Summary Background Successful reconstruction of microtia involves fabrication of a cartilaginous framework and provision of thin, durable, soft tissue cover. Vascular compromise of this skin envelope can lead to exposure of the underlying cartilage, resulting in cartilage resorption and distortion of the final form of the ear construct. We describe our algorithm for management of this complication. Methods All patients who underwent autologous ear reconstruction by a single surgeon (NWB) from April 2006 to September 2012 were retrospectively reviewed to identify any that developed exposure of the underlying cartilage framework. Details related to timing, location, size and management of the cartilage exposure were collected. Results From a total of 230 autologous auricular reconstructions (median age at first stage, 11.4 years), 15 exposures of the cartilage framework were identified. All exposures occurred following the first stage of reconstruction (mean of post-operative day 29, range, 7–86 days). Large areas of exposure (> 10 mm2) required surgical management, with debridement and coverage with either a cutaneous or fascial flap, depending on the location. Areas  Conclusion Cartilage exposure following autologous microtia reconstruction can be a devastating complication if not addressed in a prompt and effective manner. The management strategy we propose provides a concise algorithm to guide the treatment of cartilage exposure. Level of evidence Therapeutic, grade III.

Cartilage exposure following autologous microtia reconstruction: An algorithmic treatment approach✰.

In the multidisciplinary management of patients with inner ear malformations (IEMs), the correct diagnosis makes the differences in terms of clinical and surgical treatment. The complex anatomical landscape of the inner ear, comprising several small structures, makes imaging of this region particularly challenging for general radiologists. Imaging techniques are important for identifying the presence and defining the type of IEM and the cochlear nerve condition. High-resolution magnetic resonance imaging (MRI) sequences and high-resolution computed tomography (HRCT) are the mainstay imaging techniques in this area. Dedicated MRI and HRCT protocols play an important role in the diagnosis and treatment of patients with inner ear disease. The most suitable technique should be selected depending on the clinical setting. However, in cases of congenital malformation of the inner ear, these techniques should be considered complementary. Since prompt intervention has a positive impact on the treatment outcomes, early diagnosis of IEMs is very important in the management of deaf patients. This article reviews the key concepts of IEMs for clinical radiologists by focusing on recent literature updates, discusses the principal imaging findings and clinical implications for every IEM subgroup, thus providing a practical diagnostic approach.

/pdf/imaging-of-inner-ear-malformations-a-primer-for-radiologists-43pe3ls999.pdf

Imaging of inner ear malformations: a primer for radiologists

Resume Objectifs Le traitement des deformations auriculaires par conformation externe est possible si celui-ci est entrepris precocement, idealement avant la sixieme semaine de vie. La persistance de l’impregnation des hormones maternelles durant les six premieres semaines de vie permet de maintenir les cartilages malleables. Ils peuvent ainsi etre conformes dans une nouvelle position. Apres la fin de cette impregnation hormonale, les cartilages se rigidifient progressivement dans une position donnee. Materiel et methodes Tous les enfants de moins de 6 semaines de vie presentant des deformations d’oreilles isolees entre juillet 2015 et juillet 2016 ont beneficie d’un traitement neonatal par conformateur externe de type EarWell© ou realise sur mesure avec du silicone. Le dispositif etait retire lorsque l’enfant avait 6 semaines et une duree de traitement d’au moins 4 semaines. Un suivi de 6 mois minimum etait realise pour evaluer le resultat. Resultats De juillet 2015 a juillet 2016, 42 oreilles deformees ont pu etre traitees chez 38 nouveau-nes. L’âge moyen de la pose etait de 2 semaines de vie avec une duree de traitement de 5 semaines. Le resultat immediat etait evalue par les parents comme excellent dans 81 % des cas avec une oreille jugee comme « normale » et par le chirurgien evaluateur comme excellent dans 75 % des cas. Il n’y a pas eu de complications majeures. Conclusions Le traitement des deformations d’oreilles par conformation externe s’est revele etre efficace dans 75 a 81 % des cas. Il s’agit d’un traitement non-invasif qui permet d’eviter un traitement chirurgical ulterieur pour la majorite des patients.

Anomalies congénitales de l’oreille externe : traitement néonatal par conformation

Background: Group IIB constricted ear is described as a deformity of helix, antihelix, and scapha (deficient upper third of ear). The length of the ear is markedly shortened, and the skin cover is insufficient to cover the cartilaginous framework after refashioning. The current study described certain modifications to the known autologous auricular reconstruction technique to adapt specific anatomical features of severe group IIB Tanzer constricted ear and reviewed the postoperative surgical outcomes and complications. It also evaluates the postoperative patient satisfaction. Methods: A prospective study includes 20 patients who underwent modified autologous reconstruction using costal cartilage for unilateral severe grade IIB constricted ears in the period between October 2018 and November 2021. Mean follow-up period was 6 months. Satisfaction was recorded using a questionnaire form 4 months after second-stage surgery. Results: Patients reported excellent (n = 14) and good (n = 7) results. According to a four-point Likert scale, the average aesthetic outcome score was 3.8. No complications were recorded, except in one patient who shows postoperative collection. The helix, concha, and lobule were the most satisfying parts to patients. The least pleasing subunit to patients was the antihelix. All patients were satisfied with the elevation of the auricle. They reported symmetry in size, shape, and position in 14 of 20 (70%) patients. Conclusions: Modified autogenous auricular reconstruction is useful in correcting severe group IIB Tanzer constricted ear deformities. Because it addresses all the anatomical features of this deformity, this technique is reproducible and reliable and has offered consistently effective results.

Modified Reconstruction Technique to Adapt Management of Severe Group IIB Tanzer Constricted Ear Deformity

The creation of multi‐tissue auricular transplants for the treatment of microtia is a challenge due to the complex and layered structure of this anatomical tissue. A novel casting technique for the 3D biofabrication of heterogeneous, multi‐layered, and human‐scale tissue transplants using eluting agarose molds is presented. The molds are generated by casting agarose into custom 3D‐printed containers, termed metamolds, optimized to facilitate the hydrogel casting process based on geometric and topological constraints. Casting yields high resolution (50 µm) and allows for subsequent casting of further hydrogel layers on the transplant. Multi‐layered auricular constructs are fabricated on a cartilage core consisting of a hyaluronic acid‐alginate double network and an adjacent gelatin‐based dermal layer. Bonding between adjacent layers is achieved by orthogonal physical and enzymatic crosslinking of residual functional groups between each layer. Material composition and culture duration are optimized for each layer allowing for maturation into cartilaginous and pre‐vascularized dermal tissues. To demonstrate the scalability of this technique for the biofabrication of human‐sized transplants, bi‐layered human‐sized ears are cast. Overall, this novel casting technique offers a promising approach for the fabrication of complex tissue grafts, overcoming the limitations of other traditional biofabrication methods.

Biofabrication of Heterogeneous, Multi‐Layered, and Human‐Scale Tissue Transplants Using Eluting Mold Casting

Resume La reconstruction des malformations complexes de l’oreille est l’une des techniques chirurgicales les plus longues a maitriser, car il faut a la fois une analyse precise de la malformation, du potentiel cutane, ainsi qu’un long apprentissage de la sculpture des reliefs complexes de l’oreille. Les petites anomalies peuvent etre prises en charge par tout chirurgien plasticien, mais la encore il faut bien connaitre tous les raffinements techniques de la chirurgie de l’oreille. Nous faisons ici le point sur 30 ans d’experience en reconstruction auriculaire, allant des petites anomalies a la microtie (2500 cas), en excluant les variantes esthetiques que sont les oreilles decollees.

Malformations de l’oreille

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Malformations de l’oreille