Congenital ears are cosmetic deformity, which may have serious emotional and behavioral impact on the child. Otoplasty is a description of procedures to give the ear a more natural appearance and anatomy.
The history of the procedure
In 1845, Dieffenbach described correction of traumatic ear deformities. In 1881, first described Ely otoplasty.1 performed cosmetic wedge excision of full thickness skin and cartilage of the conchal bowl to reduce the size of the ear. Throughout 1890, many of the skin and cartilage cutting techniques, to reduce the visible scars, have been used by Keen, religious and Cocheril. These procedures were most advanced in the first two years of the 20th century by Morestin who cut fragments elliptical skin and cartilage in 1903, Luckett, who tried to play antihelix in 1910, 2, and Kölle, who helped launch the elastic "shell ear" by the linear incision in 1911.
Over the next 20 years, tissue transplantation has become common practice, however, according to Alexander (1928), Demel (1935), and Eitner (1937), each used excisions conch cartilage Sharp performance and wrinkles skin often remains.
In 1940, Erich new mattress sutures and used to maintain the stability of the anti-helix and found that shaving the cartilage was cut and all the relevant passages. Mustard technique, which uses permanent sutures to maintain the best vintages, has gained popularity in the 1970s because of efficiency.3 use of permanent sutures to recreate antihelix remains in practice and not resection soft tissue postauricular to correct deformities of the ears. Most surgeons now perform cartilage savings nasal cartilage, which is incised or removed to achieve the folding of natural cartilage.
ears not to harm the image of the baby itself, until the child is older than 5 or 6 years, and the operation Lop ear deformity is best done before that age. In contrast, adults often have the nose for a long time to resolve defects. Before surgery, patients tend to style their hair to camouflage deformities. After surgery, patients often feel comfortable enough to wear short hair combed or backward.
Five percent of Caucasians are affected. ears are genetic, 59% of those affected have a family, and the transmission is autosomal dominant with variable penetration. Since the inner ear develops independently of the ear, ears in patients with normal hearing generally, but other malformations (especially urogenital) may be present.
The headset is developing in the uterus during weeks 6-16. Its six hills of first and second branchial arch. Most authors consider, first, second and third hills result from the first arc, and the hills are 4.6 arcsec. Streeter said that the first arc of hills that do not contribute to the tragus, crus helices, and the propeller, and the second arc is responsible for about 85% auricle.4
The chalet is fully formed at birth. 85% of adults aged 3 years and is nearly adult size was 5 or 6 years. The age of the unit, the extension of the graft seems to be a growth of the ear.
Streeter said that the shape of the ear is up and undistorted by submitting process.4 8-12 weeks during pregnancy, the propeller is growing and overhangs antihelix. Despite Streeter theory, most embryologists believe scroll antihelical develops in the next four weeks, medializing rim spiral. Scroll to the helical rim develops during the sixth week.
ears can be in many forms, the ear of the cup, shell ear, bat ear, Machiavellian ear Lop ear. Many patients try to conceal the deformation of the hair.
questioning patients about excessive bleeding, poor wound healing, and keloid. The patient should be seen as intellectually and emotionally mature to collaborate with the regime postoperatively.
Conduct a comprehensive assessment of the ear. Asymmetry and irregularities must be noted and discussed with the patient. The ears should measure 5-6 cm in height and the longitudinal axis must be installed at approximately 20 ° to the vertical. The headset must depart from the occipital head on no more than 35 °. Antihelix should be 75-105 ° angle between the skull and Concha scaphoid. Baja wines is generally well developed, but the common upper branches may be affected. Isolated upper limb hypoplasia superior results in the field of deformation, if the common branch also affects the entire ear appears lateralized.
The most common malformations in the ears is poorly antihelical over 90 degrees, there is often significant lateral projection bowl shell. additional strain field may contain a higher strain, a fragment of a nodule or head Darwinian.
The assessment, measurement and ear lateralization document. Document and demonstrate asymmetry patients pre-existing between the ears of the size, shape and location. Helix deformation of the contour to evaluate and assess its importance in the upper pole, middle part, and just above the fold. Antihelical examine the branches folding top, bottom, and often. lateral edge of the payment must be appropriately positioned in the plane of the spiral. Displaying the trap may be due to excess skin and tail medial Helicis earlier, the lack of identifying and correcting this mistake can ruin otherwise perfect result of the operation. Conchal sidewalls may extend excessively and may cause excessive lateralization of the helix and the helix, despite adequate antihelical done.
Take pictures before preoperative standard, sideways and diagonally. In addition, for the bird eye top and / or rear views can help document the lateralization. Close-up images and oblique lateral may be useful for analyzing the deformation of the individual in each ear.
Blepharoplasty is designed to correct ears that extend more than 20 mm, an angle greater than 35 ° since the occipital headache. One or more sub-units earache can be managed.
The headset is within the cartilage structure fibroelastic connective tissue and skin, and on the sides of the skin. Headset normal about 6 cm vertically. the helical rim is generally 12-20 mm of the apophysis of the head.
The headset is a complex structure in three dimensions (see figure below). the helical rim is smooth, curved arc extending forward of the propeller raw. This structure divides the bowl of the conch horn horns cymba top of the uterus and the worst. Helix is separated from the Concha helix, less than a structure that divides the upper and lower legs. Trough between the helix and scaphoid antihelical is lower, while between the two branches called the bottom triangularis antihelix. Below, two small growths in the form of cartilage tragus and separated intertragica antitragus indentation. Helicis tail extends backwards and antitragohelicina antitragus fissure separating the two.
Number of muscles insert into the cartilage of the ear. These muscles are rudimentary in most people. Superior auricular muscle inserts on the posterior surface of the bottom of the triangle. Atrial muscle joins the back of the ear to the mastoid process, while the number of muscles poorly developed internal (eg, atrial oblique, transverse, antitragal, tragus, major and minor muscles helical) are about front and back of the ear cartilage.
the blood supply to the ear behind the ear (posterior auricular surface) and surface weather (anterior auricular surface) arteries, which are branches of the end of the external carotid artery. sensory innervation auriculotemporal (V3) and the great auricular (C3), nerves, nerve of Arnold (CN X), and branches of the facial nerve (CN VII). lymphatic drainage to preparotid, occipital and high cervical ganglia.
Nose surgery is cons-indicated in all patients with unrealistic expectations. Patients should receive appropriate preoperative counseling. Describe the existing asymmetries of the face, and emphasizes that restore balance to the facial anatomy is the goal of each operation. Patients unable or unwilling to cooperate with postoperative care are not candidates for surgery. Counselling patients with a history of hypertrophic scars or keloids, they can occur after the nose, perhaps distorting the otherwise excellent result of the operation.