Ear Reconstruction Flashcards

1
Q

Describe the etiology of cauliflower ear

A
  • auricular hematoma - hematoma forms deep to perichondrium - forms clot then forms new catilage which curls and deforms - acute - drain hematoma and bolster - late - >10days, excise fibroneocartilage layer anterior to true cartilage and bolster
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2
Q

Describe your management of a thermal injury to an ear

A

Prevent Chondroitis suppurativa - with sulfamylon onver eschar- - keep eschar as biologic dressing - if suppurative, debride and temporary STSG as biologic dressing - Abx cephalosporin + ciprofloxacin

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3
Q

Describe your management options for ear keloid

A
  • excision - intralesion steroid injection - pressure - any of the above in addition to excision - Excision plus radiation (lowest recurrence rate if commenced
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4
Q

DDx for benign skin lesions of an ear

A
  • keloid - chondritis nodularis chronica helicis (excise cartilage, not skin) - actinic keratosis - vascular lesion
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5
Q

DDX for malignant skin lesions of an ear

A

BCC, SCC KA Melanoma Meckel cell

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6
Q

Describe the sensation to the ear

A

Greater auricular n (C2,3) - lobule and inferior 1/2 of auricle ATN (CN5) - root of helix and tragus Lesser occipital (C1,2) - superior posterior auricle CN X Arnolds - concha and posterior EAC CN 9 Jacobson - anterior EAC

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7
Q

What are your goals of reconstruction for acquired ear defect

A
  • correct size, orientation and position - support fo eyeglasses - patent EAC
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8
Q

What are the subunits of the ear

A

Helical rim - key for aesthetics Lobule- key for aesthetics Antitragus Antihelix - if abnormal leads to protrusion/cauliflower deformity Concha - dispensable Cavum conchae

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9
Q

What are your goals of reconstruction for acquired ear defect

A
  • correct size, orientation and position - support fo eyeglasses - patent EAC
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10
Q

Describe your appraoch to auricle defect recon by location

A
  • Helical rim
    • Antia Buch
    • Pedicled/local skin flap and cartilage graft
  • Upper 1/3
    • Antia Buch
    • Conchal Chondrocutaneous rotation flap (orticochea)
    • Banner flap and cartilage graft
    • preauricular skin flap and cartilage graft
  • Middle 1/3
    • Antia buch
    • 1’ closur with wedges and accessory triangles/crescents (Tanzer)
    • Converse Tunnel procedure - post-auricular tubed flap
    • Dieffenbach
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11
Q

What are recontructive options for acquired ear defect

A

1’ closure with wedge FTSG/STSG Local flaps: Antia buch, Tunnel procedure, Converse flap, Pocket principle??, banner flap, retroauricular skin flap Composite grafts Regional flap: TPF Microvascular replant prosthesis with osseointergated implant

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12
Q

Describe the orticochea flp

A

Conchal chondrocutaneous pedicled flap based on crus of helix - to reconstruct upper and middle 1/3 deefects - concha is incised and rotated except for pedicle along helix of 1cm width

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13
Q

Describe the dieffenbach flap

A

post-auricular advancement skin flap to cover the anterior defect and left pedicled at base. 2-3wks later, divide pedicle, inset posteriorly and graft defect

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14
Q

Describe the converse tunnel procedure

A

2stage postauricular skin use for recon without disruption of posterior auricular sulcus. - incise in postauricualr skin at level of defect - create tunnel under postauricular skin flap for inset of ear with attached cartilage graft - allow to heal 2-3mths - division and stsg defect

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15
Q

Describe the tanzer wedge/crescentric/triangle closure

A

1’ closure with wedges removed to prevent cupping

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16
Q

Describe the dieffenbach flap

A

post-autirucular advancement skin flap to cover the anterior defect and left pedicled at base. 2-3wks later, divide pedicle, inset posteriorly and graft defect

17
Q

Describe the converse tunnel procedure

A

2stage postauricular skin use for recon without disruption of posterior auricular sulcus. - incise in postauricualr skin at level of defect - create tunnel under postauricular skin flap for inset of ear with attached cartilage graft - allow to heal 2-3mths - division and stsg defect

18
Q

Describe the tanzer wedge/crescentric/triangle closreu

A

1’ closure with wedges removed to prevent cupping

19
Q

What is your managment of a sharp ear amputation?

A

replant is possible using branch of STA/V

20
Q

WHat are your thoughts on banking cartilage

A

hyaline cartilage will warp and scar - not good for banking. Composite graft is possible if in child or small

21
Q

What are options for total ear reconstruction

A

Non-op - prosthesis Op - skin coverage and framework needed = TPF, RFFF = synthetic or autologous framework - prefabricated RFFF

22
Q

What are synthetic materials for ear prothesis

A

medpore, hydroxyapetite

23
Q

What are complications of ear reconstruction

A

Infection - chondritis - suppurative chondritis - IandD, chondrectomy, cipro and penicillin/cephalo for pseudomonas and staph Keloids

24
Q

What is your managment of the burned ear

A
  • leave eschar as biologic dressing - sulfamylon to penetrate eschar (antipseudomonal activity) - release scar contractures w zplasty and keep EAC open w stent
25
Q

What is the pocket principle

A

dermabrasion of auricular catilage and buried under postauricular pocket. left for 3wks and once release will re-epithelialize

26
Q

Describe the antia buch flap

A

For reconstruction of upper and middle 1/3 defect <2cm

  • chondrocutaneous pedicled rotation advancement flap based on the posterior auricular skin
  • incise along antihelical sulcus and dissect postauricular skin off cartilage
  • two tricks to prevent constricted ear: resect some of scapha to decrease perimeter size and advance root of helix