the ear structure.ppt
- 1. EAR RECONSTRUCTION EAR RECONSTRUCTION 1 1/31/2024
- 3. OUTLINE OF PRESENTATION Relevant Relevant Historical embryology anatomy perspectives Pinnaplasty Partial Brent and total ear reconstruction and Nagata technique Complications EAR RECONSTRUCTION 3 1/31/2024
- 4. DEVELOPMENT OF AURICLE OR PINNA: AURICULAR HILLOCKS EAR RECONSTRUCTION 4 1/31/2024
- 5. CONGENITAL ANOMALIES OF EXTERNAL EAR EAR RECONSTRUCTION 5 1/31/2024
- 6. CONGENITAL ANOMOLIES EAR RECONSTRUCTION 6 1/31/2024
- 7. MICROTIA: MARX GRADING OF MICROTIA EAR RECONSTRUCTION 7 1/31/2024
- 8. Anotia Bat Ears EAR RECONSTRUCTION 8 1/31/2024
- 9. STAHL’S BAR CONSTRICTED EAR EAR RECONSTRUCTION 9 1/31/2024
- 10. BUMPS OR DARWIN’S TUBERCLE MACROTIA EAR RECONSTRUCTION 10 1/31/2024
- 11. CRYPTOTIA (HIDDEN EAR) Low Set Ears Only Lower 2/3rd of ear is visible EAR RECONSTRUCTION 11 1/31/2024
- 12. EXTERNAL EAR EAR RECONSTRUCTION 12 1/31/2024
- 13. ANATOMY OF PINNA EAR RECONSTRUCTION 13 1/31/2024
- 14. BLOOD SUPPLY EAR RECONSTRUCTION 14 1/31/2024
- 15. NERVE SUPPLY –SENSORY Greater auricular nerve Auriculotemporal nerve Lesser occipital nerve Auditory branch of vagus EAR RECONSTRUCTION 15 1/31/2024
- 16. Nerve supply: motor Motor: Posterior auricular branch of facial nerve EAR RECONSTRUCTION 16 1/31/2024
- 17. HISTORY 600 BC: Sushrutha, the ancient Indian surgeon reconstructed ear lobules using local flaps In 1597, Tagliacozzi used a pedicled flap for reconstructing a monk’s ear In 1920s and 1930s: Modern era in ear reconstruction; autogenous costal cartilage grafts described by Harold Gillies and Pierce respectively In 1950s: Ranford Tanzer laid foundation of current ear reconstruction Refined by contemporary surgeons ;Brent and Nagata EAR RECONSTRUCTION 17 1/31/2024
- 18. PINNAPLASTY –OBJECTIVES Elimination of protrusion in upper third of ear Helical fold should be parallel to antihelical fold Helix should have a smooth and regular contour Post-auricular sulcus should not be distorted Auricle should be an appropriate distance away from mastoid Difference between both auricles should be within 3 mm EAR RECONSTRUCTION 18 1/31/2024
- 19. PINNAPLASTY :METHODS CONSERVATIVE METHODS Simple moulding or splinting devices : up to 6 months old OPERATIVE TECHNIQUES At least two consultations with patient/parents and photographs are essential for pre-operative planning and for medicolegal purposes EAR RECONSTRUCTION 19 1/31/2024
- 20. FORMATION OF UNDER-DEVELOPED ANTIHELICAL FOLD Two techniques: Cartilage sparing/suturing technique (Mustarde’) Cartilage excising/scoring technique(Stenstrom) EAR RECONSTRUCTION 20 1/31/2024
- 21. FORMATION OF UNDERDEVELOPED ANTIHELICAL FOLD EAR RECONSTRUCTION 21 1/31/2024
- 22. CORRECTION OF CONCHAL BOWL HYPERTROPHY Furnas in 1968 Source:Atlas of Operative Otorhinolaryngology and Head and Neck Surgery: Otology and Lateral Skullbase Surgery (Volume 1)Bachi T Hathiram, Vicky S Khattar CHAPTER 1:The Surgical Technique Of Otoplasty EAR RECONSTRUCTION 22 1/31/2024
- 23. KAPLAN AND HUDSON TECHNIQUE FOR STAHL’S EAR EAR RECONSTRUCTION 23 1/31/2024
- 24. PARTIAL AND TOTAL EAR RECONSTRUCTION EAR RECONSTRUCTION 24 1/31/2024
- 25. EAR RECONSTRUCTION Three key measurements Appropriate angle of rotation for longitudinal axis Vertical level for upper border of ear Horizontal distance of ear from lateral orbital margin EAR RECONSTRUCTION 25 1/31/2024
- 26. EXTERNAL EAR ANATOMY: SIZE AND PROPORTIONS EAR RECONSTRUCTION 26 1/31/2024
- 27. EAR RECONSTRUCTION Indications Complexcongenital ear deformities ( microtia and anotia) and acquired deformities involving up to two- Congenital thirds of the ear Trauma (e.g. bites, avulsions and burns) and carcinoma EAR RECONSTRUCTION 27 1/31/2024
- 28. MULTIDISCIPLINARY MANAGEMENT Maxillofacial prosthetist Otorhinolaryngology Audiologist Radiologist Plastic surgeon Psychologist Speech and language therapist EAR RECONSTRUCTION 28 1/31/2024
- 29. GENERAL RECONSTRUCTIVE OPTIONS Stick on ear prosthesis Osseointegrated ear prosthesis Use of synthetic auricular frames Total autologous reconstruction EAR RECONSTRUCTION 29 1/31/2024
- 30. EAR RECONSTRUCTION- EVALUATION OF PATIENTS o o o Detailed history including age and thorough physical examination Medical history including antenatal history Family history : clue on any syndromic deformities EAR RECONSTRUCTION 30 1/31/2024
- 31. EAR RECONSTRUCTION: EVALUATION OF PATIENTS Size, nature and location of the ear defect or deformity Unilateral or bilateral Symmetry of size, shape, angle of reclination (rotation from the vertical) and elevation or projection of ear Availability and condition of local and regional vascularized tissues for soft- tissue reconstruction Availability and condition of donor conchal and costal cartilage for structural reconstruction EAR RECONSTRUCTION 31 1/31/2024
- 32. EAR RECONSTRUCTION :EVALUATION OF PATIENTS In unilateral deficits, key aspects of normal ear are measured Clinical photographs of both ears Audiology assessment Assessment by a Prosthetist, Psychiatrist Prosthetic options Patient expectations and preferences EAR RECONSTRUCTION 32 1/31/2024
- 33. SPECIAL INVESTIGATIONS AND PLANNING o o Doppler assessment of STA Chest xray for presence of and contour of costal margin 2D templates and 3D models important for planning Nagata has designed a series of standardized templates Source: Scott-Brown ORL&HNS volume 3, Plastic surgery EAR RECONSTRUCTION 33 1/31/2024
- 34. PRINCIPLES OF EAR RECONSTRUCTION SURGERY Partial ear reconstruction : replacement of cartilage, skin cover Costal cartilage : ideal for framework fabrication in total and subtotal partial ear reconstruction Alloplastic materials like shaped silastic and high density porous polyethylene implants EAR RECONSTRUCTION 34 1/31/2024
- 35. PRINCIPLES OF EAR RECONSTRUCTION SURGERY(CONTD..) Defects of skin only on medial surface Defects on skin of lateral surface Skin-cartilage defects and full-thickness defects Large, full-thickness middle-third defect involving helix/ antihelix EAR RECONSTRUCTION 35 1/31/2024
- 36. TIMING OF EAR RECONSTRUCTION Ability of child to cooperate with post-operative care By 5 years of age, child’s ear achieves 87% and by 12–13 years 98% of adult size Nagata: two stage reconstruction (after age of 10 years and horizontal chest circumference of ≥60 cm at level of xiphoid) Brent: three or four stage, at 7–10 years of age (childhood teasing) and until a substantial amount of costal cartilage available EAR RECONSTRUCTION 36 1/31/2024
- 37. PARTIAL EAR RECONSTRUCTION Upper third defects: involves helix, superior crus and superior antihelix and inferior Small skin-only defects : closed directly Medium-sized lesions : reconstructed with local skin flaps or converted to a full-thickness triangular excision and a closing chondrocutaneous wedge performed Large defects : benefit from reconstruction with cartilage graft EAR RECONSTRUCTION 37 1/31/2024
- 38. PARTIAL EAR RECONSTRUCTION: UPPER THIRD EAR RECONSTRUCTION 38 1/31/2024
- 39. RECONSTRUCTION OF EAR- UPPER THIRD EAR RECONSTRUCTION 39 1/31/2024
- 40. PARTIAL EAR RECONSTRUCTION Peripheral middle-third defects: options Direct closure / Wedge excision and closure Local or regional skin flaps Helical and conchal chondrocutaneous advancement flaps e.g. Antia-Buch flap Cartilage graft in combination with a local or regional flap e.g. Dieffenbach flap EAR RECONSTRUCTION 40 1/31/2024
- 41. PARTIAL EAR RECONSTRUCTION Figure. Antia-Buch helical chondrocutaneous advancement flap EAR RECONSTRUCTION 41 1/31/2024
- 42. PARTIAL EAR RECONSTRUCTION EAR RECONSTRUCTION 42 1/31/2024
- 43. PARTIAL EAR RECONSTRUCTION Lower-third ear defects: affect earlobe and antitragus Cartilage excision and direct closure or local transposition flap For earlobe reconstruction: skin graft - less aesthetic, graft contracture So, cartilage batten graft inserted in a subcutaneous pocket deep to the flaps in case of lateral defects of earlobe EAR RECONSTRUCTION 43 1/31/2024
- 44. PARTIAL EAR RECONSTRUCTION Conchal defects Partial defects: full thickness skin grafts Complete defect: Swinging Trapdoor flaps Defects up to 1.5cm wide Can be excised as a wedge and closed directly in an adult sized ear EAR RECONSTRUCTION 44 1/31/2024
- 45. PARTIAL EAR RECONSTRUCTION EAR RECONSTRUCTION 45 1/31/2024
- 46. AUTOLOGOUS TOTAL EAR RECONSTRUCTION Key steps 1.Identifying and marking the ideal site for new ear 2. Making a 2D template and/or a 3D model for cartilage framework 3. Planning of soft-tissue cover at the ideal site for new ear 4.Harvesting of costal cartilage 5.Removal of remnant fibrocartilage in microtia or deformed cartilage EAR RECONSTRUCTION 46 1/31/2024
- 47. AUTOLOGOUS TOTAL EAR RECONSTRUCTION Key steps (Contd..) 6.Dissection and preparation of skin and/or fascial flaps to receive cartilage framework 7.Formation of costal cartilage framework 8. Insertion of framework and inset of overlying soft tissues 9. One or more further stages of ear reconstruction, including framework elevation EAR RECONSTRUCTION 47 1/31/2024
- 48. AUTOLOGOUS EAR RECONSTRUCTION Costal cartilage for framework fabrication is harvested from the costal margin Amount of cartilage required is estimated from features of template or model (3 or 4 costal cartilages are used, including an area of synchondrosis from the 6th and 7th costal cartilages) When harvested without perichondrium, the form of the costal margin may be restored by returning diced unused cartilage into the perichondrial sleeves EAR RECONSTRUCTION 48 1/31/2024
- 49. BRENT TECHNIQUE OF EAR RECONSTRUCTION EAR RECONSTRUCTION 49 1/31/2024
- 50. NAGATA TECHNIQUE OF EAR RECONSTRUCTION EAR RECONSTRUCTION 50 1/31/2024
- 51. NAGATA TECHNIQUE OF EAR RECONSTRUCTION EAR RECONSTRUCTION 51 1/31/2024
- 52. COMPARISON OF BRENT AND NAGATA TECHNIQUES EAR RECONSTRUCTION 52 1/31/2024
- 53. COMPLICATIONS OF EAR RECONSTRUCTION Early complications Late complications Hematoma, pain, infection Perichondritis Cartilage and soft tissue necrosis Problems with sutures Keloids and hypertrophic scars Hypoesthesia, cold susceptibility Alopecia along scalp incision scars Undercorrection and asymmetry Unsatisfactory results Pneumothorax due to costal cartilage grafts harvesting EAR RECONSTRUCTION 53 1/31/2024
- 54. Sometimes, it feels good to be different ....Thank You! EAR RECONSTRUCTION 54 1/31/2024
- 55. REFERENCES 1. 2. 3. 4. 5. Scott-Brown’s Otorhinolaryngology Head and Neck Surgery 8th Edition, volume 3, Plastic surgery Scott-Brown’s Otorhinolaryngology Head and Neck Surgery 7th Edition, volume 3, Plastic surgery Stell and Maran’s Textbook of Head and Neck Surgery and Oncology 5th Edition Dhingra’s Diseases of Ear, Nose and throat & Head and Neck Surgery 7th Edition Atlas of Operative Otorhinolaryngology and Head and Neck Surgery: Otology and Lateral Skullbase Surgery (Volume 1)Bachi T Hathiram, Vicky S Khattar 6. Auricular reconstruction Nagata Method EAR RECONSTRUCTION 55 1/31/2024
Editor's Notes
- #3: Mursi tribe of ethiopia
- #5: Development of Auricle i. By the end of 4th week, the auricle develops from 6 mesenchymal proliferations (hillocks) of 1st and 2nd pharyngeal arches, surrounding the first pharyngeal cleft. ii. These swellings (auricular hillocks), three on each side of the external meatus, later fuse and form the definitive auricle. iii. As fusion of the auricular hillocks is complicated, developmental abnormalities of the auricle are common. iv. Initially, the external ears are in the lower neck region, but with development of the mandible, they ascend to the side of the head at the level of the eyes. v. Because of its association with the pharyngeal arches, the external ear is a sensitive indicator of abnormal development in the pharyngeal region. Other anomalies of the first and second arches are often attended by abnormally located external ears (Figures 24 & 25).