Ear Reconstruction Research Articles

Otoplasty and Ear Reconstruction Complications.

Prominauris, often known as prominent ears, is one of the most frequent congenital deformities of the head and neck. Therefore, otoplasty has gained significant popularity and is now one of the most performed procedures in the field of facial plastic surgery.Reconstructing and correcting ear abnormalities remains a challenging procedure in facial plastic and reconstructive surgery. These deformities, whether congenital or acquired, have a substantial influence on patients' lives and inflict psychological harm. Addressing the deformity and tissue loss will improve the overall quality of life.Throughout history, various surgical techniques have been reported for treating external ear abnormalities. While most of these surgeries are considered safe, a comprehensive preoperative evaluation and understanding of the different techniques and risks can minimize potential complications.

Ear Reconstruction following Mohs Micrographic Surgery

AbstractRelative to other regions of the body, the ear has a high risk of developing cutaneous malignancies that often necessitate Mohs micrographic surgery (MMS) for removal. This procedure can create defects that are immediately noticeable if left untreated. Reconstructive techniques are often needed to restore the appearance of the affected ear and its symmetrical relationship to the contralateral ear. However, achieving optimal aesthetic results can be challenging due to the subtle intricacies of the external ear. Therefore, careful planning and execution should be implemented prior to managing the acquired defect. Additionally, depending on the size and location of the defect, various options aligning with the reconstructive ladder can provide desired outcomes. The purpose of this article was to highlight and discuss the different techniques used in ear reconstruction following MMS.

Atelectasis After Bilateral Costal Cartilage Ear Reconstruction.

This study, through the case analysis of 2 patients with congenital bilateral microtia, explores the causes and preventive strategies of atelectasis after bilateral rib cartilage extraction surgery. Although ear reconstruction technology is quite mature, it may lead to complications, such as atelectasis, due to thoracic surgery and general anesthesia. Pediatric patients are more prone to such complications due to narrower airways, less pulmonary surfactant, and difficulties in pain management. Therefore, for children undergoing bilateral rib cartilage extraction surgery, health care providers need to closely monitor their respiratory status, effectively manage postoperative pain, and encourage them to engage in deep breathing and coughing exercises as much as possible to prevent and improve atelectasis.

Ear Reconstruction for Auricle Defects Using an Expanded Neck Flap: A Case Report.

This case report describes a patient with a left ear deformity resulting from a flame burn sustained 20 years ago. The patient underwent an ear reconstruction procedure utilizing an expanded neck flap. The autologous rib cartilage was used as the framework, while an expanded neck flap served as the covering for the framework. The surgery was completed in 3 stages. Initially, tissue expanders were implanted and gradually inflated with water. After sufficient expansion, the expanders were removed, and the scar tissue was excised. Subsequently, the expanded flap was used to cover the defects, and the expanded neck flap was rotated to cover the autogenous costal cartilage framework obtained intraoperatively. Finally, the reconstructed ear was repaired by constructing the cephaloauricular sulcus, removing postauricular scars, and trimming the neck-flap pedicle. After a 1-year follow-up, the wound had healed satisfactorily with only minor complications. The shape of the reconstructed ear appeared realistic, and its function was maintained. Most of the scars were repaired, and the scarred alopecia was significantly improved. In patients with limited availability of the postauricular flap, especially burn patients, using an expanded neck flap can lead to superior outcomes.

Advances in the Application of Microsurgical Techniques in Repairing Traumatic Auricular Defects

Objectives: Auricular reconstruction is one of the most challenging procedures in plastic surgery. However, traumatic auricular defects present more uncertainty and complexity than congenital microtia with various surgical options in auricular reconstruction. The purpose of this article is to review advances in the use of microsurgical techniques for the treatment of traumatic ear defects. Methods: Three databases, PubMed, Web of Science, and Google Scholar, have been used to gather the most relevant papers discussing the topic. This paper searched for studies from 1980 to 2023: searching for a range of keywords such as “post-traumatic ear deformities,” “free flap,” and “free facial flap.” Using this method, studies related to free flaps in posttraumatic ear reconstruction were reviewed and discussed. Results: Fifty-four studies related to auricular reconstruction using different free flaps were obtained through screening. Conclusion: The microsurgical technique for auricular reconstruction requires both exceptional auricular reconstruction skills and microsurgical expertise due to its intricate nature. Nevertheless, microsurgical techniques remain a valuable avenue of investigation and can provide satisfactory surgical outcomes in appropriately selected patients. Level of Evidence Level V.

“Mortise and Tenon Joint” Technique to Improve the Stability of Three-Dimensional Costal Cartilage Framework in Fully Expansion Ear Reconstruction

Objective: For full expansion of ear reconstruction, the stability of a cartilage framework is very important. However, most techniques for framework fabrication focus on three-dimensional structure and adequate projection. Few studies are available on improving the stability of the reconstructed framework. This study introduces a new “mortise and tenon joint” technique to create a more stable framework in fully expansion ear reconstruction. Methods: A total of 137 patients with microtia underwent full expansion ear reconstruction with the “mortise and tenon joint” technique from January 2018 to July 2022. Results: Hematoma was found in 2 patients after the expander was implanted and evacuated timely to save the flap. Ear cartilage framework exposure occurred in 3 patients after the second stage of surgery. The wounds were debridement and covered by a retroauricular fascia flap with a skin graft. No other complications, such as infection, expander exposure, or rupture, were observed. All patients were followed up for 6 to 12 months after ear reconstruction and asked to fill in a form anonymously about their satisfaction with the reconstructed ear. One hundred thirty-four patients (97.8%) were satisfied with the results. Conclusions: In fully expansion ear reconstruction, the “mortise and tenon joint” technique improves not only the stability of the cartilage framework but also the stereoperception of the reconstructed ear. Most patients who underwent the new technique were satisfied with clear contour and delicate substructures of the reconstructed ear, matched skin color, and long-term dimensional stability.

Abdominal muscles infiltration analgesia for donor-site pain in autologous ear reconstruction: A randomized controlled clinical trial

BackgroundCostal cartilage donor-site pain is an adverse effect of autologous ear reconstruction. This study aimed to introduce rectus abdominis and external oblique muscle infiltration analgesia (RAM+EOM-IA) for costal cartilage donor-site pain and evaluate its efficacy and safety. MethodsThe study was a randomized controlled clinical trial. Patients were randomized between intermittent RAM+EOM-IA combined with intravenous patient-controlled anesthesia (IPCA) and IPCA alone. Thirty patients were followed in the RAM+EOM-IA combined with the IPCA group and 30 patients in the IPCA alone group. The primary outcome was the numerical rating score (NRS) of pain recorded during 48 h postoperatively. Secondary outcomes included the Barthel index (BI) and rescue analgesic consumption. Sensory block areas were tested using a cold stimulus. ResultsNRS was significantly lower with RAM+EOM-IA combined with IPCA than with IPCA alone at 28 h (P < 0.01), 32 h (P < 0.01), 36 h (P < 0.01), 44 h (P < 0.001), and 48 h (P < 0.01) postoperatively. The number of patients who received rescue analgesics (P < 0.01) and consumption (P < 0.01) was significantly higher for IPCA alone. RAM+EOM-IA improved the BI at 24 h postoperatively (P < 0.001), especially for mobility (P < 0.001), using the stairs (P < 0.001) and toilet use domains (P < 0.001). At 10 and 60 min after RAM+EOM-IA, the total sensory block area in the abdomen had not extended proximally beyond the xiphoid, distally beyond the navel, and beyond midaxillary and midsternal lines on either side. ConclusionRAM+EOM-IA effectively and safely prevented costal cartilage donor-site pain by blocking anterior and lateral cutaneous branches of intercostal nerves from T6 to T10 in microtia patients.

A Subunit-Based Concept for Preoperative Design of the Cauliflower Ear.

Cauliflower ear is an ear deformity caused by a closed ear injury with varying severity. Several studies on the systematic reconstruction of cauliflower ear have been reported. Here, the authors aim to introduce a simplified subunit-based reconstruction concept for the cauliflower ear. The authors retrospectively analyzed all patients who underwent surgery to repair cauliflower ear in our department from April 2021 to April 2023. Patients' demographic information, clinical characteristics, and outcomes were recorded. All patients were followed up for 1 year. The authors assessed each subunit of the cauliflower ear in sequence in terms of the change in size and shape and decided whether tissue removal or grafting is needed. The surgical design was obtained by a combination of all subunits. The authors included a total of 5 patients with mild and moderate cauliflower ear repaired by the subunit-based method. The shape of all the involved ear subunits of our patients was almost restored. No patient needed the use of cartilage grafts and flaps. The authors summarized 5 common subunits with deformity: helix, scaphoid fossa, antihelix crura and triangular fossa, antihelix body, and concha. The pathology results reported a keloid in 1 case. All patients reported no recurrence and were satisfied with the surgery after 1 year. The authors reported a simplified subunit-based method of preoperative evaluation and design of cauliflower ear, as a new alternative option to complement the current clinical strategies. The authors also reported the first case of a keloid in cauliflower ear.

Classification of Microtia With Unusable Remnant Ear and Techniques in the First Stage of Two-Stage Auricular Reconstruction.

The remnant ear is a very important material in auricular reconstruction surgery; its dimension, position, and shape determine how it is used. However, the local conditions of microtia patients are complex and variable. Situations may be encountered where a series of abnormal remnant ears cannot be utilized in clinical practice. Currently, there are no literature that elaborates on this type of microtia and provides systematic treatment methods. The purpose of this article is to systematically classify them and optimize the two-stage method auricular reconstruction, to provide an effective surgical method for these patients. Based on the size, shape, and relative position of the residual ears, the unusable remnant ears were classified into three types: tiny size, abnormal shape, and relative position anomaly (over 1-cm higher than the contralateral earlobe). Fifty-three microtia patients with unusable remnant ear (54 ears) who underwent two-stage auricular reconstruction from August 2020 to August 2023 were reviewed. All patients had experienced earlobe reconstruction by using autologous rib cartilage during the first stage of surgery. Aesthetic assessments were evaluated from the naturalness of the earlobe reconstructed with autologous rib cartilage and the connection with the overall framework. The data on any complications that occurred during the follow-up period and patient satisfaction were collected. Among all patients, 31 had tiny size, 14 had abnormal shape, and 8 had excessively high positions. Patients were followed up for an average period of 9.2 months (6 to 12 months). No complex complications such as infection, skin necrosis, or cartilage exposure occurred. Fifty patients (94.3%) achieved excellent or good aesthetic outcomes. Fifty-one patients (96.2%) were satisfied with the reconstruction outcomes. An accurate assessment of the residual ear preoperatively is essential. Reconstructing and splicing the earlobe with autologous rib cartilage in cases where the residual ear cannot be utilized compensate for the defect that the soft tissue cannot provide the earlobe flap. This is an effective surgical method for the ear reconstruction in such patients.

Interleukin-4-Loaded Gelatin Methacryloyl Hydrogel Promotes Subcutaneous Chondrogenesis of Engineered Auricular Cartilage in a Rabbit Model.

Tissue engineering technology offers a promising solution for ear reconstruction; however, it faces the challenge of foreign body reaction and neocartilage malformation. This study investigates the impact of interleukin-4 (IL-4), an anti-inflammatory factor, on cartilage regeneration of hydrogel encapsulating autologous auricular chondrocytes in a rabbit subcutaneous environment. Initially, we assessed the influence of IL-4 on chondrocyte proliferation and determined the appropriate concentration using the CCK-8 test in vitro. Subsequently, we loaded IL-4 into gelatin methacryloyl (GelMA) hydrogel containing chondrocytes and measured its release profile through ELISA. The constructs were then implanted autologously into rabbits' subcutis, and after 3, 7, 14, and 28 days, cartilage matrix formation was evaluated by histological examinations, and gene expression levels were detected by qRT-PCR. Results demonstrated that IL-4 promotes chondrocyte proliferation in vitro, and maximum release from constructs occurred during the first week. In the rabbit subcutaneous implantation model, IL-4-loaded constructs (20 ng/mL) maintained a superior chondrocytic phenotype compared to controls with increased expression of anti-inflammatory factors. These findings highlight IL-4 as a potential strategy for promoting chondrogenesis in a subcutaneous environment and improving ear reconstruction.

Splicing of Helix Framework in Modified Nagata Method Stage I for Auricle Reconstruction in Patients With Insufficient 8th Rib Cartilage.

The 8th rib cartilage was sometimes insufficient to construct a complete external helix in ear reconstruction for microtia. The aim of this study was to investigate the splicing technique of 8th rib cartilage in modified Nagata method stage I. Between September 2022 and May 2023, 231 consecutive patients with microtia underwent auricular reconstruction with modified Nagata method stage I. Thirty-four patients with insufficient 8th rib cartilage were screened out by three-dimensional (3D) computed tomography preoperatively, who were included in the study prospectively. The 8th rib was spliced to create the external helix when fabricating the ear framework in the stage I surgery for the 34 patients. The median duration of follow-up was 12.1 months (8-15 months). There were no perioperative complications in our study. During follow-up, all patients had satisfying outcomes, with no inward collapse, displacement, or absorption of the spliced external helix. The splicing point was not obvious. It was safe and effective to splice the 8th rib cartilage for external helix of the cartilage framework in ear reconstruction for microtia.

Conductive Hearing Loss Associates With Dementia, and Middle Ear Reconstruction Mitigates This Association: A Multinational Database Study.

To test the hypothesis that conductive hearing loss (CHL) is associated with dementia, and that middle ear reconstruction (MER) associates with improved outcomes for these measures in a multinational electronic health records database. Retrospective cohort study with propensity-score matching (PSM). TriNetX is a research database representing about 110 million patients from the United States, Taiwan, Brazil, and India. Subjects older than 50 years with no HL and any CHL (ICD-10: H90.0-2). Subjects of any age with and without any MER (CPT: 1010174). Odds ratios (ORs) and hazard ratios with 95% confidence intervals (95% CIs) for incident dementia (ICD-10: F01, F03, G30). Of 103,609 patients older than 50 years experiencing any CHL, 2.74% developed dementia compared with 1.22% of 38,216,019 patients with no HL (OR, 95% CI: 2.29, 2.20-2.37). Of patients experiencing CHL, there were 39,850 who received MER. The average age was 31.3 years, with 51% female patients. A total of 343,876 control patients with CHL were identified; 39,900 patients remained in each cohort after 1:1 PSM for HL- and dementia-related risk factors. Matched risk for developing dementia among MER recipients was 0.33% compared with 0.58% in controls (OR: 0.58, 0.46-0.72). CHL increases the odds for dementia, and MER improves the odds for incident dementia. This study represents the first population study on the topic of CHL, MER, and dementia.

A Feasibility Study of HoloLens Ear Image Guidance for Ear Reconstruction.

An ideal 3D cartilage framework and accurate anatomical location are the most important factors to carry out a satisfactory reconstruction of the ear. To streamline this process, we developed an augmented reality assistance system, HoloLens Ear Image Guidance, which is based on computed tomography (CT) data, tailor-made navigation kits to guide reconstruction, data processing software, and HoloLens hardware. The objective of this study is to verify its feasibility in a clinical setting. This study first validated our system in healthy controls and then extrapolated data to test on patients with microtia. First, three healthy volunteers were recruited, and reconstructive navigation kits were made using 3D printing. CT data were collected for the head and neck and imported into the HoloLens Ear Image Guidance Application to generate a personalized 3D virtual ear image. Volunteers then wore the navigation kits while researchers observed them through the HoloLens to check accuracy, track delay, and view the ear image guide.Ten patients with unilateral microtia were recruited and CT data were collected, and reconstructive navigation kits were made to assist with surgery. The procedure was monitored to record the surgeon's experience wearing the HoloLens, the patients' complications associated with wearing navigation kit, and to measure the symmetry between the reconstructed ear and the reference counterpart. In control patients, the deviation between the virtual image and the real ear was less than 2.4% (±0.22%); the tracking delay was less than 1.26 s (±0.09 s), the display effect was good, and surgeons did not report discomfort or dizziness while wearing the HoloLens. Volunteers did not report any pain from holding the navigation reference in their mouth during the test. Following validation, the HoloLens-assisted procedures were not associated with surgeon discomfort or dizziness. No complications were noted in patients including injury to the oral mucosa. Symmetry between the reconstructed ear and the contralateral ear was noted to be satisfactory in HoloLens-assisted surgery. The HoloLens Ear Image Guidance initially met clinical demands in registration accuracy, tracking speed, and subjective user experience, which can be used as the basis for continual software improvements and clinical application.

Relative effects of serratus anterior plane block performed with dexmedetomidine combined with ropivacaine or ropivacaine alone on quality of recovery in children undergoing ear reconstruction

BackgroundDexmedetomidine (Dex) as a local anesthesia adjuvant for nerve block procedures can improve the quality of patient recovery. However, the impact of utilizing Dex as a local anesthetic adjuvant for serratus anterior plane block (SAPB) procedures on recovery quality for children undergoing ear reconstruction remains unclear. MethodsEighty-four patients undergoing ear reconstruction with autogenous costal cartilage (ACC) were randomized into two groups (n = 42/group) in which SAPB was performed with ropivacaine alone (R group) and one in which SAPB was performed with Dex and ropivacaine (DR group). Primary outcomes were patient 15-item quality of recovery (QoR-15) scale scores on days 1 and 2 post-surgery. Secondary outcomes included postoperative rest and coughing numerical rating scale (NRS) chest pain scores, duration of analgesia, oral rescue analgesic usage, and opioid-related side effects. ResultsForty patients per group completed the study. QoR-15 scores on days 1 and 2 post-surgery in the DR group were significantly increased relative to the R group (126.35±9.81 vs 115.53±8.58 and 131.78±8.67 vs 122.80±8.59, all P<0.001). Rest and coughing NRS chest pain scores at 2, 4, 8, 12, and 24h postoperatively in the DR group were all significantly lower relative to the R group (all P<0.05). The DR group also exhibited a significantly longer analgesic duration (P<0.001), and significantly reduced oral rescue analgesic usage and opioid-related side effect incidence (all P<0.05). ConclusionCombining Dex and ropivacaine for SAPB in children undergoing ear reconstruction with ACC can significantly improve quality of recovery, quality of analgesia, and analgesic duration.

Single-stage reconstruction of severe question mark ear with the absence of large portions of the lobule using affected cartilage graft and 3 flaps

BackgroundQuestion mark ear is a congenital abnormality characterized by a prominent curve within the helix that resembles a question mark. Several surgical reconstruction techniques have been proposed to treat this deformity. In this study, we aimed to evaluate the cosmetic outcomes of a new cartilage and postauricular flap surgical reconstruction technique for patients diagnosed with severe QME. MethodFrom 2017 to 2023, 33 patients with severe QMEs were treated with a new reconstruction surgical technique at the Plastic Surgery Hospital of Peking Union Medical College. The perimeter, width, length, and auriculocephalic angles of both ears were measured and compared to assess the symmetry. The patient’s satisfaction with the surgical outcomes and the incidence of postoperative complications were also evaluated. The average follow-up duration was 15.48 months. ResultsThe auricular perimeter, width, and length changed significantly after surgery. The dimensions between the left and right ear did not vary significantly in both patients with unilateral or bilateral severe QME after surgery and at the end of one-year follow-up. The majority of patients (87.88%) or carers were satisfied with cosmetic outcomes after surgery. All patients underwent suture removal 14 days after surgery and exhibited excellent wound healing without any complications such as hematoma, infection, and flap necrosis. ConclusionOur new surgical reconstruction technique for severe QME resulted in good cosmetic outcomes, high patient satisfaction, fast recovery, and no post-operative complications.

One-Year Results of Ear Reconstruction with 3D Printed Implants.

External ear reconstruction has been a challenging subject for plastic surgeons for decades. Popular methods using autologous costal cartilage or polyethylene still have their drawbacks. With the advance of three-dimensional (3D) printing technique, bioscaffold engineering using synthetic polymer draws attention as an alternative. This is a clinical trial of ear reconstruction using 3D printed scaffold, presented with clinical results after 1 year. From 2021 to 2022, five adult patients with unilateral microtia underwent two-staged total ear reconstruction using 3D printed implants. For each patient, a patient-specific 3D printed scaffold was designed and produced with polycaprolactone (PCL) based on computed tomography images, using fused deposition modeling. Computed tomography scan was obtained preoperatively, within 2 weeks following the surgery and after 1 year, to compare the volume of the normal side and the reconstructed ear. At 1-year visit, clinical photo was taken for scoring by two surgeons and patients themselves. All five patients had completely healed reconstructed ear at 1-year follow-up. On average, the volume of reconstructed ear was 161.54% of that of the normal side ear. In a range of 0 to 10, objective assessors gave scores 3 to 6, whereas patients gave scores 8 to 10. External ear reconstruction using 3D printed PCL implant showed durable, safe results reflected by excellent volume restoration and patient satisfaction at 1 year postoperatively. Further clinical follow-up with more cases and refinement of scaffold with advancing bioprinting technique is anticipated. The study's plan and results have been registered with the Clinical Research Information Service (CRIS No. 3-2019-0306) and the Ministry of Food and Drug Safety (MFDS No. 1182).

Safety and performance of the new med-el total ossicular replacement prostheses.

This multicentric, retrospective study provides safety and performance data of the MED-EL total ossicular replacement prostheses (TORP). Patients underwent tympanoplasty with mXACT Total Prosthesis Center, mXACT Total Prosthesis Offcenter or mXACT PRO Total Prosthesis. The clinical data were retrospectively analyzed. Follow-up examination included access to the medical record (for adverse events) of the patients, ear microscopy and pure-tone audiometry to determine the post-operative pure tone average of the frequencies 0.5, 1, 2 and 3kHz (PTA4). The post-operative PTA4 air bone gap (ABG) was used to evaluate the audiological outcome. A post-operative minimum and maximum follow-up period was not defined. 103 patients were implanted with a TORP. 102 (88 adults, 14 children; 37 CHL, 64 MHL, 1 not specified) patients were analyzed for safety and 92 (79 adults, 13 children) patients for performance of the prostheses. ADVERSE EVENTS RESULTS (N = 102): In 1 patient (child, mXACT Total Prosthesis Offcenter) a prosthesis dislocation was reported, which lead to a revision surgery. No prosthesis extrusion or migration was reported. AUDIOLOGICAL RESULTS (N = 92): 49 (53.3%) of the 92 patients had a PTA4 ABG of ≤ 20dB and therefore a successful rehabilitation. The mean post-operative PTA4 ABG of all 92 patients was 21.0 ± 9.7dB. The first endpoint, improvement in post-operative PTA4 ABG of ≤ 20dB by ≥ 25% of the patients was achieved. The individual Δ BC PTA4 (post-operative minus pre-operative BC PTA4) thresholds were stable (within ± 5dBHL) in 91 (98.9%) patients. 1 patient had a BC PTA4 deterioration of 11.3dBHL. The MED-EL TORPs are safe and effective for middle ear reconstruction. Trial registration number NCT05565339, September 09, 2022, retrospectively registered.

A Comprehensive Literature Review on Advancements and Challenges in 3D Bioprinting of Human Organs: Ear, Skin, and Bone.

The field of 3D bioprinting is rapidly emerging within the realm of regenerative medicine, offering significant potential in dealing with the issue of organ shortages. Despite being in its early stages, it has the potential to replicate tissue structures accurately, providing new potential solutions for reconstructive surgery. This review explores the diverse applications of 3D bioprinting in regenerative medicine, pharmaceuticals, and the food industry, specifically focusing on ear, skin, and bone tissues due to their unique challenges and implications in the field. Significant progress has been made in cartilage and bone scaffold fabrication in ear reconstruction, yet challenges in functional maturation persist. Recent advancements highlight the potential for patient-specific ear substitutes, emphasizing the need for extensive clinical trials. In skin regeneration, 3D bioprinting addresses limitations in existing models, offering opportunities for improved wound healing and realistic skin models. While challenges exist, progress in biomaterials and in-situ bioprinting holds promise. In bone regeneration, 3D bioprinting presents personalized solutions for defects, but scaffold design refinement and addressing regulatory and ethical considerations are crucial. The transformative potential of 3D bioprinting in the field of medicine holds the promise of redefining therapeutic approaches and delivering personalized treatments and functional tissues. Interdisciplinary collaboration is essential for fully realizing the capabilities of 3D bioprinting. This review provides a detailed analysis of current methodologies, challenges, and prospects in 3D bioprinting for ear, skin, and bone tissue regeneration.

Assessment of Patients’ Satisfaction after Reconstruction of Unilateral Microtia Using Modified Questionnaire Form

Abstract Background Microtia is a rare and severe craniofacial abnormality that impairs newborns' appearance. The most favored treatment for microtia is regarded as autologous ear reconstruction. Patient satisfaction is paramount element in improvement of surgical outcomes. Most studies depended on medical stuff reviews for reconstruction. Aim of the Work Thus, this study aims to help define items that individual’s own satisfaction is based on. Patients and Methods In this cross sectional study, 44 patients, 28 females and 16 males ; with unilateral microtia underwent autologous ear reconstruction using costal cartilage graft were selected. Bilateral cases and Anotia types were excluded.6th to 8th costal cartilage were harvested in the 1st stage to shape the framework. Elevation was done in the 2nd stage. Satisfaction was recorded using a questionnaire form 4 months postoperatively. Results All patient were satisfied with their surgery and never regret doing it. Helix and lobule get higher satisfaction rates than those for antihelix and concha. Conclusion Helix and lobule of reconstructed auricle get the highest level of satisfaction while antihelix and concha still need more continuous work and follow up to enhance their aesthetic outcome.

Single-stage Auricular Reconstruction in Hemifacial Microsomia With Low Hairline by Using Temporoparietal Fascia Flap.

Auricular reconstruction is one of the most complicated operations in plastic surgery and is more difficult for patients with a low hairline due to limited skin availability. In traditional operations, the skin of the mastoid area was used to cover the front of the ear scaffold, and the retroauricular fascia, combined with a free skin graft, was used to cover the back of the ear framework. This may cause problems such as inadequate skin coverage and affecting the shape of the reconstructed ear when the hairline is low. Hemifacial microsomia patients with low hairline have little skin flap to perform the ear reconstruction, and we refined a single-stage ear reconstruction surgery to solve the problem. The temporoparietal fascia is used to cover the entire costal cartilage scaffold, and its surface is covered with a free split-thickness skin taken from the chest wall, thigh, and other parts. From December 2019 to December 2020, 12 patients with hemifacial microsomia underwent single-stage reconstruction with temporoparietal fascia. The duration of patient follow-up was 6 to 24 months. The application of this technique can solve the problem of insufficient available skin flap, complete the ear reconstruction through 1 operation, reduce the treatment cycle, achieve a good shape of the reconstructed ear, and the postoperative effect is satisfactory. According to the characteristics of the HFM patients with low hairline, we recommend this new, improved single-stage auricular reconstruction using the temporoparietal fascia for these patients. This method is a suitable choice for HFM patients with low hairline.Level of Evidence: Level-IV, Cases Study.