Superior Crus Research Articles

Auricular spoon-shaped crus malformation including variants: Clinical features and a novel surgical approach

BackgroundCertain auricular malformations are uncommon and lack generally accepted diagnostic names. This study investigates an uncommon complex auricular malformation known as auricular spoon-shaped crus malformation providing a detailed description of its external characteristics. Additionally, an effective surgical approach is proposed. MethodsBetween 1991 and 2023, 12 auricles from 11 patients with as the auricular spoon-shaped crus malformation including variants were surgically treated at our center. Patient medical records and photographic data were retrospectively reviewed. ResultsEach auricle exhibited 2 to 4 major structural deformities within the five areas of the superior crus, inferior crus and stem of the antihelix, helical crus, and earlobe. These deformities resulted in depression between the antihelix and antitragus, vertical shortening, horizontal elongation of the auricle, and/or drooping of the ear. Three patients displayed a low positioning of the malformed ear, and eight patients exhibited mild to moderate hemifacial microsomia. Earlier corrections we conducted utilized various methods with variable aesthetic outcomes. Recently, the improved corrective method we implemented yielded consistently promising aesthetic results. We have confidence that adopting the surgical approach we suggest can lead to promising aesthetic results when addressing this malformation. Furthermore, we hope that the presented malformation will be recognized as a primary auricular malformation by auricular surgeons in the future.

Lateral Canthotomy Revisited: A Refined Surgical Approach for Orbital Access

Summary: The transconjunctival incision is a common and effective approach for establishing surgical exposure to the orbital floor. When access to the lateral orbit is also required, this incision may be extended by an accompanying lateral canthotomy, which releases the tarsal plates from the conjunctiva. Although this approach broadens surgical access through a simple extension, it is often remarked for unpredictable healing patterns and negative aesthetic sequelae, such as rounding of the lateral canthal angle. Traditionally, lateral canthotomy is performed by a transverse incision through a natural skin crease of the lateral palpebral fissure. Herein, we discuss our experience with a less common approach to lateral canthotomy, in which only the inferior crus of the lateral canthal tendon is divided. This approach limits manipulation of delicate orbital anatomy and aims to minimize unsightly scarring while still affording excellent visualization of the lateral orbit and orbital floor.

40. Lateral Canthotomy Revisited: A Refined Surgical Approach for Orbital Access

PURPOSE: Lateral canthotomy is a surgical technique which may broaden access to the lateral orbit and orbital floor. Despite the benefits of this maneuver, it has also been reported to lead to unpredictable healing and possible negative sequelae, such as rounding of the lateral canthal angle, entropion, and visible scar. We evaluate a less common modification to lateral canthotomy that aims to minimize complications while improving surgical access. METHODS: Lateral canthotomy was performed through a vertically-oriented incision made 2-3 mm medial to the lateral canthal angle along the lower lid. By this approach, only the inferior crus of the lateral canthal tendon was divided. A retrospective chart review was performed of patients with orbital floor fractures who underwent reconstruction using a transconjunctival incision and lateral canthotomy as described. Postoperative clinical documentation was evaluated on serial outpatient follow-up to assess for aesthetic and functional complications. RESULTS: The senior author performed 47 orbital floor repairs using a transconjunctival approach with lateral canthotomy. The average patient was 35.2 years of age (range, 4 - 75), and followed for 20.7 weeks (range, 0.4 - 132.1). The overall complication rate was 10.6%, consisting of residual enophthalmos 3 (6.4%), blurry vision 1 (2.1%), and infection 1 (2.1%). No patients demonstrated rounding of the lateral canthal angle, ectropion, entropion, or other aesthetic concerns. CONCLUSION: Our retrospective study highlights an uncommon approach for lateral canthotomy which minimizes risks traditionally associated with this surgical maneuver, while still affording the same degree of surgical exposure as the classical method.

Nonsurgical Creation of an Auriculocephalic Sulcus in Children With Congenital Auricular Deformities.

Nonsurgical correction of congenital auricular deformity is known to be effective in newborns. In this study, the authors investigated factors influencing the outcome of nonsurgical or surgical correction of the auriculocephalic sulcus, an important auricular structure and one that is necessary for wearing glasses or a mask. A total of 80 ears (63 children) were splinted using a metallic paper clip and thermoplastic resin in our outpatient clinic between October 2010 and September 2019. The ears were divided into a group, in which the auriculocephalic sulcus was formed nonsurgically (n =5 6) and a group, in which surgery was needed (n = 24). The authors compared the clinical characteristics of the deformities, whether cryptotia affected the superior or inferior crus, and whether constricted ears were Tanzer group IIA or IIB between the two study groups by retrospective chart review. There was a significant correlation between the age, at which ear-molding treatment was initiated and outcome ( P < 0.001). The optimal cutoff value for age, before which ear-molding treatment should be initiated was 7 months. Inferior crus-type cryptotia was corrected adequately by splinting, but all Tanzer group IIB constricted ears needed surgical treatment. Earlier initiation of ear-molding treatment is recommended, preferably before 6 months of age. Nonsurgical treatment is an effective intervention for the creation of the auriculocephalic sulcus in ears with cryptotia and Tanzer group IIA constricted ears but cannot correct for an inadequate amount of skin over the auricular margin or a defect in the antihelix.

Lateral Canthotomy/Cantholysis Performance Gap Analysis and Training Recommendations for Expeditionary Physicians.

Preservation of life, preservation of limb, and preservation of eyesight are the priorities for military medical personnel when attending to casualties. The incidences of eye injuries in modern warfare have increased significantly, despite personal eye equipment for service members. Serious eye injuries are often overlooked or discovered in a delayed fashion because they accompany other life- and limb-threatening injuries, which are assigned a higher priority. Prehospital military ocular trauma care is to shield the eye and evacuate the casualty to definitive ophthalmic care as soon as possible, with exceptions for treatment of ocular chemical injury and orbital compartment syndrome. Retrospective analysis of eye injuries in recent conflicts identified gaps in clinical capabilities with up to 96% of ocular injuries being suboptimally managed. Ocular compartment syndrome (OCS) is a complication associated with orbital hemorrhage, where significant morbidity occurs as a result of increasing intracompartment pressure. The ischemic tolerance of the retina and optic nerve is approximately 90 minutes, so OCS must be rapidly diagnosed and aggressively treated through lateral canthotomy/cantholysis (LC/C) to prevent permanent vision loss. LC/C procedures consist of using hemostats to crush the lateral canthal fold and cutting the lateral canthal tendon from the inferior crus to relieve increasing intracompartment pressure. The purpose of this study was to examine the baseline capabilities of military physicians and surgeons to accurately and independently perform the LC/C procedures and identify performance gaps that could be closed through focused professional development activities. This study received institutional review board approval at our institution. A total of 60 subjects voluntarily participated in the study from emergency medicine (15), general surgery (28), and ophthalmology (17). All procedural assessments were performed 1:1 by expert faculty ocular trauma specialists using a high-reliability eye trauma simulator (Sonalysts, Inc.). The competency standard was set at independent and accurate completion of all procedural components and all critical procedural components. Analyses were performed using descriptive statistics and analysis of variance to examine between-group differences (P < 0.05). There was a significant difference between the total score performance and the critical score performance for the three groups (P < 0.001). Outcomes indicate a significant linear relationship between the expertise level of the clinical provider and the procedural performance of LC/C. Outcomes demonstrate the baseline surgical capabilities of the general surgeons transferred to LC/C performance; however, they were unfamiliar with the anatomy and the procedural techniques and requirements. The group of emergency medicine participants demonstrated performance gaps not only in the same areas as the general surgeons but also in their baseline surgical abilities. This suggests that different professional development activities are necessary for surgeons and physicians tasked with performing LC/V procedures. We identified significant performance gaps among emergency medicine physicians, general surgeons, and ophthalmologists in their abilities to recognize and treat OCS through LC/C procedures. These sight-saving procedures are a critical competency for forward-situated clinicians in expeditionary contexts. We identified the need for targeted approaches to professional development for closing the performance gaps for both emergency medicine physicians and general surgeons.

Issue Information

Deformational external ear anomalies in neonates. Conchal crus (A); a leg extending from the middle part of the cavity of concha to its vertical wall, Stahl ear (B); cartilaginous structure starting from the superior crus of antihelix and passing through the fossa scaphoid towards the edge of the helix, Lop ear (C); abnormal downward curving of the upper part of the auricle and absence of the superior crus of antihelix, Rim kink (D); vertical depression in the helix, Prominent ear (E); prominent ear. Further details can be seen in the article by Erdem et al. in this issue. image

Ear Reconstruction: Empirical Data of 406 Cases of Carving the Convex Structures of the Framework.

In auricular reconstruction, the convex structures of the framework determine the esthetics, and young doctors often need sufficient training to determine the best carving techniques. This study aimed to recommend optimal carving methods and provide measured data of convex structures of the carved costal cartilage framework to prevent complications, improve esthetics, and reduce the learning curve. From 2018 to 2021, 406 patients with microtia who underwent costal cartilage carving were enrolled. The helix is formed by the eighth costal cartilage. The complex of the antihelix was fabricated from part of the eighth costal cartilage or the ninth costal cartilage. The tragus was constructed using residual cartilage pieces from the base frame. These components were measured, and those from the new ear graded "excellent" were used for data analysis. The statistical analysis was principally processed using Excel software. A total of 112 ears were graded "excellent". The following are the mean and standard deviation of each group of data: antihelix thickness, 0.31 ± 0.06 cm; antihelix width, 0.40 ± 0.06 cm; superior crus thickness, 0.18 ± 0.04 cm; superior crus width, 0.38 ± 0.09 cm; inferior crus width, 0.22 ± 0.04 cm; inferior crus thickness, 0.28 ± 0.05 cm; helix thickness, 0.31 ± 0.04 cm; the four-point height of the helix, 0.52 ± 0.08 cm/0.51 ± 0.07 cm/0.46 ± 0.06 cm/0.41 ± 0.06 cm; and tragus height, 0.98 ± 0.15 cm. These data may help beginners in reducing the learning curve of ear reconstruction. Framework fabrication based on these data allows attaining a harmonious ear framework and satisfactory three-dimensional auricle outline, yielding acceptable results and few complications. 4 Laryngoscope, 133:569-575, 2023.

597 Reconstruction of Lop Ear Deformities After Severe Burn Injury in Pediatric Patients: An 11-year Experience

IntroductionThe ear is one of the most highly visible structures on the face. One or both ears are frequently involved in panfacial burns. Because they are bilateral structures, asymmetries are clearly visible. Reconstruction of burned ear deformity often requires replacement or modification of skin and/or cartilage. Even these are successfully replaced, scar contractile forces can cause deformation of the ear. One of these deformities is lop or cup ear, in which the helical rim is either folded over, wrinkled or tight. We describe the necessity of applying otoplasty techniques to address this problem.MethodsA retrospective chart review analysis was performed to assess demographic variables, procedural indications and procedural outcomes in pediatric patients treated at our hospital for complex ear reconstruction for ear deformities after her surgery. Inclusion criteria were pediatric patients aged 0 to 21 years admitted to Shriners Hospital for Children-Boston from January 1, 2010 to January 1, 2021 for burn injury, who subsequently required follow-up complex ear reconstruction for ear deformities after burn injury. Of these patients, those with lop ear deformities who required construction were examined. Using the Trauma Registry of the American College of Surgeons (TRACS) and Shriners Hospital for Children Information Source (SHCIS) databases, we identified 12 eligible patients. Surgical procedure data was obtained from the SHCIS electronic medical records. Surgical photographs were obtained with patient informed consent. Those patients who required Medpor or cartilage frame reconstructions were excluded.Results12 patients required an otoplasty-type procedure to obtain desired results or symmetry with the contralateral ear. This technique involved a posterior incision in the auriculomastoidmastoid sulcus, are you a year and cartilage modification with sutures to to re-create the antihelical fold an superior crus as well as conchal setback sutures.ConclusionsBecause ears are bilateral structures, symmetry is extremely poor. Because of multiple contractile forces on the external ear from secondary healing or contraction of skin grafts, the ear is often displaced anteriorly and the upper portions become folded. Treatment requires reconstruction of the natural folds of the ear and shortening of the helical rim to mastoid distance. this requires an otoplasty approach with a posterior incision,, exposure of the cartilaginous framework and modification of the cartilage with incisions and sutures. This technique however requires adequate soft tissue coverage of the ear.

Lop Ear to Conchal Microtia: An Algorithmic Surgical Approach.

The lop ear deformity is defined by a deficient helix and scapha, underdeveloped anthelix, and downfolding of the helix. The terminology used is still confusing, and the treatment is not entirely structured. The aim of this study was to provide a new systematic surgical approach of this deformity based on our center's experience. All patients undergoing surgical correction of lop ears between 2007 and 2019 at Great Ormond Street Hospital were included. Patients' data, surgical techniques, and postoperative complications were recorded. Based on our records, we identified 3 surgical techniques for the correction of lop ears, based on the degree of deformity encountered. In a mild lop ear, correction was achieved with a modified otoplasty technique by improving the definition of the antihelix and superior crus. In a moderate deformity, additional remodeling of the lidded helix was performed (extended otoplasty), whereas for the severe lop ear, the amount of cupping and the deficient cartilage required formal reconstruction using a carved rib cartilage framework. There were a total of 109 patients and 146 lop ears: 58 mild, 27 moderate, and 61 severe lop ears. We feel that there is a point in the spectrum of congenital ear deformity when a severe lop ear becomes a conchal microtia and recommend this approach to simplify the management of these cases. This is intended to bring greater clarity to how to deal with lop ears, based on the severity of the deformity and the surgical techniques used.

Preauricular pull through flap for reconstruction of the auricle

Reconstruction of the crus of the antihelix after tumor resection is a significant surgical challenge and to date no ideal method has been described. The authors present a novel approach using a pedicled flap from preauricular excess skin, which is tunneled through the helix to the anterior auricular surface. The presented technique was successfully applied in a series of three patients requiring reconstruction of the superior and inferior crus of the antihelix after resection of skin malignancies. Technique and outcomes are described in detail. Postoperative course was uneventful in all patients and all flaps healed with excellent esthetic results. Initial flap edema was observed in two cases that resolved spontaneously. The preauricular pull-through flap is a versatile, straightforward, and reliable method for reconstruction of auricular defects located at the superior and inferior crus of the antihelix, including the triangular fossa, using the natural preauricular skin excess.

Modified Postauricular Incision for Preservation of the Lesser Occipital Nerve and the Great Auricular Nerve in Ear Surgery

Objective: To describe the feasibility of preserving the lesser occipital nerve (LON) and the great auricular nerve (GAN) in postauricular incision in ear surgery. Methods: The distribution of the LON and the GAN was first identified in human cadavers. Then a clinical study was performed in 34 patients who underwent middle ear surgery between September 2016 and January 2017. Patients were divided into the conventional incision group and the modified incision group, according to incision types, and underwent sensory testing and subjective evaluation of auricular numbness after surgery at different times. Results: Most frequently, the auricular branches of the LON went into the postauricular groove at the same height of inferior crus of antihelix. The vertical dimension from the intersection of the highest auricular branch of the GAN and postauricular groove to intertragic notch ranged from 5.7 to –4.2 mm. Preservation of the LON and the GAN reduced sensory loss in the modified incision group compared to the conventional incision group. Conclusion: Preservation of the LON and the GAN with modified postauricular incision can reduce postoperative auricular numbness.

The Double-reverse Wedge Excision Technique: A Novel Approach to Reconstruction of Stahl’s Ear Deformity

Stahl's ear deformity presents with an abnormal third crus of the antihelix and varying degrees of severity. This paper aims to describe a novel technique for reconstruction of Stahl's ear involving a double-reverse wedge excision of the third crus cartilage and skin, as well as use of Mustardé sutures to recreate the superior crus and Furnas sutures to complete the auricular setback. This novel technique for correction of Stahl's ear deformity produces a more stable aesthetic result versus classic otoplasty with desired auricular setback, minimal reduction in the size of the ear, and limited scarring on the anterior auricular surface. Reconstruction of Stahl's ear deformity can be accomplished using this double-reverse wedge excision technique of the third crus cartilage and skin with Mustardé and Furnas sutures to recreate the superior crus and complete auricular setback, effectively restoring anatomic harmony to the ear.

Different Methods of Fabricating Cartilaginous Ear Framework in Children With Microtia According to the Length of the Eighth Costal Cartilage Intraoperatively.

There is controversy over the optimal timing of microtia reconstruction. The eighth costal cartilage, which is used to shape the helix framework, can be one of the key factors determining surgical timing of microtia reconstruction. Nevertheless, it is difficult to predict the length of the eighth costal cartilage preoperatively. The aim of the present study was to discuss different methods of fabricating cartilaginous ear framework in children with microtia according to different lengths of the eighth costal cartilage. Based on the actual length of the eighth costal cartilage in microtia children, there are 2 methods to fabricate auricular framework. In method I, the eighth costal cartilage was divided into 2 parts. Part A was used to fashion the helix, while part B was used to protrude the antihelix, superior, and inferior crus. The seventh rib was used to form the main body and the sixth rib was used to form the base of the framework. In method II, the seventh costal cartilage was used to fashion the helix and extrude the antihelix, superior, and inferior crus as method I did. The sixth rib was used to form the main body and the eighth rib was used to form the base of the framework. A total of 68 microtia children underwent auricular reconstruction adopting the modified techniques between 2015 and 2016. The great majority of patients (66 patients) were satisfied with the reconstructed ears. Two patients were relatively satisfied with the reconstructed ears. Three cases have been selected to illustrate the favorable result achieved. They revealed that the helix, antihelix, superior crus, and inferior crus all appeared distinct and presented a favorable result of the contour of the reconstructed auricle. Based on different lengths of eighth costal cartilage in children, different methods of fabricating ear framework make full use of the autogenous costal cartilage and elevate anatomical details, demonstrating that personalized treatment is necessary.

A New Surgical Method of Correcting Abnormal Cartilage in Mild or Moderate Cryptotia.

This study aimed to introduce a new technique for the correction of mild or moderate types of cryptotia. During January 2010 to March 2015, patients with cryptotia deformities came to our hospital and were enrolled in this study. A new surgical method of correction of abnormal cartilage by combining irregular incisions in auricle malformation and directional transplantation of auricular cartilage was designed. The irregular Z shaped flap was designed to correct the skin defects. In the ipsilateral cavum conchae, the auricular cartilage strut was harvested, followed with irregular cartilage incisions and cartilage transplantation. After correction, the corrected auricles in 3 cases showed natural contour with deep auriculotemporal sulcus and no conspicuous scars. The antihelix folding and backward rotation deformities of the auricular cartilage were corrected, and the morphology of superior and inferior crus of the antihelix was not destroyed. One case appeared necrotic. During 1 year of follow-up, there was no incidence of recurrence or revision. The combined techniques for correction of abnormal cartilage are simple and easy to operate, and the reconstructed auricles show natural contour without conspicuous scars. The new technique is suitable for correction of mild and moderate cryptotia.

Open reduction of zygoma fractures with the extended transconjunctival approach and T-bar screw reduction.

BackgroundZygomaticomaxillary complex (ZMC) fractures mostly occur in the form of tripod fractures. The surgical field is accessed using a combination of three classic approaches. However, the subciliary incision may have unfavorable aesthetic results. Herein, the authors report the advantages of the extended transconjunctival approach (ETA) combined with T-bar screw reduction in minimizing scarring and complications for the treatment of ZMC fractures.MethodsA total of 26 patients underwent ZMC reduction through the ETA and intraoral approach. A skin incision measuring roughly 5 to 8 mm in length was placed following the lateral canthal skin crease. After releasing the inferior crus of the lateral canthal tendon for canthotomy, the medial periosteum of the lateral orbital rim was preserved for canthal reattachment. A limited subperiosteal dissection and partial relaxing incision of the orbicularis oculi were performed to expose the fracture line of the inferior orbital rim and zygomaticofrontal suture. Reduction was performed using a T-bar screw through the transconjunctivalincision and an elevator through the intraoral incision.ResultsThe aesthetic and functional results were excellent. Successful reduction was achieved and the skin incision was less than 8 mm in 20 cases (76.9%). Only six patients had an additional skin incision (less than 5 mm) to achieve reduction. No cases of ectropion, entropion, or excessive scarring were noted.ConclusionsThe ETA using a T-bar screw is a useful method for maximizing aesthetic results in ZMC fractures, with the advantages of minimal scarring, faster recovery, and maintenance of pretarsal fullness.

Modified Methods of Fabricating Helix and Antihelix in Total Auricular Reconstruction Based on Different Length of Eighth Costal Cartilage

Attaining an ideal appearance of the reconstructed ear depends primarily on the fabricated cartilaginous ear framework. Despite the role of eighth costal cartilage, the length of the eighth rib cartilage is difficult to anticipate, and growth of the eighth cartilage is variable. The authors discussed modified methods of fabricating helix and antihelix based on different length of eighth costal cartilage. Based on the actual length of the eighth costal cartilage, patients were divided into group A and group B. In group A, the eighth costal cartilage was divided into 2 parts. Part I was used to fashion the helix, whereas part II was used to fabricate the antihelix and superior crus. In group B, the seventh costal cartilage was cut into 3 parts. Part I and part II were used to fashion the helix, antihelix, and superior crus as group A did. Part III was assembled to the lateral part of the framework to form the inferior crus. A total of 56 patients underwent auricular reconstruction adopting the modified techniques between 2015 and 2016. Three cases have been selected to illustrate the favorable result achieved. They revealed that the helix, antihelix, superior crus, and inferior crus all appeared distinct and presented a favorable result of the contour of the reconstructed auricle. Based on different length of eighth costal cartilage, modified methods of fabricating helix and antihelix make full use of the autogenous costal cartilage, elevate anatomical details, and enhance the overall aesthetics of reconstructed ear. The great majority of patients have satisfactory surgical outcomes, demonstrating that personalized treatment is necessary.

A new technique for transcutaneous fixation of the costal cartilage block utilized in reconstructed ear elevation for microtia

PurposeWith the aim of implementing good projection of the three-dimensional frame (auriculo-cephalic angle) and maintaining projection, a significant issue during the stage of auricular elevation for avoiding the potential for dislodging the cartilage blocks remains. Herein we present an innovative and technically simple method of transcutaneous fixation of the costal cartilage block during the stage of auricular elevation. Materials and methodsAfter elevation of ear frame from the basement, two suspension stitches on the surface of the elevated ear were used to fix the embedding cartilage block into the auriculo-cephalic sulcus at the upper (bifurcation point of the anti-helix where the inferior and superior crus meet to form the triangular fossa) and lower (projection point of the concha wall, parallel to the level of the tragus) ones. A loop of suture was placed through a dermal anchor, ear frame, and piece of the cartilage block. ResultsAmong a total of 50 patients, 94% achieved ‘excellent’ and ‘good’ outcomes in terms of auricular symmetry. Likewise, 86% (n = 43) of patients achieved ‘excellent’ and ‘good’ outcomes in terms of projection in postoperative 6- month follow-up. There were no instances of significant cartilage or knot exposure or absorption of the embedded cartilage blocks. ConclusionThe technique of transcutaneous fixation of cartilage blocks for ear elevation described in this study was associated with excellent outcomes, producing stable clinical results based on our long-term experience with ear reconstruction.

Reevaluation of the arterial blood supply of the auricle.

The anatomical basis for auricular flaps used in multiple aesthetic and reconstructive procedures is currently based on a random distribution of the underlying arterial network. However, recent findings reveal a systematic pattern as opposed to the present concepts. Therefore, we designed this study to assess the arterial vascular pattern of the auricle in order to provide reliable data about the vascular map required for surgical interventions. Sixteen human auricles from eight body donors (five females/three males, 84.33±9.0years) were investigated using the unique 'Spalteholz' method. After arterial injection of silicone, a complete transparency of the tissue was achieved and the auricular arteries and branches were visible. Qualitative and quantitative evaluation of the arterial vascular pattern was performed. The superior and the inferior anterior auricular artery provided the vascular supply to the helical rim, forming an arcade, i.e. helical rim arcade. On the superior third of the helical rim another arcade was confirmed between the superior anterior auricular artery and the posterior auricular artery (PAA), i.e. the helical arcade. The perforators of the PAA were identified lying in a vertical line 1cm posterior to the tragus, supplying the concha, inferior crus, triangular fossa, antihelix and the earlobe. The results of this study confirmed the constant presence of the helical rim arcade (Zilinsky-Cotofana), consistent perforating branches of the PAA, and the helical arcade (Erdman), and will help and guide physicians performing auricular surgeries toward fast and simple procedures with optimal patient satisfaction.

Release of the Inferior Crus in Antihelix Plasty.

Protruding ears with a hypoplastic antihelix often have poorly developed inferior cura. Publications on this topic until now have only dealt with absent inferior crus and have neglected its importance in everyday antihelix plasty. This article describes a new surgical technique to improve treatment of the antihelix. Patients with protruding upper third ears received either standard otoplasty with crus superior remodeling (ST) or the newly developed surgical procedure including crus inferior release (STI). To evaluate the results, a survey containing 10 questions about different outcome parameters was conducted with the patients. Each question was given a score ranging from 0 to 10, where 10 meant the best outcome and 0 the worst. From January 2013 to March 2014, 216 patients underwent otoplasty, of which 99 completed the questionnaire. No differences could be found between ST and STI patients except for their duration of pain, which was significantly less in group STI. Overall, the scores from the questionnaire were 89.85 in ST and 92.35 in STI. Mean values for satisfaction were 9.33 in group ST and 9.56 in group STI. When correcting the antihelix, the inferior crus must always be checked because the protruding upper third cannot be compensated only by overcorrecting the superior crus. It should be a matter of routine to recognize the degree of malformation and determine the best possible treatment. This novel technique is an additional valuable option in otoplasty to improve the upper third in a more natural way and create highly satisfactory results.

A simplified method for correcting Tanzer's group II constricted ears: Construction of the superior crus as a strut with cartilage expansion grafting

A constricted ear, also known as a cup ear or lop ear, is a deformity characterized by curling of the upper portion of the ear, including the helix, scapha, and antihelix. In Tanzer's classification, group II constricted ears have deformities involving the helix and the scapha. Although partial or total absence of the superior crus of the antihelix has been noted in group II constricted ears, most plastic surgeons have corrected group II constricted ears using the expansion technique and skin flaps, without formation of the superior crus. However, the expansion technique does not always yield satisfactory results in group II constricted ears. Between May 2011 and April 2014, the authors operated on 21 patients with group II constricted ears using the technique described in this study. The follow-up period ranged from 2 months to 2 years. In our procedure for correcting group II constricted ears, we focused on restoring the superior crus of the antihelix. As a strong superior crus acts as a strut in the upper third of the ear, it supports the helical rim and creates the scapha. Eventually, the newly formed superior crus enables the helical rim to expand in the upper third of the constricted ear. In this article, we present our method of correcting group II constricted ears, in which the superior crus is constructed as a strut and cartilage expansion grafts are used.