Modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction / 华西口腔医学杂志

OBJECTIVES@#This study aimed to analyze the application value of a modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction.@*METHODS@#Condyle reconstruction was performed in 16 patients (9 females and 7 males) with modified tragus edge incision and transmasseteric anteroparotid approach. After regular follow-up, the function of condyle reconstruction was evaluated by clinical indicators, such as parotid salivary fistula, facial nerve function, mouth opening, occlusal relationship, and facial scar. The morphology of rib graft rib cartilage was evaluated by imaging indicators, such as panoramic radiography, CT, and three-dimensional CT image reconstruction.@*RESULTS@#At 6-36 months postoperative follow-up, all patients had good recovery of facial appearance, concealed incisional scar, no parotid salivary fistula, good mouth opening, and occlusion. One case had temporary facial paralysis and recovered after treatment. Radiographic evaluation further showed that costochondral graft survived in normal anatomic locations.@*CONCLUSIONS@#The modified tragus edge incision and transmasseteric anteroparotid approach can effectively reduce parotid salivary fistula and facial nerve injury in condylar reconstruction. The surgical field was clearly exposed, and the incision scar was concealed without increasing the incidence of other complications. Thus, this approach is worthy of clinical promotion.

Análisis de tratamiento de la otitis media crónica simple con miringoplastía en el Hospital Barros Luco Trudeau

Resumen Introducción: La otitis media crónica simple (OMC) es una patología común en nuestra población y hasta la fecha no queda bien claro cuál técnica y material de injerto da mejores resultados. Objetivo: Determinar si existen diferencias en los resultados anatómicos y funcionales al utilizar fascia de músculo temporal (FMT) versus injerto de cartílago de trago (CT) en los pacientes con OMC en que se les realizó miringoplastía en el Hospital Barros Luco Trudeau. Material y Método: Estudio de cohorte no concurrente de datos obtenidos de la revisión de fichas clínicas. Resultados: De 227 fichas, 154 cumplieron criterios de inclusión. En 102 pacientes (66%) se utilizó FMT y en 52 pacientes (34%) CT. Con FMT 38 presentaron reperforación (37%) y 41 presentaron un éxito funcional (40%). Con CT 18 presentaron reperforación (35%) y 22 presentaron un éxito funcional (42%). 38 pacientes presentaban antecedente de tabaquismo activo y de ellos 53% presentaron reperforación, mientras que de los sin antecedentes de tabaquismo solo un 31%, siendo esta diferencia estadísticamente significativa (p < 0,05). Conclusión: No se obtuvieron diferencias estadísticamente significativas entre los resultados anatómicos y funcionales comparando el uso de injerto FMT y CT para el tratamiento quirúrgico de la OMC simple con miringoplastía.

Abstract Introduction: Simple chronic otitis media (COM) is a common pathology in our population, and it is currently unclear, which grafts technique and material gives the best results. Aim: To determine if there are differences in the anatomical and functional results, when using temporal muscle fascia (FMT) or tragus cartilage graft (CT) in patients with COM who underwent myringoplasty at the Barros Luco Trudeau Hospital. Material and Method: Retrospective analytical cohort study of data obtained from clinical records. Results: Of 227 medical records, 154 met inclusion criteria. FMT was used in 102 patients (66%) and CT in 52 patients (34%). With FMT, 38 had reperforation (37%) and 41 had functional success (40%). With CT 18 had reperforation (35%) and 22 had functional success (42%). 38 patients had a history of active smoking and 53% of them presented reperforation, while of those without a history of smoking only 31%, this difference being statistically significant (p < 0,05). Conclusion: No statistically significant differences were obtained when analyzing the anatomical and functional results comparing the use of FMT and CT graft, for the simple surgical treatment of COM with myringoplasty.

Hair Follicle Nevus Located on the Neck: Comparison with Accessory Tragus, Cervical Chondrocutaneous Branchial Remnants and Trichofolliculoma

Hair follicle nevus (HFN) is a rare, benign, follicular hamartoma that most frequently presents as a congenital nodule on the face. We experienced a rare case of HFN on the neck of a 14-year-old boy and performed a pilot immunohistochemical study with cytokeratin 19 (CK19) to compare the staining pattern of hair follicles in HFN and its differential diagnoses, accessory tragus, cervical chondrocutaneous branchial remnants (CCBR) and trichofolliculoma. With hematoxylin and eosin stain, HFN showed numerous tiny hair follicles in the dermis with several sebaceous and eccrine glands, and perifollicular fibrous thickening. With CK19 stain, some hair follicles in HFN and CCBR showed positive expression, a few hair follicles in accessory tragus showed weak expression, and no hair follicles in trichofolliculoma showed expression. The present report supports the view that HFN, accessory tragus and CCBR are within the same spectrum of hamartomas.

Correction of preauricular depression using the composite flap of microtic cartilage and soft tissue in tragus reconstruction / 中华整形外科杂志

Objective@#To summarize the clinical effect of using the composite flap of microtic cartilage and soft tissue in tragus reconstruction to correct preauricular depression.@*Methods@#From January 2015 to November 2016, we corrected preauricular depression of 523 patients with congenital microtia that were treated with tragus reconstruction by using the composite flap of residual ear cartilage and soft tissue.@*Results@#All the composite flap of residual ear cartilage and soft tissue were transplanted successfully. No blood circulation disorder and significant contracture occurred. All patients were followed up for 6-14 months with an average of 10 months. The reconstructed tragus looked projective and the preauricular depression was corrected, demonstrating a similar looking to the healthy side. The patients were satisfied with the results.@*Conclusions@#The residual ear tissue could form the composite flap of residual ear cartilage and tissue. Using the composite flap to fill the preauricular depression was effective, which was not easily absorbed. The residual ear tissue is the best resource for filling the preauricular depression. It should not be discarded in ear reconstructive surgery, but reserved for the next operation for tragus reconstruction.

Small incision through the tragus for the treatment of sagittal condylar fracture / 口腔疾病防治

Objective@#The purpose of this study was to a new operative approach for sagittal condylar fractures via a preauricular small incision-based technique and to examine the effectiveness of this approach. @*Methods@#Fifteen patients (19 sides) with sagittal condylar fractures were included in the study. The incision length was approximately 4 cm through the tragus, exposing the superficial temporal vessels, which was then pulled forward. Next, the deep temporal superficial fascia was cut, and the surface of the zygomatic arch and the articular capsule of the temporomandibular joint were exposed. Joint capsule incision was performed, with mandibular condylar fracture fixation under direct vision. We followed up with the patients postoperatively for 6 months with clinical and radiographic examinations. @*Results @#All patients had 1 week postoperation before being discharged, during which 2 cases of mild facial paralysis (with lateral temporal level Ⅱ facial paralysis, with lateral temporal branch level Ⅲ facial paralysis and level Ⅱ zygomatic branch of facial nerve paralysis after treatment) were observed, after given nerve nutrition agents, 2 cases returned to normal within 3 months. No patient exhibited a postoperative delayed fistula infection or other serious complications. Intraoperative occlusion relationships recovered well, and postoperative CTs suggested that the fracture ends and condyles were in good condition. The occlusion relationship was normal for 3 months after surgery, with a degree of opening greater than 30 mm, no play in the joints and no oblique openings being observed, and reexamination 6 months after the surgery revealed no obvious scars.@*Conclusion@#This surgical method involves a small incision and clear anatomic structures and avoids damage to the facial nerve. This method provides better surgical vision for treatment of sagittal condylar fractures, is safe and convenient, and deserves clinical recommendation.

Accessory auricle: Classification according to location, protrusion pattern and body shape

BACKGROUND: Accessory auricles (AAs) are common congenital anomalies. We present a new classification according to location and shape, and propose a system for coding the classifications. METHODS: This study was conducted by reviewing the records of 502 patients who underwent surgery for AA. AAs were classified into three anatomical types: intraauricular, preauricular, and buccal. Intraauricular AAs were divided into three subtypes: intracrural, intratragal, and intralobal. Preauricular AAs were divided into five subtypes: precrural, superior pretragal, middle pretragal, inferior pretragal, and prelobal. Buccal AAs were divided into two subtypes: anterior buccal and posterior buccal. AAs were also classified according to their protrusion pattern above the surrounding surface: pedunculated, sessile, areolar, remnant, and depressed.Pedunculated and sessile AAs were subclassified as spherical, ovoid, lobed, and nodular, according to their body shape. Cartilage root presence and family history of AA were reviewed. A coding system for these classifications was also proposed. RESULTS: The total number of AAs in the 502 patients was 1,003. Among the locations, the superior pretragal subtype (27.6%) was the most common. Among the protrusion patterns and shapes, pedunculated ovoid AAs were the most common in the preauricular (27.8%) and buccal areas (28.0%), and sessile lobed AAs were the most common in the intraauricular area (48.7%). The proportion of AAs with a cartilage root was 78.4%, and 11% of patients had a family history. The most common type of preauricular AA was the superior pretragal pedunculated ovoid AA (13.2%) with a cartilage root. CONCLUSIONS: This new system will serve as a guideline for classifying and coding AAs.

Extracapsular dissection of the upper part of parotid gland benign tumor using a tragus edge combined retroauticular hairline incision approach / 口腔疾病防治

Objective@#To investigate the clinical effect of dissection in the upper part of parotid gland benign tumor using a tragus edge combined retroauticular hairline incision approach.@*Methods@#20 cases of upper part of parotid gland benign tumor were resected using the tragus edge combined retroauticular hairline incision approach, the surgery and cosmetic effect were analyzed. @*Results@#Parotid gland tumors were checked by CT before the operation and diagnosed by frozen section analysis during the operation. The tumors were successfully complete resected in all cases. There were no complications of Frey’s syndrome, postoperative bleeding, and flap necrosis, 2 cases showed a temporary earlobe numbness, 1 case of temporary facial nerve paralysis and 1 case of salivary fistula. There were no tumor recurrence after 24 ~ 48 months followed up. Surgical incision cosmetic effect is satisfactory. @*Conclusion@#The tragus edge combined retroauticular hairline incision is safe and feasible, with less complications for the upper part of parotid gland benign tumor resecetion.

An in vivo study to correlate the relationship of the extraoral and intraoral anatomical landmarks with the occlusal plane in dentulous subjects.

Background: The occlusal plane position is considered to be the primary link between esthetic and function. Aim: To evaluate the relationship between extraoral and intraoral soft tissue landmarks with the occlusal plane in dentulous subjects on both sides and to check for any variations. Study and Design: An in vivo study and 100 subjects with all healthy permanent teeth in normal arch and alignment were selected from Modern Dental College and Research Centre, Indore. Materials and Methods: Three custom made instruments (occlusal plane analyzer, buccinator groove relator, and level analyzer) were indigenously designed to check parallelism of the interpupillary line, ala‑tragus line, buccinator groove with the occlusal plane. Relation of retromolar pad with the occlusal plane was checked with the metallic scale. Statistical Analysis: Chi‑square test. Results: In 20.0% subjects, the occlusal plane was parallel to the interpupillary line. The posterior reference point for ala‑tragus line was middle point on right side in 56% and left side in 58% subjects. Intraorally, right side 59% and left side 62% subjects had the occlusal plane at the same level as that of buccinator groove. Right side 48% and left side 45% subjects showed occlusal plane at the middle one‑third of retromolar pad. Conclusion: The occlusal plane is not generally parallel to interpupillary line. The occlusal plane is parallel to the ala‑tragus line with middle point of tragus as posterior reference point on right and left sides. Both sides, the buccinator groove and the middle one‑third retromolar pad are coinciding with occlusal plane level.

A Case Report of Cervical Chondrocutaneous Branchial Remnants / 대한피부과학회지

No abstract available.

Faculty-supervised measurements of the face and of mandibular movements on young adults

PURPOSE: The purpose of this study was to determine the average facial proportions and mandibular movement capacity of 316 first-year dental students who carefully recorded them on each other. MATERIALS AND METHODS: This early exacting clinical experience was closely supervised by the authors in Columbus, Ohio during 1969-70. Five vertical and six horizontal distances were measured on each subject's face. An ala-tragus line and an occlusal line were drawn on the left side of the face to determine if these two lines were parallel. Measurements of mandibular movements involved maximum normal and hinge opening at the incisors and maximum amounts of right, left lateral and protrusive excursions of the mandible. RESULTS: The ala width and distance between the tips of upper right and left canine cusps averaged (35.2 mm and 34.8 mm) but with very large individual variations. The distance between ala to occlusal plane lines was 29.9 mm at the tragus and 31.3 mm near the ala. The angle between orbitale and ala-tragus averaged 13.6 degrees. CONCLUSION: The upper lip length was the most variable and the distance between the pupils was the most stable of the eleven facial measurements. The ala-tragus line and the occlusal plane lines were for all practical purposes parallel. Maximum jaw opening averaged 51.2 mm which was 3.0 times larger than maximal hinge opening of 17.2 mm. The maximum right plus left side jaw excursions (9.2 and 9.4 mm) totaled 18.6 mm, 2.3 times more than the 8.0 mm mean maximum forward protrusion.

Cephalometric Comparison of Frankforts Horizontal Plane And Occlusal Plane With Variations In Ala- Tragus Line.

The glossary of prosthodontic terms defines occlusal plane as an average plane established by the incisal and occlusal surfaces of the teeth. Generally, it is not a plane but represents the planar mean of the curvature of these surfaces. Another definition defines it as the surface of wax occlusion rims contoured to guide in the arrangement of denture teeth. Ala-tragus line according to the glossary of prosthodontic terms is defined as a line running from the inferior border of the ala of the nose to some defined point on the tragus of the ear, usually considered to be the tip of the tragus. It is frequently used, with a third point on the opposing tragus, for the purpose of establishing the ala-tragus plane. Ideally, the ala-tragus plane is considered to be parallel to the occlusal plane. The occlusal plane is at an angle of approximately 10 degrees relative to the Frankfort horizontal plane, when viewed in midsagittal plane. No precise, scientific method exists for determining the level of the occlusal plane in edentulous patients. Several principles have been postulated for determining the occlusal plane. The use of ala-tragus line to orient the occlusal plane has been controversial. This controversy is primarily due to disagreement on the exact point of reference for this line.Therefore the main objective of this study was to find out a reference line most parallel to the natural occlusal plane so that this reference point on the tragus can be used to determine the occlusal plane during the fabrication of complete denture

A determination of occlusal plane comparing different levels of the tragus to form ala-tragal line or Camper's line: A photographic study

PURPOSE: The purpose of this study was to determine accurately the part of the tragus to be used to form the Ala-Tragal line or Camper's line in orthognathic profile patients. MATERIALS AND METHODS: 150 dentate subjects with age of 18-40 years with orthognathic profile were sampled. Life-size lateral digital photographs of the face with fox plane were taken in natural head position. Different angles between Eye-Ear plane and occlusal plane (OT1-OP), Eye-Ear plane and ala-superior border of tragus (OT1-AT1), Eye-Ear plane and ala-middle border of tragus (OT1-AT2) and Eye-Ear plane and ala-inferior border of tragus (OT1-AT3) were calculated using computer software package, AutoCAD 2004. From the three angles formed by the Eye-ear plane (OT1 or FH plane) and the ala-tragal lines, the one closest to the angle formed between Eye-Ear plane (OT1) and occlusal plane (OP) was used to determine the occlusal plane of orientation. The obtained results were subjected to ANOVA F test, Tukey's Honestly significant difference test, followed by Karl Pearson coefficient of correlation test. P values of less than 0.05 were taken as statistically significant. RESULTS: The mean of base line angle i.e. OT1-OP angle (11.96 +/- 4.36) was found to be close to OT1-AT2 angle (13.67 +/- 1.93) and OT1-AT3 angle (10.31 +/- 2.03), but OT1-OP angle was found to be more closer to OT1-AT3 angle. Comparison of mean angles showed that OT1-OP angle in both males (11.68) and females (12.51) is close to OT1-AT3 angle (males- 11.01, females- 11.95). CONCLUSION: The line joining from ala to the lower border of the tragus was parallel to the occlusal plane in 53.3% of the subjects. There was no influence of the sex on the level of occlusal plane.

Cephalometrically assessing the validity of superior, middle and inferior tragus points on ala-tragus line while establishing the occlusal plane in edentulous patient

PURPOSE: The purpose of this study was to decide the most appropriate point on tragus to be used as a reference point at time of marking ala tragus line while establishing occlusal plane. MATERIALS AND METHODS: The data was collected in two groups of subjects: 1) Dentulous 2) Edentulous group having sample size of 30 for each group with equal gender distribution (15 males, 15 females each). Downs analysis was used for base value. Lateral cephalographs were taken for all selected subjects. Three points were marked on tragus as Superior (S), Middle (M), and Inferior (I) and were joined with ala (A) of the nose to form ala-tragus lines. The angle formed by each line (SA plane, MA plane, IA plane) with Frankfort Horizontal (FH) plane was measured by using custom made device and modified protractor in all dentulous and edentulous subjects. Also, in dentulous subjects angle between Frankfort Horizontal plane and natural occlusal plane was measured. The measurements obtained were subjected to the following statistical tests; descriptive analysis, Student's unpaired t-test and Pearson's correlation coefficient. RESULTS: The results demonstrated, the mean angle COO (cant of occlusal plane) as 9.76degrees, inferior point on tragus had given the mean angular value of IFH [Angle between IA plane (plane formed by joining inferior point-I on tragus and ala of nose- A) and FH plane) as 10.40degrees and 10.56degrees in dentulous and edentulous subjects respectively which was the closest value to the angle COO and was comparable with the values of angle COO value in Downs analysis. Angulations of ala-tragus line marked from inferior point with occlusal plane in dentulous subject had given the smallest value 2.46degrees which showed that this ala-tragus line was nearly parallel to occlusal plane. CONCLUSION: The inferior point marked on tragus is the most appropriate point for marking ala-tragus line.

A Dermal Turnover Flap for Treating the Accessory Tragus

PURPOSE: Accessory tragus is a fairly common congenital malformation and usually located at pretragal area. Surgical removal is a common treatment of accessory tragus irrespective of location and morphology. Most accessory tragi do not have depression site around them, but some do. So in those cases, simple surgical excision was not enough to promote the aesthetic facial appearance. For depression site remodeling, the excess amount of skin and cartilage need to be remained partially instead of total excision. This method can achieve the symmetric contour of pretragal area. The authors excised the epidermis and cartilaginous tissue totally and remained the dermis for reconstruction of the depression site around accessory tragus. The depression site is filled with dermal turnover flap. The purpose of this report is to present new idea to promote cosmetic result in treatment of accessory tragus containing the depression site. METHODS: Two patients had a pair of accessory tragi at pretragal area. One was a common featured accessory tragus, but the other was different. Depression site was found around accessory tragus. After epidermis and cartilaginous tissue were removed from it, dermis component was used as turnover flap for reconstruction of depression site. RESULTS: After accessory tragus was removed and depression site was reconstructed, facial contour and cosmetic result was achieved. Complication such as flap necrosis and wound dehiscence was not observed. CONCLUSION: The accessory tragus has variant morphology and degree of invasive depth. And some has a depression site around them. In those cases, simple surgical removal results in morphological distorsion and do not promote facial symmetry. The authors suggest dermal turnover flap as reconstruction method of the depression site. This method improves both surgical outcome and cosmetic result.

A Case of Accessory Tragus on the Nasal Vestibule

We present a case of accessory tragus (AT) which developed at an unusual site, the nasal vestibule, of a 1-day-old girl. To our knowledge, this is the first report of an accessory tragus that appears on the nasal vestibule.

Reconstruction of Atypical Tragus in Patients with Accessory Tragus or Macrotragus

PURPOSE: Tragus is one of the key structure of the normal shape of auricle. We experienced several cases of hypoplastic tragus with preauricular appendage. This article describes the methods of reconstruction of atypical tragus using accessory tragus or macrotragus to make better aesthetic results rather than simple excision. METHODS: From April, 2004 to March, 2009, 21 patients got operations by our method. Seven patients had bilateral deformity of tragus. Mean age was 12.7 years. For 17 cases of accessory tragus, simple excision, z-plasty and interpolation flap was performed. For 11 cases of macrotragus, debulking and z-plasty was performed. Mean follow-up period was 9.4 months. RESULTS: Reconstructed tragus looked symmetric with the opposite side in contour, size, direction and partial coverage of auditory meatus. There was no enlargement of remnant appendage for the follow up period and there was no complication such as hematoma, infection and chondritis. CONCLUSION: In cases of small and deformed tragus, preauricular tissue such as accessory tragus and macrotragus could be a good source of tragal reconstruction.

A Case of Oculo-auriculo-vertebral (OAV) Syndrome / 대한피부과학회지

We present a patient with various features of oculo-auriculo-vertebral syndrome (OAVS), also known as Goldenhar's syndrome. In general, multiple accessory tragi in a linear distribution from the preauricular skin to the mandible or to the lateral neck suggest a diagnosis of OAVS. However, in most cases, an accessory tragus is an isolated developmental defect without an associated congenital syndrome. A female infant presented with a solitary, skin colored, sessile papule on the right lower cheek, microtia, and ear deformity since birth. A biopsy specimen showed numerous irregularly spaced hair follicles with a prominent connective tissue framework in the subcutaneous fat, but without central cartilage. Multiple congenital anomalies, including ocular lipodermoid, sensorineural hearing loss, and vertebral deformity, were found on further evaluation.

A Case of Accessory Tragus on the Posterior Neck / 대한피부과학회지

Cervical accessory tragus is a rare congenital malformation presenting at birth as a firm nodule on the neck along the anterior edge of the sternocleidomastoid muscle. It has also been reported under different names, such as elastic cartilage choristoma of the neck, Meckel's cartilaginous remnant, cervical tab, cervical auricle, and wattle. Histologically, cervical accessory tragus is composed of numerous hair follicles, and a prominent connective tissue framework in the subcutaneous fat and central core of cartilage. We report a case of an 8-year-old female who presented with a solitary flesh colored papule on the posterior neck that was histopathologically diagnosed as cervical accessory tragus.

A Case of Accessory Tragus on the Posterior Neck / 대한피부과학회지

Cervical accessory tragus is a rare congenital malformation presenting at birth as a firm nodule on the neck along the anterior edge of the sternocleidomastoid muscle. It has also been reported under different names, such as elastic cartilage choristoma of the neck, Meckel's cartilaginous remnant, cervical tab, cervical auricle, and wattle. Histologically, cervical accessory tragus is composed of numerous hair follicles, and a prominent connective tissue framework in the subcutaneous fat and central core of cartilage. We report a case of an 8-year-old female who presented with a solitary flesh colored papule on the posterior neck that was histopathologically diagnosed as cervical accessory tragus.

Familial Isolated Accessory Tragi / 대한피부과학회지

Accessory tragi are an unusual congenital disorder, which are derived from a developmental abnormality of the first branchial arch. They appear at birth as soft or firm skin-colored papules or nodules, usually located in front of the auricle. There was no report of familial accessory tragi in Korean literature. Herein, we present two cases of familial accessory tragi occurring in a brother and a sister.