Auricular Repair & Otoplasty Flashcards
(46 cards)
√Describe the normal dimensions and angles of the adult ear
- Superior limit: Brow level
- Vertical axis: 20 degrees inclination posteriorly
- Vertical height: around 6cm
- Width: 55% of height (Goode = 0.55-0.6)
- Protrusion: 1-2cm = 15-30 degrees
Kevan FP Page 69
√What is the normal growth pattern of the ear after birth? At what age does it reach adult size?
- Rapid growth in first 3 years of life
- 85% growth by 3 years of age
- 95% growth by 5 years of age
- Then growth proceeds slowly until age 12
Otoplasty recommended ~age 5-6 years old (when child starts school)
√Define Prominauris. What causes it, list two most common reasons
Prominauris = prominent ears
Top two common deformities:
1. Deep conchal bowl
2. Absent antihelical fold
3. Lobule malpositioning (also addressed during otoplasty)
√What are the ideal helix-mastoid distances when conducting otoplasty?
- Mastoid to Superior helix = 10-12mm
- Mastoid to Mid-helix = 16-18mm
- Mastoid to Lobule = 20-22mm
√Describe non-surgical management of protruding ears 3
- Observation
- Auricular molding or surgical taping (usually has poor results unless started within days of birth. Auricular molding from 3 days of birth until 6 months. Surgical tape also ideally done within days of birth)
- Adhesive based prosthetic
√What is the usual timing of otoplasty?
Age 5-6
Ear has achieved almost its adult size, but before school starts to prevent teasing
√Describe 4 techniques for creating/modifying the anti-helical fold
- Stenstrom Technique
- Involves scoring the anterior cartilage with a rasp, anterior to the proposed antihelix, tunnel beneath the perichondrium
- Cartilage then bends AWAY from the scored side
- To remember how this bends, think of how a scored sausage bends when you cook it (away from the side thats scored)
- Results in mild improvement - Mustarde Technique
- Cartilage sparing technique
- Involves making a posterior auricular incision and reconstituting the antihelical fold with horizontal mattress sutures
- Advantages: Cartilage sparing, can create normal appearing antihelical fold
- Disadvantages: Can cause suture extrusion, does not address conchal bowl - Converse Technique
- Involves creating/cutting an island of cartilage which then sits anteriorly to the rest of the conchal cartilage; suture the island of cartilage onto itself so it is folded over
- Advantages: More permanent antihelical fold, can also create a normal appearing fold, useful in patients with thick cartilage
- Disadvantages: Experienced surgeon must perform. Not cartilage sparing - Pitanguy Technique
- Similar to converse technique, except the island of cartilage is excised and removed, and the remaining parts are opposed and sutured together/overlapped (incision from post auricular)
- Similar advantages and disadvantages to converse
Kevan FP Page 70
√Describe 2 techniques to modify the conchal bowl
- Cartilage excision or overlapping
- Excise or overlap the cartilage in the conchal bowl to reduce the depth. - Furnas Conchomastoid sutures
- Sutures the conchal cartilage to the mastoid fascia to achieve a set-back
Kevan FP Page 71
√Describe an approach to address both the conchal bowl and antihelical fold in prominent ears
Farrior Technique
- Involves removing wedges from posterior concha to change curvature of conchal bowl (reduce depth and flatten it) and then excise a portion and projecting it to create an antihelical fold
- Essentially a combination of a cartilage scoring technique + Pitanguy’s technique
Kevan FP Page 71
√Describe the technique for lobule repositioning
Modified fishtail excision
Kevan FP Page 71
What are the top 3 most common auricular defects?
- Prominauris
- Lop ear
- Stahl’s ear
√What is the Roger’s classification of auricular defects?
Rogers classification:
1. Type 1 = Microtia
2. Type 2 = Lop ear (second most common)
3. Type 3 = Cup ear
4. Type 4 = Prominauris (most common)
What is cryptotia?
Where the root of the helix is buried in temporal lobe skin
Kevan FP Page 72
https://services.nhslothian.scot/earrecon/wp-content/uploads/sites/46/2022/06/cryptotia.jpg
What is Stahl’s ear? (aka Satan’s ear)
Third most common auricular deformity
Where there is an addition (third) perpendicular superior crus of the antihelix that traverses the scaphoid fossa, resulting in a pointy, triangular elongation of the auricle
Kevan FP Page 72
Vancouver 392
https://www.chop.edu/sites/default/files/styles/gallery–main/public/stahls-ear-deformity-screenshot-layout-780x439-4.jpg?itok=nBPX4XKJ
https://www.chop.edu/sites/default/files/styles/gallery–main/public/stahls-ear-deformity-screenshot-layout-780x439-6.jpg?itok=uofKBhXU
What is a constricted/lop ear?
= Lop ear
Lidding or folding over of helical skin over the triangular ± scaphoid fossa
Due to poorly developed superior helix or scapha, triangular fossa, and posterior crus and antihelix
Lidding = mild version of lop ear (mild folding over)
Lop ear = severe folding over of helical skin
Constricted ear = partial absence of cartilage at the upper third of helical rim and sometimes concha, results in purse string at helix
Kevan FP Page 72
Vancouver 392
What is a helical rim?
Flattened superior helix
- Not to be confused with Stahl’s ear, this is a very flat “pushed in” look to the helix
See Kevan FP Page 72
https://d1l9wtg77iuzz5.cloudfront.net/assets/6153/282425/original_Helical_Rim_Ear_Deformity.jpg?1573947928
What is a cup ear?
Excessive helical rim and cupped
- Overdeveloped concha, underdeveloped antihelix and helix (hence, looks like a cup)
(see Kevan FP Page 72)
Vancouver 392
What is a conchal crus?
Abnormal fold of cartilage crossing the mid portion of the concha symba that appears to divide the ear in half. Often a result of prominent ear
https://s40764.pcdn.co/wp-content/uploads/sites/242/2022/12/Conchal-Crus.jpg.optimal.jpg
Kevan FP Page 72
List 10 possible complications of otoplasty
MOST COMMON:
1. Inadequate correction - Most common
2. Hematoma - easiest to detect but most emergent
3. Chondritis - most feared
4. Telephone ear deformity (result of over-correction of middle third portion of ear and over-resection of conchal bowl - middle 1/3 over-corrected, upper and lower third under-corrected)
“CHIT” like SHIT = Chondritis, Hematoma, Inadequate correction, Telephone ear
OTHER:
1. Scar
2. Adverse cosmesis
3. Cauliflower ear
4. Stuck-down ears (overall overcorrection)
5. Cartilage or skin necrosis
6. EAC stenosis
Vancouver 394
√Describe the epidemiology of microtia. What is the incidence in live births? Sex predominance? Ear predominance?
1/7-8000 live births
M>F
R>L
√Describe the genetics of microtia. What percentage are associated with other developmental abnormalities? What are 3 associated conditions?
50% of patients with microtia have other developmental abnormalities or syndromes
Associated conditions:
1. Treacher Collins
2. Branchio-oto-renal syndrome
3. Oculo-auriculo-vertebral syndrome (Goldenhaar)
Describe the characteristic features of Treacher Collins. Specifically, what is the mutation, what chromosome, what protein is affected, what is the inheritence?
List 15 features and their classifications
Mutation: TCOF1
Chromosome: 5 (same # as TCOF1)
Protein: Treacle protein
Inheritance: Autosomal dominant
Features:
A. Facial Abnormalities
1. Convex Profile
2. Prominent nasal dorsum
3. Maxillary hypoplasia
4. Micrognathia
5. Glossoptosis
B. Ear abnormalities
1. Microtia
2. Middle ear abnormalities
3. EAC stenosis
4. CHL, SNHL
C. Eye Abnormalities
1. Downsloping palpebral fissures
2. Lower lid colobomas (part of tissue of iris missing)
3. Hypoplasia of the lower lids
D. Airway abnormalities
1. Narrow upper airway
2. Cleft palate (PRS)
3. Choanal atresia
Kevan FP Page 73
Describe the genetics, and 10 clinical features of Goldenhar syndrome
Unilateral findings - hemifacial microsomia
Genetics - unclear; mostly sporadic
Clinical Features:
A. Facial features
- Asymmetric facial development
- Unilateral underdeveloped mandible, orbit, facial muscles
- ± CNVII abnormalities
B. Eyes:
- Upper lid coloboma
- Limbal dermoid
C. Ears:
- Anything from mildly deformed ears to anotia, EAC atresia, ossicular abnormalities
D. Spine
- Cervical Hemivertebrae
Describe the clinical diagnostic criteria for Brachio-Oto-Renal Syndrome. What is the mutation and what chromosome? What is the other name for the syndrome?
aka. Melnick-Fraser Syndrome
Mutation: EYA1 Gene
Chromosome 8q13 (‘8 looks like B in BOR)
Diagnostic Criteria
- Major Criteria:
1. B = Branchial anomalies
2. O = Otologic abnormalities (pre-auricular pits)
3. R = Renal anomalies
4. Deafness
- Minor Criteria:
1. External ear abnormalities
2. Middle ear abnormalities
3. Inner ear abnormalities
4. Pre-auricular tags
5. Other: facial asymmetry, palate abnormalities
Diagnosis requires:
1. 3 Major criteria; or
2. 2 Major + 2 Minor criteria; or
3. 1 Major + 1st degree relative
