree of facial aging signs has not yet been established. This study aimed to evaluate the utility of an extended superolateral cheek lift with a short preauricular scar technique for the correction of facial aging signs. A total of 200 female patients (mean age: 43y, range 27-56y) who underwent a local anesthesia-based extended superolateral cheek lift for the correction of facial aging signs confined to the malar and nasolabial area, lower eyelid, jawline, and neck were included. Data on the Global Aesthetic Improvement Scale, patient-reported outcomes, and complications were recorded at 1, 6, 12, and 24 months postoperatively. The Global Aesthetic Improvement Scale scores revealed exceptional improvement in 90% of patients along with no complications at month 24. None of the patients developed a depressed scar, skin necrosis, breaking of the superficial musculoaponeurotic system plication sutures, asymmetry, or facial nerve problems. At postoperative month 24, the appearance was reported to be very much improved by 90% of patients, and 94% of patients reported that they were very satisfied with the treatment and that they would recommend this treatment to friends and acquaintances. Our findings revealed the potential utility of an extended superolateral cheek lift with a short preauricular scar as a local anesthesia-based practicable technique for the correction of facial aging signs in middle-aged patients, offering a favorable postoperative outcome, lack of complications and high patient satisfaction in addition to invisible scars and a short-term postoperative recovery.

A Novel Technique for Resection and Reconstruction of the Temporomandibular Joint by Sliding Vertical Ramus Osteotomy using Only Submandibular Approach.

In this paper, an innovative technique for resection and reconstruction of the temporomandibular joint by sliding vertical ramus osteotomy using only a submandibular approach is presented. Before pulling the posterior mandibular border slightly downward to expose parts of the condyle, the vertical ramus osteotomy was performed. With the help of 3D simulation and surgical templates, the condylectomy was carried out using the ultrasonic osteotome through the submandibular approach. Our technique achieved the desired results while preventing complications of facial nerve paralysis, the occurrence of Frey syndrome, and the preauricular scar. Therefore, we suggest that this surgical method represents an alternative treatment option for temporomandibular joint lesions.

Minimally invasive retroauricular approach parotidectomy: A pictorial essay.

The surgical approach to a parotid neoplasm has traditionally been taught through a modified-Blair incision. This approach results in a visible scar in the preauricular, retromandibular, and upper neck skin. Various modifications have been undertaken which aim to improve cosmesis either by decreasing overall incision length and/or relocation of the incision to the hairline via what is commonly described as a "facelift approach". We describe a novel minimally invasive parotidectomy approach which utilizes a single retroauricular incision. This approach eliminates both the preauricular scar as well as the extended incision in the hairline and additional skin flap elevation which accompanies it. Sixteen patients underwent parotidectomy using this minimally invasive incision and the excellent clinical outcomes are reviewed. The minimally invasive retroauricular approach to parotidectomy provides excellent exposure with no visible incision/scar in appropriately selected patients.

Preauricular Incision Approach as a Management of Zygomaticomaxillary Complex Fracture Reduction: A Case Report

Introduction: A zygomatico maxillary complex fracture is a facial bone fracture that commonly occurs as a centrally and laterally protruding zygomatic area. The effective surgical approach and exact reduction of the displaced fracture is the most important task in the treatment of a zygomatic fracture, from the aesthetic point of view. Determination of surgical approach and the fixation point of zygomatic arch fracture is one of the most challenging procedure. The purpose of this case report is to find out that the preauricular incison approach is one of the effective methods for reduction of zygomaticomaxillary complex fracture. Case Report: A 53 years old male patient presented with right zygomatico maxillary complex fractures. Diagnosis of right side tetrapod zygomatico maxillary complex fracture deformity was done by clinical examination and confirmed by computed tomography which included 3-D reconstruction view. The authors performed 4-point fixation using the preauricular approach to counter the disadvantages of the coronal approach. The results and usefulness of preauricular approach with 4-point fixation are reported in this study. Conclusion: Preauricular incision is an effective surgical approach for the reduction of zygomatic arch fracture. 4-point fixation using the easier-to-manipulate preauricular approach would be more useful than the conventional method that uses the coronal approach. Satisfactory reduction that showed exact correction was observed. In an outpatient follow-up, no complication such as nonunion or malunion was found, and facial symmetry was also shown. In addition, the preauricular scar was hardly observed. Keywords: zygomaticomaxillary complex fracture, preauricular incision, reduction, fixation

The Rhytidectomy Scar: Analysis of Patient and Surgeon Perspectives.

An understanding of patient preference is vital for surgeons to create outcomes that align with the goals of patients undergoing cosmetic surgery. This study analyzes the perception of the rhytidectomy scar from the perspective of cosmetic patients and surgeons. Cross-sectional surveys were administered in-person to cosmetic patients and online to facial plastic and reconstructive surgeons in the United States. Participants were presented with standardized lateral view photographs of preauricular scars for 10 patients at least 12 months post rhytidectomy procedure. A variety of rhytidectomy incisions were chosen to include pre- versus post-tragal incisions, blunted hair tuft, hypopigmentation, narrow versus wide scar healing. Participants were asked to rate the outcome of the preauricular rhytidectomy scar using the Likert scale from 1 to 10. Quantitative analysis indicates that while both surgeons and cosmetic patients viewed hypopigmented scars less favorably, surgeons were more concerned with pre-tragal incision and blunted hair tuft. Furthermore, the number of rhytidectomies performed by surgeons resulted in more critical analysis of the scars presented in this study. Qualitative analysis of the frequent use of "natural" in the patient comments suggests the importance of maintaining a sense of "normalcy" as well. In contrast, the surgeon comments are most frequently about the relationship between the scar and surrounding anatomical structures, suggesting a descriptive focus on the technicality of scar placement and subsequent anatomical result. Cosmetic patients are primarily concerned about scar appearance while surgeons are more focused on the technical orientation of the scar. An understanding and comparison of the language and perceptions of surgeons and cosmetic patients regarding rhytidectomy scars are vital in creating aesthetic results and managing patient expectations.

Aesthetic Design of Expanded Bilateral Superficial Temporal Vascular Fascial Pedicled Flap for Repairing Maxillocervical Scars.

Large-scale maxillocervical scars impair face and neck function and damage appearance. The forehead expanded bilateral superficial temporal pedicled flap is a good treatment strategy for this area; however, the traditional cutaneous pedicled flap damages the temporal hair area. This impairs aesthetics and causes alopecia; furthermore, requires an additional pedicle-cut operation. A retrospective study was performed on 7 patients with large-scale maxillocervical scars from January 2014 to August 2018. Forehead expanders were implanted in the first-stage operation for all patients. After the injection and rest period, patients were treated using the forehead expanded bilateral superficial temporal vascular fascial pedicled flap. Superficial temporal vascular fascia pedicles were carefully harvested. The use of an intralesional or hidden retrotragus incision was determined by the presence of a preauricular scar. Patient satisfaction with postoperative neck activity and the incision scar was evaluated. Intralesional and retrovagus incisions were used in 4 and 3 cases, respectively. One flap developed hematoma, which recovered completely after conservative treatment; all other cases had no complications. All flaps healed well. The neck mobility of the patients was significantly improved with no visible scar in the temporal region. Six cases reported being "very satisfied" and one was "relatively satisfied" with their improvement in neck mobility. All cases reported being "very satisfied" with frontotemporal morphology. The forehead expanded bilateral superficial temporal vascular fascial pedicled flap is a good choice for patients with large-scale maxillocervical scars. This technique can maintain the aesthetics of temporal hair and reduce patients extra surgical injury.

Dislocated pediatric condyle fractures — should conservative treatment always be the rule?

AimThe results of conservative treatment of pediatric dislocated (luxative) condyle fractures are usually unsatisfactory. We therefore decided to present and analyze the results of surgical treatment of these fractures. Patients and methodsChildren with dislocated condyle fractures were treated surgically, with the approach always including opening the temporomandibular joint (TMJ).Postoperatively, patients had regular controls at 1 week, 1 month, 3 months, and 6 months, and then yearly thereafter. At each control visit, facial symmetry, maximal mouth opening, lateral chin deflection upon mouth opening, TMJ pain, condylar motion, palpable pathological phenomena, and occlusion were all checked clinically. Healing of the fracture site, condylar height, shape and growth were assessed on panoramic radiographs. Possible surgical complications were noted: temporary facial nerve palsy, development of a parotid salivary fistula, disturbance of auricle sensibility due to injury of the greater auricular nerve, miniplate fracture, intraoperative bleeding, postoperative hematoma formation, infection, and reoperation due to fragment malposition. The postoperative scars were assessed. ResultsOver the 6-year period from 2013 until the end of 2018, seven children with dislocated condyle fractures were treated surgically. Six of the seven patients were treated with open reduction and internal fixation, and the plates and screws were deliberately not removed. The age range of the patients was 1.5–14 years (average 6.1 years). Follow-up time was 15 months to 6 years. No growth disturbances or facial asymmetries were seen over this follow-up period, with all patients maintaining proper occlusion, joint movement, and mouth opening. Fracture healing and condylar growth were clearly demonstrated with serial control panoramic radiographs. Condylar height asymmetry was observed only in one case, in which only reduction of the fracture with no fixation was performed. In all other cases, condylar height was symmetric. None of the children presented with chewing difficulties or joint pain. No intra- or postoperative surgical complications were noted. The preauricular scars were all very discreet, and none of the patients or parents complained about them. ConclusionSurgical treatment in cases of dislocated (luxative) condylar fractures in children and small infants restores anatomy and thus securely enables further symmetric growth of the condyles, mandible, and the entire facial skeleton.

Feasibility of 4-Point Fixation Using the Preauricular Approach in a Zygomaticomaxillary Complex Fracture

A zygomaticomaxillary complex fracture is a facial bone fracture that commonly occurs as a centrally and laterally protruding zygomatic area. The exact reduction of the displaced fracture is the most important task in the treatment of a zygomatic fracture, from the aesthetic point of view. In some types of zygomaticomaxillary complex fracture, however, it is somewhat difficult to maintain the reduction after the surgery using 3-point fixation. In addition, surgery using 3-point fixation may cause malunion or nonunion. Thus, 4-point fixation using the coronal approach is alternatively considered. The authors performed 4-point fixation using the preauricular approach to counter the disadvantages of the coronal approach. The results and usefulness of 4-point fixation using the preauricular approach are reported in this study. This study was conducted on 172 patients who had a zygomaticomaxillary complex fracture and an isolated zygomatic arch fracture from March 2010 to September 2011. Open reduction and internal fixation were performed on the patients with a zygomaticomaxillary fracture, and closed reduction using the Gilles technique was performed on the patients with an isolated zygomatic arch fracture, among whom reduction using the preauricular approach was further performed on 17 patients who had insufficient intraoperative reduction or who had unsatisfactory intraoperative radiologic outcomes. An approximately 1.8-cm preauricular incision was made from 1.5 cm anterior to the helical root of the ear to 1 cm anterior to the tragus in a curved shape. After the incision, the temporoparietal fascia was dissected to confirm that the incision had reached the zygomatic arch behind the facture line. The reduction was performed, whereas the displaced fractured bone was being observed with the eyes, followed by the internal fixation. Plane x-ray and 3-dimensional head computed tomography were performed before the surgery, after the surgery, and 6 months after the surgery to examine the reduction status and outcomes of the displaced fracture. The mean follow-up period was 5.5 (range, 5-6) months. Reduction using the preauricular approach was further performed on 17 patients who showed unsatisfactory reduction among 172 patients with a zygomaticomaxillary complex fracture and an isolated zygomatic arch fracture. Reduction using the preauricular approach was further performed on the displaced fractured site that remained unrepaired in an intraoperative radiologic examination. In the postoperative 3-dimensional head computed tomography and plane x-ray, satisfactory reduction that showed exact correction was observed. In an outpatient follow-up, no complication such as nonunion or malunion was found, and facial symmetry was also shown. In addition, the preauricular scar was hardly observed. Exact reduction and internal fixation of a fracture site are required to restore the appearance and functions of the normal face and to reduce complications such as malunion or nonunion in patients with a zygomaticomaxillary complex fracture. If a complex fracture of the zygomatic body or facture of the zygomaticomaxillary buttress is accompanied by a fracture of the inferior orbital rim, and thus, if incomplete reduction or malunion is anticipated, 4-point fixation using the easier-to-manipulate preauricular approach would be more useful than the conventional method that uses the coronal approach.

Suspensão circular fechada do terço médio da face

O tratamento cirúrgico apresentado neste artigo tem inovações táticas e torna o procedimento pouco agressivo. O objetivo é demonstrar uma maneira diferente de executar a suspensão do terço médio da face. O procedimento é realizado com agulhas semicirculares tipo Stocchero, com passagem de fio de náilon 2.0 no plano subcutâneo, na altura da borda anterior da glândula parótida, e fixação do fio na fáscia temporal. Foram operados com emprego desse método 49 pacientes, com obtenção de bons resultados estéticos. Em um paciente, houve necessidade de executar uma cicatriz pré-auricular, para acomodação da pele. O método é seguro, simples, não necessita de internação hospitalar, evita uma cicatriz pré-auricular e o resultado oferece boa satisfação aos pacientes.

Minimally invasive endoscopic resection of benign tumours of the accessory parotid gland: an updated approach

The most common conventional approaches for the resection of benign tumours in the accessory parotid gland are a standard parotidectomy incision, a modified standard parotidectomy incision, or a face-lift incision. The resulting scars may severely affect the patient's postoperative appearance. The previously reported endoscopically assisted approach offers a less aesthetically invasive technique, but it may still leave a visible preauricular scar 4–5cm long. We have used a modified endoscopic approach with minimal, and concealed, incisions for the resection of benign tumours in the accessory parotid gland. Five patients were diagnosed by physical examination, imaging, and preoperative fine-needle aspiration biopsy. They had endoscopically assisted resections using our modified approach, and we evaluated its feasibility. All the resections were successful. The mean operating time was 108min (range 90–130). The postoperative scars were concealed and aesthetically satisfactory. There were no facial paralyses, salivary fistulas, or recurrences in the short term. Using endoscopically assisted resection we completely removed benign tumours from the accessory parotid gland and obtained good aesthetic results. Our updated endoscopic approach for these resections is successful with shorter, concealed incisions. It is a viable alternative to conventional approaches.

Rhytidoplasty Without Periauricular Scar

As plastic surgeons, it has always been our goal to reduce the scarring associated with facial plastic surgeries. These scars generally occur on the scalp and in both the pre- and retroauricular areas. In 194 of our patients who underwent rhytidoplasties, we successfully eliminated these retroauricular and preauricular scars. To achieve these results, we did not make periauricular incisions; instead, we made a superior incision, a subcutaneous dissection, and used various surgical maneuvers such as subdermal plication and structural grafting. By utilizing this facelift technique, we were able to eliminate the appearance of periauricular scars associated with facial plastic surgery, reduce complications, achieve natural-looking results, and increase patient satisfaction.

Minimally invasive endoscopic-assisted resection of benign tumors in the accessory parotid gland: 5 case studies

A modified Blair's incision or standard facelift incision is recommended to remove tumors in the accessory parotid gland. These incisions frequently result in long and visible scars. Therefore, the authors have introduced an endoscopic approach via a small preauricular incision to achieve excision of benign tumors in the accessory parotid gland. The endoscopic surgical technique was performed on 5 patients with benign tumors in the accessory parotid gland. Endoscopic-assisted resection of the benign tumors in the accessory parotid gland was feasible in all 5 patients. This procedure lasted 105 minutes on average. Facial paralysis, salivary fistula, and ear-lobular numbness were not found postoperatively. The follow-up period was 1 year, during which no Frey's syndrome and recurrence were found. All preauricular scars were aesthetically satisfactory. The minimally invasive endoscopic approach via a small preauricular incision is an optional method of the accessory parotid gland benign tumor resection.

Modification of surgical technique in isolated zygomatic arch fracture repair: seven case studies

Closed reduction is applied in most cases of isolated zygomatic arch fracture. Open reduction and internal rigid fixation through a coronal incision have to be performed in other comminuted arch fractures. The authors introduced an endoscopic-assisted approach via a small preauricular incision to achieve reposition and osteosynthesis of isolated zygomatic arch fractures. The endoscopic-assisted surgical technique was performed in 7 patients with unilateral isolated zygomatic arch fractures. Endoscopically controlled management of the isolated zygomatic arch fracture was feasible in all 7 patients. The follow-up period was 1 year. All preauricular scar and facial lateral contour were aesthetically satisfactory. The endoscope-assisted approach via a small preauricular incision can achieve in situ reduction and fixation in zygomatic arch fracture and it should become an integral part of isolated zygomatic fracture repair, assuming the development of specialized training programs and improvements in endoscopes.

Temporomandibular Joint Reconstruction With Costochondral Graft Using Modified Approach

12 patients presenting with long standing temporomandibular joint (TMJ) ankylosis were treated with a costochondral graft inserted through a modified approach. The age of the patients ranged from 5 to 17 years. A preauricular incision was made for resection of the ankylosed condyle. After release of the ankylosis the contralateral rib was harvested with costal cartilage. An intra-oral incision was made along the external oblique ridge to the mucobuccal fold and was used for resection of the coronoid process and insertion and fixation of the graft. The graft was fixed with a minimum of three titanium screws. The patients were instructed to start physiotherapy 1 week postoperatively and were followed up clinically and radiographically using 3D CT. Postoperative results were encouraging, the graft took well in all patients without postoperative infection or graft rejection. The graft was properly positioned in all cases. There were no visible scars as the preauricular scar is relatively hidden, no possibility of damaging the facial nerve or the marginal mandibular branch and shorter operating time.

The J-Lift/Internal Face-Lift for Facial Rejuvenation

Objective: To evaluate our experience with the J-lift/internal facelift, which includes lipoaspiration of the lateral cheek and neck, limited subcutaneous dissection with multivector superficial musculoaponeurotic system plication, and subperiosteal dissection in the jowl and malar areas with implant placement. Methods or Design: A retrospective chart review of 139 patients who underwent J-lift and internal face-lift between 2001 and 2004. The number of complications was addressed and results analyzed photographically using a 3 point scale. Results: 137 patients expressed satisfaction with the technique. The two that did not suffered from extensive adiposity in the neck tissues. There were three complications, which consisted of a small eschar over the tragus, a widened preauricular scar and some asymmetry of one prejowl implant which were successfully addressed with minor revision surgery. There were no cases of expanding hematoma, postoperative auricular displacement, injury to cranial nerves V or VII, or loss of hair in the temporal area. Photographic assessment of the results indicated fair to moderate improvement in the midface and good to excellent improvement in the jowl and cervicomental angle. Conclusions: The J-lift is an effective and safe technique for patients with jowl and cervicomental angle rhytids.

A Clinical Retrospective Study Comparing Two Short-Scar Face Lifts: Minimal Access Cranial Suspension versus Lateral SMASectomy

The purpose of this study was to retrospectively compare the short- and long-term cosmetic outcomes of two minimal incision rhytidectomies and analyze their advantages and disadvantages. The results of minimal access cranial suspension face lift versus minimal incision rhytidectomy with lateral SMASectomy were evaluated after 1 and 24 months. Statistical analysis considered surgeon/patient satisfaction, time used in the procedures, pain, and learning curves. Photographs were sent to the patients and two plastic surgeons, unfamiliar with the cases, for evaluation of results that were assessed by an objective grading system described by Strasser. Eighty-two patients completed 1 and 24 months' follow-up. Complications were two hematomas, two retroauricular-lobule dog-ears, and one hypertrophic preauricular scar. Surgical time was longer for the SMASectomy. Postoperative pain was worse for minimal access cranial suspension face lift. There were no differences in cosmetic results between the two techniques at 1-month and 2-year follow-up. Incorporating age, sex, postoperative pain, and duration of surgery as confounding factors did not modify the model. Surgeon/patient satisfaction showed no difference with either technique, but the photographic evaluation of all cases at 24 months revealed that more than 50 percent of the sample needed a tuck procedure to correct jowling and redundant skin. Advantages of short-scar face lifts are the avoidance of the postauricular and occipital incisions, and the disadvantages are the moderate results in the neck and nasolabial folds and their potential short duration. For 24 months in this study, the duration of results was similar for both minimal access cranial suspension and lateral SMASectomy.

The pretragal incision in rhytidectomy

Although an endotragal incision is used in rhytidectomy to avoid a visible pretragal scar, patients may not understand that the superior and inferior portions of the preauricular scar cannot be hidden inside the ear. The endotragal incision is also more likely to distort normal external ear anatomy. The author explains his preference for the pretragal incision and presents his face lift technique. ( Aesthetic Surg J 2001;21:564-568.)

Endoscopic subcutaneous and SMAS facelift without preauricular scars.

Since the advent of endoscopic techniques for facial rejuvenation, we have seen an increasing number of patients asking for facial improvement who refuse a conventional full facelift. During the last 3 years, in seeking to obtain good results for this group of patients with minimally invasive techniques, we have been using a subcutaneous approach for lifting of the mid- and lower face. This subcutaneous temporofacial lift combined with SMAS suspension, which resembles our conventional approach of rhytidectomy but avoids preauricular scars, is an excellent approach for selected cases.

Evolution from endoscopic to miniinvasive facelift: a logical progression?

Endoscopy has revolutionized the field of aesthetic surgery, permitting the advent of cosmetic surgery via minimal incisions. The procedures are modifications of subperiosteal lifting techniques which grew out of craniofacial surgery. Nonetheless, the cumbersome instrumentation and changes in operator technique have led to the development of a subperiosteal facelift through minimal incisions without the aid of endoscopy. This miniinvasive approach has yielded equivalent results to our endoscopic rhytidectomies in appropriate patients, with reduced morbidity, edema, and operating time. Further, it permits the avoidance of preauricular scars in the majority (84%) of patients; 63 cases are presented, with a follow-up of up to 4 years.