Date post: | 16-Apr-2017 |
Category: |
Health & Medicine |
Upload: | ajay-manickam |
View: | 305 times |
Download: | 2 times |
DEFECT BASED RECONSTRUCTION : EAR
Dr. Ajay ManickamJunior Resident ENT & Head neck surgeryR. G. Kar Medical College
The Auricle
The complex 3 dimensional shapes of any human appendages – skin & cartilage
Emotional & psychological distress
The auricle
Cosmetically important structure
History
Susruta reconstructed ear lobules using local flaps 600BC
Autogenous costal cartilages – modern era – Harold Gillies 1920
Ranford Tanzer 1950 laid foundation for current ear technique.
Anatomy
Blood supply (1) posterior branch of superficial temporal artery & (2) posterior auricular artery
Anatomy of periauricular area – most important
Anatomic axis of the ear
Ear anomalies
Congenital Acquired
Congenital ear anomalies
Tanzer’s classification
Cosman’s classification
Anotia Complete hypoplasia Hypoplasia of middle
third of auricle Hypoplasia of superior
third of auricle Prominent ears
Lidding Smaller ear Low ear position
Reconstruction of ear
Stick on ear prosthesis Osseo integerated ear prosthesis Use of synthetic auricular frames Total autologous reconstruction
Stick on ear prosthesis
Prosthetic pieces attached using skin adhesives
Limitations – may not attach strongly in mean time, skin reaction
Osseontegerated ear prosthesis Pliable silicone –
shaped & colour matched with opposite ear
Anchorage by bone anchored osseointegerated titanium plates
Limitations – daily cleaning, risk of local tissue unflamation
Synthetic auricular frames Synthetic frame used to recreate shape of ear Frames burried in subcutaneous pocket or
covered with superficial temporal fascia Silicone or PTFE Better success with temporalis fascia flap Significant risk of infection
Total autologous reconstruction
Ear frames from autologous costal cartilage
Burried in subcutaneous pocket or temporalis fascial flap
Popular methods are BRENT and NAGATA
Microtia
Nagata’s classification
Lobule type Concha type Small concha
type Anotia Atypical
microtia
Microtia repair
Brent technique Nagata technique 5 years of age Four stages 6th, 7th, 8th, costal
cartilages harvested Nylon sutures Auricular projection
involves only skin graft
10 – 12 years of age Two stages 6th, 7th, 8th, costal
cartilages harvested Stainless steel sutures Auricular projection
involves cartilage wedge sup temporal artery flap
Acquired ear defects
Partial defects – direct closure, local tissues, autologous reconstruction
Total defects – congenital total defect Skin only defects – full thickness skin
flap, local flaps
Reconstructive options
Upper third – local flaps – VY technique . Post auricular flap defects involving helical rims
Middle third – Antia Buch reconstruction & dieffenbach flap
Lower third – lobule. Local flaps are used
Defects of the concha – trapdoor flaps
Defects upto 1.5cm wide can be excised as a wedge and closed directly
Upper third local flaps
VY flaps – helical rims or marginal reconstruction defectPedicled flap based on post auricular artery
Middle third
We can use post auricular artery based flapsDieffenbach flap – staged reconstruction of pinnaAntia buch advancement flap – incorporates chondrocutaneous segment – but smaller ear
Lower third
Local flaps are used one or two stage procedure Often Non anatomical cartilage graft can give support for reconstructed ear lobule
Defects of concha
Trapdoor flaps are used for this purpose
Flap is inset after tunnelling through post part of the auricular defect
Partial ear defects
Local flaps , skin only flaps may not deliver best results
Bespoke cartilage frames are increasingly used in reconstruction.
Cartilage framework for pinna reconstruction upper 1/3
Middle third recontruction
Conclusion
There is yet no ideal alloplastic implant
Scalp skin grafts provide best texture and colour match
Costal cartilage provide best framework reconstruction
Thank you