Otoplastic Surgery for Calcified Auricular Deformity

Auricular hematoma is one of the most common problems among people who have got repetitive blunt trauma to the external ear. Prompt managements are drainage of hematoma and following prevention of re-accumulation (e.g. compression dressing). If the treatment is not successful, many complications can occur, including perichondritis, infection and necrosis. Especially long-lasting loss of blood supply to the ear cartilage and formation of neocartilage from disrupted perichondrium can result in cauliflower ear deformity. There were some studies trying to classify and to treat the cauliflower ear by the degree of deformities. And excision of deformed cartilage with reshaping of the auricle has been reported several times. In this article, we would like to introduce a successful drilling technique of otoplasty as a useful treatment option.

Ability to Identify External Ear Deformities and Normal External Ear Anatomy Based on Year and Specialty of Medical Training

The aim of this study was to analyze a potential association between resident training level/specialty type and correct identification of external ear deformities/external ear anatomy. A Qualtrics survey was distributed via email to all pertinent residency programs in the United States. The survey captured specialty type (Otolaryngology, Pediatrics, and Plastic Surgery) and level of training (PGY 1-2 and PGY 3+). The assessment asked residents to identify 10 clinically relevant external ear deformities and 10 normal pinna anatomic subunits. Chi-square tests were used to examine the association between the level of training/specialty type and performance on individual survey items. To examine group performance on overall mean scores of the external ear deformity/external ear anatomy survey, a t-test and factorial analysis of variance (ANOVA) were used. Responses from 105 residents were analyzed. Senior residents (PGY 3+) performed significantly better in correctly identifying Microtia Grade 3, Question Mark ear, and Cryptotia as compared to junior residents (PGY 1-2). Senior residents performed significantly better in the identification of external ear deformities ( P = .002) and normal pinna anatomical subunits ( P < .001). Otolaryngology and Plastic Surgery residents performed significantly better in the identification of external ear deformities ( P < .001) and normal pinna anatomical subunits ( P < .001) than Pediatrics. There were no significant interaction effects between the level of training and the specialty type on either ear deformity or normal pinna anatomy identification. Residents had a 34.5% success rate of identifying ear deformities and showed improved confidence in identification when exposed to a digital-based examination. Improved education methods for detection will help with timely correction of ear deformities.

Otoplasty: a graduated approach

Background Bat ear deformity is a common presentation among the ENT patients (22.5%). Many surgical procedures have been described to manage such a problem. A thorough study of the anatomical anomalies contributing to such deformity is required by any plastic surgeon in handling this anomaly. Results Modified anterior scoring (Chong-Chet) was done on 45 bat ear deformities in 31 patients. Good surgical results were obtained in 97.7% of patients, and the surgical time ranged from 60 t0 90 min. Postoperative pain and infection were minimal and effectively managed. Conclusions The modified Chong-Chet anterior scoring is a reliable and effective surgical tool for managing bat ear deformity done through one postauricular incision. This technique could be used in young as well as adult patients because it renders the auricular cartilage easier to manipulate.

Novel Classification of Posttraumatic Ear Deformities and its Surgical Management

Background Classification of posttraumatic ear deformities and its reconstruction is an uphill task for a reconstructive surgeon as they present in various combinations. In our study, we have described ear deformity as per a new classification and reconstructed the ear accordingly. Method Posttraumatic ear deformity was described under the following four headings: (a) zone of defect, (b) size of defect, (c) missing components, and (d) condition of surrounding skin. Twenty-six posttraumatic ear deformities were operated using postauricular skin flap (14), temporoparietal fascial (TPF) flaps (8), preauricular skin flap (1), intralesional excision (2), and primary closure with chondrocutaneous advancement in one patient. Costal cartilage was used for reconstruction of framework wherever required. Framework elevation was done 4 to 6 months postoperatively. Results Posttraumatic ear deformity was more common in males. Bite injury and road traffic accidents were the common causes. Zones I, II and III were most frequently involved. Four patients complained about size, contour, and projection of reconstructed ear. Three patients were not satisfied by the appearance of junction between reconstructed and residual ear. Four patients in whom the reconstruction was done with TPF, costal cartilage, and thin (SSG) split skin grafts complained of hyperpigmentation of reconstructed ear. Conclusion Classification of posttraumatic ear deformity and its reconstruction is a surgical challenge. Unscarred postauricular skin and TPF flaps are the workhorse flaps for reconstruction of acquired ear deformities. Our classification helps in describing the defect, documenting it, planning reconstruction, and aiding in assessing postoperative outcomes.