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Head and Neck / CF > Ear - Congenital Anomalies & Correction > Flashcards

Ear - Congenital Anomalies & Correction Flashcards

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1
Q

Describe anatomy of ear

A

Antihelix antitragus complex helix lobule complex concha/scapha/tringular fossa depressions Crus of helix

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2
Q

What is the vascular supply to the ear

A

posterior auricular STA

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3
Q

What is the innervation to the ear

A
  • Greater auric (C2,3) - lower 1/2
  • ATN (V3) - tragus and crus
  • Lesser occipital Arnold’s nerve CNX - EAM
  • Jacobson CNIX - posterior EAC
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4
Q

What are antropometric landmarks/rules for the position of the ear

A

20’ off axis from line parallel to nasal dorsum Top of ear in line with lateral brow Bottom of ear in line with columella Ear should be one ear length behind lateral orbital rim Ear should protrude 1-2cm from skull with angle 20-25degrees at level of tragus

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5
Q

Describe the embryology of the ear

A

Ear development is divided into Inner and MIddle/External

Inner ear - ectoderm - otic placode->pit->otocyst-> semicircular canals, endolymph sacs, organ of corti

Middle extenal - derived from branchial structures 3wks->6mths

Branchial arch 1: Merckel cartilage (Incus Malleus), anterior hillocks (tragus, crus, helix)

Branchial arch 2: Recikert cartilage (stapes), posterior hillocks (antihelix, antitragus, lobule)

Branchial cleft 1: EAC and meatus

Branchial pouch 1: Eustachian tube

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6
Q

Classify congenital ear anomalies

A

Nagata classification

  1. Lobule-type microtia (no concha/meatus/tragus)
  2. Choncal-type microtia (includes concha/tragus)
  3. Small-concha type (less developed than type 2)
  4. Anotia
  5. Atypical microtia
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7
Q

Define microtia

A

defined as a small ear - includes spectrum of ear abnormalities from small ear to complete anotia

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8
Q

What is the epidemiology of congenital ear deformities?

A

M>F 3:2 Bilateral most common in syndromic cases R>L>Bi 6:3:1 Highest incidence in navajo and japan

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9
Q

What is the hereditary patterns of microtia?

A
  • variable penetrance or dominant/recessive traits - dominant inheritance for protruding, appendages/preauricular pits
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10
Q

What are associated abnormalities with microtia?

A
  • middle ear abnormalities (half of normal hearing)
  • congenital syndromes (TC, HFM, G, T18, BOR)
  • CN7 weakness
  • Branchial arch deformities**** (1/3)
  • Cleft lip/palate
  • CV, renal
  • Macrostomia
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11
Q

What congenital syndromes are associated with microtia?

A

MAINLY bilateral

  • Treacher collins
  • HFM
  • Goldenhar syndrome
  • Trisomy 18
  • Brachi-otorenal syndrome
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12
Q

What syndromes should you think of when you seen bilateral microtia?

A

TC HFM G T18 BOR

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13
Q

What are options for management of microtia

A

Non-surgical

  • camouflage
  • prosthesis

Surgical

  • autologous recon
  • alloplastic recon (silicone, medpor)
  • prefabricated engineered frameworks (remain experimental)
  • prothesis with OI implant
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14
Q

What are the ADv/Disad of autologous vs alloplastic recon vs prostheis w OII

A

Autologous - lower comx rate (exposure/infection) - multiple OR, donor site mrbidity Alloplastic - high exposure/infectionr ate - may eliminate chance of autologous recon Prosthesis - need replacements over lifetime

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15
Q

What are the difference between brent and nagat techqnieues for autologous microtia recon

A
  1. Timing
  2. # stages
  3. Cartilage harvested
  4. Suture material

BRENT

  • 4 stages, age 5-8
  • Contralateral rib 6-8, clear nylon suture

NAGATA

  • 2 stages, age 10 or chest circum >60cm
  • Ipsilat 6-9, steel wire
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16
Q

What are criticism of brent technique

A
  • too many stages(4)
  • poor definition concha, antitragal region
  • loss of auriculocephalic contour
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17
Q

What are criticism of nagata technique

A
  • chest wall defomirty
  • flap necrosis
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18
Q

Describe the 4 stages of Brent Technique (starts at age 5-8)

A
  1. Cartilage Harvested, Framework carved and positioned in pocket between dermis and TPF, ala, commisure, canthus used for position
  2. Lobule transposition with z-plasty
  3. Create auricolocepahlic sulcus with banked wedge and skin graft
  4. Tragus reconstruction with conchal graft from normal ear
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19
Q

Describe Nagata Technique (2stages, starting from 5-10yrs when chest circumf >60cm)

A
  1. Cartilage harvest, framework carved including tragus and placed, Lobule transposed.
  2. Create auriculocephalic sulcus with TPF flap
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20
Q

Describe Nagata framework

A

Multilayer

Base framework

+ Helix + crus helicis

+ Antihelix

+ Superior crus + Inferior Crus

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21
Q

Describe complications of autologous reconstruction for microtia repair

Study These Flashcards
A

EARLY

  • PTX
  • Wound dehiscence, skin flap loss
  • infection, hematoma, seroma
  • graft loss

LATE

  • chest wall deformity
  • malposition
  • framework resorption
  • poor scarring
  • suture/framework exposure
22
Q

What are your options for failed reconstruction

Study These Flashcards
A

1- Re-attempt autologous recon (excise scar, use TPF is not used by nagata techqnieue

2- prosthesis with or not OIimplant

23
Q

Classify congenital ear abnormalities

Study These Flashcards
A

1- Microtia

2- Prominent ear

3- Constricted ear

4- Cryptotia

5- Stahl’s ear

6- Preauricular tags/sinuses

24
Q

Define Ear Prominence

Study These Flashcards
A
  • Helical rim to mastoid distance at level of tragus >2cm
  • Conchoscaphal angle >35 degrees
  • Adequate helical rim/length (as oppose to constricted ear)
25
Describe the inheritance pattern/etiology
Variable penetrance of AD trait Due to high estrogen levels and cartilage plaibilty
26
Describe the pathophysiology of the prominent ear
1- Poorly develop anti-helical fold 2- Overly developed conchal wall 3- Combination of both
27
Describe Anatomic characteristis (5)
1. Poor definition of antihelix w flat superior crus 2. Conchal height excess 3. increase angle from helical rim to scalp 4. Scaphoconchal angle \>90 5. normal helical length
28
What do you manage ear prominence?
Non-surgical - camouflage - moulding \*\*\*initiate with 72hrs of birth to tak eadv of circulatinghormones Surgical - Antihelix manipulation (Mustarde, Stenstorm, Luckett or Converse-Wood) - conchal manipulation (Furnas Cm sutures) - Conchal excision
29
Describe technique for antihelix manipulation
1. Mustarde: recreate antihelix fold and reduce scophoconchal angle (posterior approach 2. Stenstrom: scoring anterior surface 3. Luckett or COnverse-wood: Full thickness excision
30
Describe technique for Conchal manipulation
1. Furnas: (CM sutures) Reduce of conchal prominence with excision of skin, postauric muscle and ligament and conchomastoid sutures 2. Conchal excision: used ofen in combo with furnas CM suture
31
Describe post-operative course after prominent ear correction surgery
Close f/u to assess for complications Head wrap/band for 3-6wksto protect during sleep/activity
32
What are complications of ear prominence correction surgery
EARLY - hematoma, infection, chondritis, necrosis LATE - poor scarring - recurrence - suture exposure - injury to GAN - sharp edges, poor correction
33
Define Constricted ear
Inadequate helical rim/circumference
34
What is a lop ear and cup ear
Older terms for Constricted ear - Lop ear: inadequate helical rim + missing scapha, poor antihelix - Cup ear: inadequate helical rim + poor antihelix+ deep concha
35
How do you classify Constricted ear?
Tanzer classification 1. Type 1 - Helix involved only 2. Type 2A - Helix and scapha invovled, sufficient skin 3. Type 2B - Helix and scapha involved, NOT sufficient skin 4. Type 3 - Helix, scapha and concha invovled, - some classify as microtia
36
How do you manage constricted Type 1 (Helical rim involved only)
Mark where normal Height of helix should be 1- Lid of extra skin excised 2- Prominent upper pole set back with scapho-mastoid suture
37
How do you manage constricted type 2A (helix and and scapha invovled with enough skin)
Deglove upper cartilage structures Cartilage graft for increasing helical rim
38
How do you manage constricted type 2B (helix and and scapha invovled with NOT enough skin)
- Split ear at middle 1/3 to open ear up - chondrocutaneous flap from conchal bowl for anterior defect and retroauricular skin for posterior skin defect created
39
How do you manage constricted type 3 (helix scapha antihelix concha invovled )
Reconstruciton as per microtia (too small of an ear - needs framework)
40
Defien Cryptotia
Upper pole of ear fails to stand out from head (helical rim is buried superiorly under temporal tissues ) - lack of fold superiorly)
41
What are anatomic characteristics of Cryptotia?
- buried superior pole of helix - scapha underdeveloped - sharp antihelix common in asians
42
How do you manage cryptotia
Non surgical - camouflage - early splinting Surgical - recreate auriculocephalic sulcus w zplasty, VY adv
43
Define Stahl ear
Deformity with a third crus traversing traingular fossa forcing rim up at the jx point
44
How do you manage stahl ear
non-surgical - splinting Surgical -direct excision/rotation and suturing
45
Define preauricular sinus/cyst
INcomplete fusion of 6Hillocks with extodermal invagination/entrapment Located anterior to EAC, at ascending crus of helix
46
How to do you manage preauricular cyst/fistula/sinus
Usually asymptomatic Conservative if no infection If symptomatic complete excision of sinus/tract + part of helical cartilage
47
Define preauricular tag
mound of epithelium pedunculated in preauric area Do not contian cartilage/bone and are not connected to ear structures
48
What syndromes/disorders are associated with preauricular tags?
BOR syndrome brachio-otorenal OAV syndrome oculoauriculovertebral
49
What are complications associated with OIimplants
CSf leak, open mastoid air cells skin irritation
50

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