External ear- development
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External ear development occurs between weeks 5-8 of gestation. Congenital ear deformities can include malformations of the outer and middle ear, which make up 70-90% of cases. Ear pits and cysts are the most common type of malformation and are often bilateral or multiple. Pinna malformations are classified using the Weerda system. Cup ear deformities involve underdevelopment of the helix, antihelix, or entire upper pinna. Surgical techniques to correct prominent ears include scoring or reshaping cartilage and setting back the concha. Cryptotia involves loss of the upper auricular sulcus and is treated by creating a new sulcus. Secondary procedures may be needed to prevent over
External ear- development
- 4. Week 5 -> Week 8
- 13. • Malformations of ENT - 50% is Ear. • Malformations of the outer and middle ear - 70-90% • Right side - 58-61% • Incidence of ear malformations is - 1:3800 • Incidence of outer ear malformations - 1:6000 to 1:6830 newborns • Prevalence of microtia - 3:10,000
- 14. Ear pits and ear cysts • lined by squamous or respiratory epithelium • in preauricular location • often bilateral or multiple
- 15. • Type I – “duplication” of EAC normally lined by skin – postauricular > preauricular – run parallel to EAC and usually end blindly lateral or superior to facial nerve. • Type II – true EAC doublings, lined by skin + cartilage – Open in EAC and in front of SCM muscle. – can cross over or under the facial nerve. – can also open behind the ear
- 26. • Type I: only the helix. longitudinal axis of pinna is slightly shortened • Type IIa: hood-like overhang of helix accompanied by flattening or absence of superior crus and pronounced inferior crus of antihelix • Type IIb: antihelix flattened • Type III: underdevelopment of upper pinna with extreme overhanging
- 27. Surgeries: 1. Cartilage incised in zig-zag fashion to expand it once the skin has been peeled off the rim. 2. Series of radial incisions and to splint them open with a cartilage graft. 3. V-Y plasty at root of helix combined with undermining of adjacent skin. 4. Formal reconstruction (carved costal cartilage framework)
- 28. Tags • lesion involves only skin • long tail of cartilage • Preauricular • excision of the skin tag and cartilage spindle • apply a Liga clip
- 30. Mirror ear or polyotia skin is peeled off the extra-auricular tissue and protruding cartilage remnants are trimmed. The trimmed cartilage fragments are packed into the anterior conchal hollow and then the skin of the extra ear is redraped
- 31. Abnormal folds (Stahl's bar)
- 32. 1. direct wedge excision of the Stahl‘s bar (skin and cartilage) 2. splint
- 34. Prominent ('bat') ears • Due to – an absent antihelical fold – conchal bowl is excessively deep – Prominent lobe or antitragus
- 36. • Surgical techniques to remould cartilage: – anterior scoring – reshaping of curves by use of posterior sutures (to emphasize the antihelical fold or to setback concha) – Excision techniques to set back the concha • Age of five years
- 41. thin indented rim cartilage is re inforced with a cartilage graft and rim is splinted
- 42. Cryptotia (the hidden ear) • Only lower two-thirds of an ear is visible • Upper auricular sulcus seems lost • a small Ear Buddies (to create the upper sulcus) • revision procedure
- 44. Secondary procedures 1. Over-correction 2. Visible cartilage irregularities or unnatural contours 3. Unpleasing shape of the ear (e.g., telephone ear, protruding lobules) 4. Under-correction, usually of the upper pole of the ear.
- 45. References • Plastic surgery. Neligen. Vol II • Scott Brown’s otorhinology, head & neck surgery. Vol I • Development of the Human External Ear. C. Gary Wright. J Am Acad Audiol (1997) • Classification and diagnosis of ear malformations. Friedrich, Wolke. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2007