OtoplastyRobert Saunders

Pg 748

Anatomy: Pinnae

Anatomy Thoracic Area

PhysiologyExternal ear directs sound into external acoustic meatus.

Pathophysiology

● Any defect or Deformity● Microtia: Congenital absence of all or part of

the ear● Prominent Ears: Pinnae abnormally protruding

from sides of the head. Usually caused by inadequate folding or absence of the antihelix. Causes scapa and heliod ring to protrude out.

Diagnostic ExamsH&P

Standard X-ray

X-ray film or sheet is placed over ear to trace outline. This serves as a template for the new ear in microtia patients. Must be sterilized and available during surgery.

Surgical InterventionAnatomically positioning or reconstructing the ears to appear naturally proportionate and contoured with little to no evidence of surgery.

Special ConsiderationsIdeal time to perform procedure is before patient starts school

Microtia may require several separate surgical procedures focusing on one aspect of the pinnae at a time. Earlobe, separating reconstructed pinna from head, tragus. 1st step is costal cartilage graft.

Microtia procedures can be lengthy and require 2 setups, one on ear, other on costal cartilage removal and shaping.

Separate space set up for cartilage graft shaping in microtia procedure, could be prep stand, or back table.

AnesthesiaGeneral on pediatrics

Local with MAC on adult patients

PositioningSupine, arms at side, head in donut affected side up. Opposite ear padded well, since these procedures can sometimes be long.

Skin PrepNeck to Shoulder

External Ear

Around external Ear

Go as far lateral as you can

*Avoid pooling in eyes or ear canal, cotton ball can be inserted in ears to prevent this

DrapingHead wrap/turban, leaving ear(s) exposed

Fenestrated ear drape

U drape or Split Sheet

Incisions● Intercostal and usually postauricular in

microtia● Posterior elliptical incision on ear for

prominent ears

Microtia Supplies, Equipment, InstrumentsPlastic instrument set

Minor ortho set

Headrest

Marking pen

ESU

Thoracotomy Instrument Set

X-ray film

Bulb Syringe

Pediatric Chest tubes, various sizes

Chest Drainage system

Power drill

Burs

Topical thrombin

Local Anesthetic w/ epi

Procedure Steps: Microtia Intercostal portion1. Costal Cartilage site for graft is

marked, usually take 6, 7, 8 or 9th space

2. #15 blade intercostal incision3. Rib segment removed using

template for shape, perichondrium preserved

4. Pleura checked with saline from bulb syringe. If bubbles appear, immediately obtain a chest tube of desired size for insertion and attachment to chest drainage system. No bubbles, close wound.

Procedure Steps: Microtia Auricle reconstructionSurgeon forms graft with template, drill, burs, and suture on table. Wrap in saline soaked sponges, keep on back table till needed.

Procedure Steps cont.● #15 blade postauricular incision● Temporoparietal fascia elevated,

graft inserted.● Skin pulled over & sutured,

hemostasis maintained several ways like esu, thrombin, local anesthetic with epi

● Bulky dressing

https://youtu.be/tqd1WNNYFIs?t=110

Prominent Ears Supplies, Equipment, InstrumentsPlastic instrument set

Minor ortho set

Headrest

Marking pen

Esu

25-gauge needles

Methylene Blue

Cotton-tipped applicators

Mineral oil

Procedure Steps: Prominent Ears due to Absence of Antihelical Fold

1. Surgeon bends ear back with finger to make Antihelical Fold

2. Fold marked anterior to posterior with 25-gauge needle tipped with methylene blue. Tech responsible for methylene blue application with cotton tip applier when needle is through ear exposed on posterior side. 3-4 marks are done.

Procedure Steps cont.1. #15 blade, elliptical portion

of skin from posterior ear excised.

2. Cartilage incised near new antihelical fold, anterior surface scored to allow the cartilage to bend backward.

3. Several sutures placed to hold anatomical position of cartilage

4. Close with suture, bulky dressing applied.

CountsMicrotia intercostal portion:

● Initial ● Subcutaneous● Final

Microtia ear portion:

● Initial ● Final

Prominent Ears:

● Initial● Final

Dressing MaterialBulky dressing with petrolatum gauze, several fluffs, all held in place with rolled gauze on ear

4x4’s and tape on intercostal incision

Specimen CareSkin sent to pathology

Prognosis1-2 days close hospital observation

Bulky dressing worn for several days, avoid excessive pressure on ear

After dressing removal, loose headband is worn when sleeping for 3-6 weeks. This keeps the ear from being pulled forward

ComplicationsPost op SSI

Hematoma

Overcorrection or unnatural contour

Suture complications like extrusion, sometimes associated with granulomas

Death

Wound ClassClass l

Works CitedSurgical Technology for the Surgical Technologist, 4th edition

http://doctorlib.info/surgery/plastic/27.html