Correction of Constricted Ear

The constricted ear was suggested by Tanzer for the purpose of obviating the confusion involving lop ear, cup ear and prominent ear as defect whose helix turns down, and scapha and fossa triangularis are narrowed. The constricted ear has a spectrum of severity and therefore, requires a graded surgical approach. Tanzer has described the degree of deformities of the constricted ear as falling into three groups. For the correction of constricted ear, there are numerous techniques but we have had difficulties in adopting these techniques in various type. We also describe the various constricted ear as the Tanzer's classification and adopted three methods to each type, banner flap(group I), concha cartilage graft (group II) and rib cartilage graft(group III) for reducing postoperative deformity and confusion in correcting the ear deformities. Constricted ear repairs must be individualized to accomodate each specific deformity. We corrected 22 cases of constricted ear in 20 patients using each optimal method described above according to the degree of deformities. Mild deformities need only reshaping and adjusting of existing tissues, moderate deformities need additional skin and severe deformities require a cartilage graft. For correction of constricted ear, accurate identification of the severity of deformity is essential. The results were satisfactory and we report our experience with relative literatures.

Double Eyelid Operation with Three Tiny Incisions

There are numerous noninvasive buried suture methods available to make a double eyelid, such as, fixation with skin and pretarsal tissue, fixation with skin and conjunctiva through the tarsal plate and the sling technique, which goes between the levator and Muller muscle and subdermal tissue. But these methods have some shortcomings and many operators are concerned for preventing the double fold to lower and to fade away in puffy eyelid. Because, in puffy eyelid, the excessive orbital fat may migrate to the area of fixation and it jeopardizes the effect of suturing. So, We tried to change the thick and puffy eyelid to the slim eyelid by selectively removing soft tissue(pretarsal fat, muscle, orbital fat) through the three tiny incisions. Ninety-five patients underwent operation for creation of a double fold between January of 1996 and February of 1999. All were female. The patients' age ranged from 16 to 31 years, with the mean of 22 years. Most of our patients were satisfied except 5 cases with minor complication(mild asymmetry: 4 cases, foreign body granulation: 1 case). Our method is very similar to various nonincisional methods, however, we removed a portion of pretarsal tissue, muscle, and/or orbital fat around three small incision sites to facilitate tissue adhesion. A continued modification in nonincisional method and improvement in results for double eyelid operation can be expected.

Tragus formation by chondrocutaneous flap in reconstruction of microtia

Tanzer reported microtia reconstruction using autogenous costal cartilage, thereafter so many plastic surgeons have tried various modification to get further refinement of reconstructed auricle. But the multiple stages of ear reconstruction required prolonged hospitalization and cost. In order to decrease the number of surgical stages and for the maximal convolution, we have employed a surgical procedure with three layered costal cartilage graft for the high profile auricle, concha formation and lobule transposition at the same time. However, it has still been difficult to reconstruct the tragus in cases of microtia that lack such component. We reconstructed the tragus using part of the microtic ear in addition to our above procedure simultaneously. This procedure is started with transposition of the lower two-thirds of the microtic ear to make lobule and then the upper third of the microtic ear is elevated as a chondrocutanenous flap which is then transposed 120-180degree C downwards to reposition at the area anterior to the conchal cavity. Using this technique, we have reconstructed 28 microtic ears. Adequate positioning of the auricle and tragus have been achieved and a more natural auricle obtained.

Reduction mandibular angleplasty assisted by c-arm fluoroscopy

The prominent mandibular angle is one of the disfiguring features in the Oriental, commonly seen and considered to be unattractive. Because it gives a square and muscular facial appearance, its surgical correction is dine frequently as a modality of facial contouring surgery in the Oriental. The reduction mandibular angleplasty is not a simple surgical technique for the unexperienced surgeon. We adopted C-arm fluoroscopy as a method of identifying the osteotomy line for the beginners. The reduction mandibular angleplasties assisted by C-arm fluoroscopy were performed in 9 patients, providing symmetric and satisfactory results. Now we are sure that the reduction mandibular angleplasty assisted by C-arm fluoroscopy can be an accurate and safe method for the unexperienced surgeon, especially the patient with deep-seated prominent mandibular angle.

CLOSED REDUCTION OF ZYGOMATIC ARCH FRACTURE UNDER C-ARM TYPE ROENTGENOGRAM

No abstract available.