Summary and analysis of total auricle reconstruction in adult microtia patients / 中华耳鼻咽喉头颈外科杂志

Objective: To observe the clinical effect of auricle reconstruction in adult patients with microtia and summarize the experience. Methods: Clinical data of adult patients with microtia who underwent total auricle reconstruction using the modified Nagata's two stage for microtia reconstruction from June 2016 to June 2021 were analyzed. A total of 41 adult patients (42 ears) with microtia were enrolled, including 30 males and 11 females, with the median age at the time of surgery of 37 years. Autogenous costal cartilage was used as the auricular framework for all patients in this group. The first stage surgery was performed according to the modified Nagata's two stage for microtia reconstruction procedure,cartilage auricular framework carving was performed by different methods according to the ossification state of adult costal cartilage. Six months following the primary operation, ear elevation and cranioauricular angle formation, retroauricular facial flap transfer and medium-thick skin grafting were performed in the second stage. Results: All patients successfully completed two stage operation. During the follow-up of 3 months and 24 months, all the 41 patients were satisfied with the morphology of reconstructed auricle. Conclusion: According to the costal cartilage status of adult patients, different costal cartilage carving techniques can be used for total auricle reconstruction to obtain ideal surgical results.

Orejas en asa. Presentación de casos y revisión bibliográfica / Earpining. Presentation of cases and bibliographic review

Las orejas prominentes se deben a una o varias anomalías congénitas que pueden asociarse entre sí en grados diversos. Los pabellones auriculares son considerados demasiado visibles tanto por la falta de plegamiento del antihélix, la abertura del ángulo cefaloconchal y la hipertrofia de la concha, según la clasificación de Davis. Son un problema estético frecuente, observándose en el 5% de la población. El conocimiento de la anatomía del pabellón normal y de los criterios antropométricos es indispensable. El grosor del cartílago condiciona la rigidez y la elasticidad del pabellón, mientras que sus relieves definen la forma y la posición. La finalidad en la otoplastia es corregir estas anomalías, remodelando el cartílago para obtener unas orejas con una plicatura adecuada, situadas y orientadas según parámetros estéticos, simétricas, con un tamaño y aspecto natural. Se pueden combinar distintos procedimientos quirúrgicos los cuales deben ser simples, rápidos, tener un resultado armonioso y duradero. Se realizó una revisión retrospectiva entre los años 2018 a 2020 en el Servicio de Cirugía Plástica del Hospital Tornú, en la que se presentan 4 casos de orejas prominentes a los cuales se les realizaron diferentes técnicas quirúrgicas de otoplastia (Davis, Stentstrom y Furnas). El total de los pacientes (n=4) tratados presentó un resultado satisfactorio tanto para el paciente como para el equipo quirúrgico, sin complicaciones significativas. La resolución quirúrgica de las orejas prominentes puede realizarse mediante numerosas técnicas; estas se dividen entre aquellas que realizan un procedimiento agresivo sobre el cartílago (resectivas) y las que intentan ser más conservadoras, sin resección del mismo para evitar al máximo las complicaciones. La diversidad de enfoques indica que no existe una técnica definitiva para corregir estos problemas. Las orejas prominentes o en asa, si bien no presentan alteraciones funcionales, tienen consecuencias sobre los efectos estéticos y psicológicos en el paciente que pueden ser sustanciales. Es importante conocer su base anatómica y realizar una adecuada evaluación, elegir técnicas para la corrección de la deformidad y conocer las posibles complicaciones del procedimiento para obtener un buen resultado estético y duradero.

Prominent ears are due to one or more congenital anomalies that may be associated with each other to varying degrees. The pinnae are considered too visible due to the lack of folding of the antihelix, the opening of the cephalo-conchal angle and the hypertrophy of the concha, according to the Davis classification. They are a frequent esthetic problem, being observed in 5% of the population. Knowledge of normal pinna anatomy and anthropometric criteria is essential. The thickness of the cartilage determines the rigidity and elasticity of the pinna, while its relief defines its shape and position. The purpose of otoplasty is to correct these anomalies, remodeling the cartilage to obtain ears with an adequate plication, positioned and oriented according to aesthetic parameters, symmetrical, with a natural size and appearance. Different surgical procedures can be combined, which must be simple, fast, have a harmonious and lasting result. A retrospective review was performed from 2018 to 2020 in the Plastic Surgery Department of the Tornú Hospital, presenting 4 cases of prominent ears which underwent different otoplasty surgical techniques (Davis, Stentstrom and Furnas). The total number of patients (n=4) treated presented a satisfactory result for both the patient and the surgical team without significant complications. Surgical resolution of protruding ears can be performed by numerous techniques, divided between those that perform an aggressive procedure on the cartilage (resective) and those that try to be more conservative, without resection of the cartilage to avoid complications as much as possible. The diversity of approaches indicates that there is no definitive technique to correct these problems. Prominent or protruding ears, although they do not present functional alterations, the consequences on the esthetic and psychological effects on the patient can be substantial. It is important to know their anatomical basis and to perform an adequate evaluation, to choose techniques for the correction of the deformity and to know the possible complications of the procedure in order to obtain a good esthetic and lasting result.

Treatment effect of hemifacial dysplasia by injecting transplantation of autologous tissue in the second stage surgery for total auricle reconstruction / 中华耳鼻咽喉头颈外科杂志

Objective: To observe the treatment effect of hemifacial dysplasia by injecting transplantation of autologous dermis and fat granules in the second stage surgery for total auricle reconstruction. Methods: From March 2013 to March 2018, 57 patients with unilateral microtia and mild-to-moderate hemifacial dysplasia were divided into concurrent treatment group (32 cases, including 13 females and 19 males and aged 6-33 years old with an average age of 12.5 years) and traditional treatment group (25 cases, including 10 females and 15 males and aged 6-21 years old with an average age of 11.3 years) according to the different surgical methods. Modified Nagata method of auricular reconstruction was chosen, in the second stage surgery (cranial ear angle plasty), patients in concurrent treatment group received the treatment of hemifacial dysplasia with autologous dermal and fat injection transplantation at the same time; Patients in traditional treatment group only received cranial ear angle plasty. Statistical analysis of the two groups of patients was carried out for the average operation time, the average length of hospital stay, the incidence of common complications and postoperative satisfaction rate. SPSS 21.0 software was used for statistical analysis. Results: The mean operation time of the concurrent treatment group (282.0±3.4)min was longer than that of the traditional treatment group (243.0±3.1)min, and the difference was statistically significant (t=9.884, P<0.05). There were no statistically significant differences in the average length of stay between the the concurrent treatment group (9.4±0.3)d and the traditional treatment group(9.5±0.2)d, t=0.256, P>0.05. There were no statistically significant differences in the incidence of common surgical complications between the concurrent treatment group (12.5%, 4/32) and the traditional treatment group(12.0%, 3/25), χ2=0, P>0.05. Postoperative satisfaction rate of the concurrent treatment group(90.6%, 29/32) was significantly higher than that of the traditional treatment group(56.0%, 14/25), the difference was statistically significant (χ2=9.081, P<0.05). Conclusions: Auricular reconstruction with treatment of hemifacial dysplasia should not significantly increase the average length of stay and the incidence of common complications compared with auricular reconstruction alone. Although the operation time is slightly extended, the scheme of concurrent treatment can reduce the times of operations, save medical resources and increase the satisfaction rate of patients.

Correction of severe cup ears using postauricular tongue-shaped flap combined with deep fascial suspension / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the effect and satisfaction of using the postauricular tongue-shaped flap combined with deep fascia suspension in correcting severe cup ear malformation. Methods: Between August 2018 and November 2019, nine cases (10 ears) of Tanzer type Ⅲ severe cup ear malformation were treated with postauricular tongue-shaped flap combined with deep fascia suspension in this study. Results: Nine cases primary healed without hematoma, infection or skin necrosis, except one case with postoperative incision dehiscence. The cup ear deformity was significantly improved after the operation, the helix was intact, and the anti-helix was visible. The length, width, and circumference of the auricle were significantly enlarged three months following surgeries. There were no other complications except 1 patient recurrence 12 months after surgery. The patients were highly satisfied with the results of the surgery. Conclusions: Although the aesthctic of the reconstructed auricle is insufficient, this new technology makes full use of the autologous auricle tissue to correct severe cup ear malformation with good results.

Colgajo doble banderín de región retroauricular para reconstrucción del hélix / Double flag flap in the retroauricular region for helix reconstruction

El objetivo del presente artículo es mostrar los resultados de la reconstrucción de los defectos de la superficie del borde del hélix utilizando el colgajo doble banderín de región retroauricular. Se describen los pedículos vasculares del colgajo en disecciones anatómicas. Se presentan detalles técnicos del procedimiento, así como se muestran casos clínicos, analizando resultados y evaluando los mismos en 30 casos

The objective of this article is to show the results of the reconstruction of the defects of the surface of the helix edge using the double flag flap of the retroauricular region. The vascular pedicles of the flap are described in anatomical dissections. Technical details of the procedure are presented, as well as clinical cases are shown, analyzing results and evaluating them in 30 cases.

Reconstrucción auricular en lesiones malignas de hélix / Auricle reconstruction in malignant helix lesions

La complejidad del pabellón auricular hace que su reconstrucción sea técnicamente dificultosa. Hay una gran variedad de técnicas para la reconstrucción del hélix luego de la resección tumoral. La cirugía de elección en los centros especializados es la de Mohs; sin embargo, no se dispone de ella en todos los centros, por lo que debemos tener claras las indicaciones de las técnicas tradicionales. Como objetivo evaluamos la resolución quirúrgica de lesiones malignas ubicadas en el hélix auricular y el resultado estético de acuerdo al tamaño tumoral y su localización. Realizamos un análisis retrospectivo de 7 pacientes tratados con la técnica de cuña escalonada y la de Antia y Buch para defectos de hasta 3 cm del hélix auricular. Concluimos que ambas tienen una extraordinaria versatilidad y un excelente resultado estético funcional, y que la elección de una u otra se basará en el tamaño auricular y el excedente de piel que tengamos al momento de la reconstrucción.

The complexity of the earpiece makes its reconstruction technically complicated. There are several techniques for reconstruction of the helix after tumor resection. Gold standard in specialized centers is Mohs´s surgery; however, you do not have it at all centers, so we must have clear indications of traditional techniques. The aim is to evaluate the surgery resolution of malignant pathology in the auricular helix and the aesthetic result according to tumor size and location. We describe a retrospective analysis of 7 patients treated with the technique step wedge and Antia and Buch for defects up to 3 cm earpiece helix. We conclude that both have an extraordinarily functional versatility with excellent cosmetics result, and we think in choosing one or the other based on the ear size and excess of skin that we have at the time of reconstruction.

Locally aggressive trichilemmal carcinoma

Abstract: Trichilemmal carcinoma is a rare adnexal neoplasia with histologic features reminiscent of the outer root sheath of hair follicles. The clinical presentation of trichilemmal carcinoma is variable, as it may mimic basal cell carcinomas and squamous cell carcinomas, thus requiring histologic diagnosis. We report the case of a patient with aggressive trichilemmal carcinoma in the auricle.

Otoplastia Combinada / Combined Otoplasty

Introdução: Orelha em abano é a deformidade congênita mais comum de cabeça e pescoço, cuja transmissão se dá por herança autossômica dominante, sem predileção por gênero. A orelha proeminente ou "em abano" ocorre quando há um excesso ou hipertrofia da concha auricular, apagamento da antélice, um ângulo escafoconchal maior que 90º ou uma combinação destes, ocorrendo uni ou bilateralmente. O objetivo é apresentar uma abordagem conservadora para correção de orelha em abano, com a associação de técnicas. Métodos: Foi utilizada uma variação cirúrgica para realização de otoplastia com o auxílio de uma abordagem anterior para ressecção da concha auricular associada ao enfraquecimento da antélice com incisões parciais na cartilagem também por via anterior e a realização de pontos de Mustardé por via posterior para melhor definição da antélice, sem a fixação da concha à mastoide. Foram operados 200 pacientes com idade média de 17 anos, entre janeiro de 1987 e janeiro de 2015, sendo 60% do gênero feminino. Resultados: Dos 200 pacientes, apenas 24 necessitaram revisões cirúrgicas discretas. Conclusão: O procedimento cirúrgico é simples, facilmente reprodutível, proporcionando bons resultados, com alto grau de satisfação e baixo índice de complicações/morbidade.

Introduction: Protruding ear is the most common congenital deformity of the head and neck, with an autosomal dominant inheritance and no predilection for sex. Protruding ear or prominent ear occurs when there is concha excess or hypertrophy, erasure of the antihelix, a scapho-conchal angle greater than 90°, or a combination of these factors, occurring unior bilaterally. The objective is to present a conservative approach to correct protruding ear, with a combination of techniques. Methods: The otoplasty surgical technique involved an anterior approach for resection of the auricular concha, which was associated with weakening of the antihelix, and partial incisions of the cartilage were performed through anterior access and of Mustardé sutures, through posterior access for better definition of the antihelix without fixation of the concha to the mastoid. Two hundred patients with a mean age of 17 years underwent operations between January 1987 and January 2015, 60% of whom were female. Results: Of the 200 patients, only 24 patients needed discrete surgical revisions. Conclusion: The surgical procedure is simple, easily reproducible, provides good results, and is associated with a high degree of satisfaction and a low rate of complications/morbidities.

Pinna synthetic mold for otoplasty techniques application / Molde sintético auricular para aplicação de técnicas de otoplastia

Abstract Introduction The ear deformity Tanzer type V, also known as prominent ears, is the most common genetic defect of the pinna. The surgery designed for its correction is known as otoplasty. This esthetic surgery can be performed using different techniques, which requires great skill of its operator. Objective The purpose of this work is the development of a new tool for otoplasty techniques training, aimed on the possibility to minimize errors during the otoplasty. Methods Synthetic molds of the external ear from patients with Tanzer type V deformity were made, using silicone material and rayon. Results The main procedures of otoplasty could be performed in the molds made of silicone and rayon with a good esthetic result. Conclusion The elaborated molds had identical size and shape of a human ear and could be positioned in the same shape of the patient ears. Thus, the synthetic molds were presented as promising simulation tools for the training and surgical enhancement of otoplasty, especially for doctors beginners.

Resumo Introdução A deformidade da orelha tipo V de Tanzer, também conhecida como orelhas proeminentes, é o defeito genético mais comum da aurícula. A cirurgia criada para sua correção é conhecida como otoplastia. Essa cirurgia estética pode ser feita com diferentes técnicas, o que requer grande habilidade de seu operador. Objetivo O objetivo desse trabalho é o desenvolvimento de uma nova ferramenta para o treinamento de técnicas de otoplastia, com o objetivo de minimizar erros durante a otoplastia. Método Foram feitos moldes sintéticos da orelha externa de pacientes com deformidade tipo V de Tanzer com material de silicone e rayon. Resultados Os principais procedimentos de otoplastia foram feitos nos moldes de silicone e rayon com um bom resultado estético. Conclusão Os moldes elaborados tinham tamanho e forma idênticos aos de uma orelha humana e puderam ser posicionados no mesmo formato das orelhas dos pacientes. Assim, os moldes sintéticos foram apresentados como ferramentas de simulação promissoras para o treinamento e aperfeiçoamento cirúrgico da otoplastia, especialmente para médicos iniciantes.

Tratamento de deformidade auricular / Treatment of Auricular Deformity

Neste artigo, apresentamos um caso de uma deformidade auricular de difícil correção cirúrgica, envolvendo unidade escafo-helicoidal associada com a orelha proeminente em uma paciente de 25 anos de idade. Esta é uma malformação congênita incomum da orelha, o que resulta em uma borda helicoidal achatada, não curvilínea e dobrada sobre a escafa, comprometendo a aparência helicoidal. Foi proposto um tratamento cirúrgico com abordagem posterior e enxerto de cartilagem conchal à restauração do contorno borda helicoidal em um procedimento único. Esta nova abordagem proporciona um resultado agradável para o ouvido, principalmente por restaurar uma nova unidade escafo-helicoidal sem cicatriz na superfície orelha anterior e tratamento da orelha proeminente.

In this paper, we present a case of auricular deformity whose surgical correction is difficult, involving scapha-helical unit associated with prominent ear in a 25-year-old female patient. This is an uncommon congenital malformation of the ear, resulting in a flattened, straightened and folded helical rim over the scapha, compromising the helical appearance. The proposed surgical treatment involved posterior approach and conchal cartilage graft to the restoration of the helical rim contour in a single procedure. This new approach provides a fine result to the ear, particularly because it restores the scapha-helical unit with no scar on the surface of the anterior ear and also effectively treats the prominent ear.

Staged retroauricular flap for helical reconstruction after Mohs micrographic surgery

Abstract Staged retroauricular flap is a great option for full-thickness defects along the helical rim and antihelix. Donor site consists of the posterior ear, postauricular sulcus and mastoid area. The advantages of this flap include hidden donor scar, donor tissue similarity and rich vascularity. We present a case of collision tumor on the left helix treated with Mohs micrographic surgery and the resulting full-thickness defect repaired with a staged retroauricular flap. This flap is an effective technique for full-thickness helical defect repair with relatively little operative morbidity. High esthetic and functional results may be obtained restoring the ear size and shape.

Reconstrucción de una pérdida parcial del pabellón auricular por trauma / Reconstruction of a partial traumatic auricular loss

La posición expuesta de la oreja la hace vulnerable a muchos tipos de lesiones, entre las que se encuentran los traumas. Nuestro propósito es presentar un caso clínico en el que se realizó la reconstrucción de una pérdida parcial del pabellón auricular por trauma. Acude al cuerpo de guardia del Hospital Universitario General Calixto García; un paciente masculino de 42 años refiriendo haber perdido un fragmento de oreja en una riña. Se decide realizar hemostasia y fijación mediante puntos de sutura del pabellón auricular remanente a la región temporal, previa incisión en la zona. A los 3 meses del evento traumático se reevalúa con fines de realizar la planificación preoperatoria reconstructiva. Se decide la realizarla mediante injerto de cartílago costal colocado en forma de bolsillo; en la región temporal. Al mes de esta última intervención quirúrgica se realiza, bajo anestesia local, la liberación de la región auricular, el avance de un colgajo temporal y la colocación de un injerto libre de piel en la cara posterior del área reconstruida. Se observa una excelente evolución posoperatoria. El paciente refirió una gran satisfacción por los resultados estéticos obtenidos. En este caso se empleó una secuencia diagnóstica y terapéutica, según elección de los cirujanos involucrados, ante un defecto traumático parcial del pabellón auricular en sus tercios superior y medio. Este tipo de secuela traumática requirió el empleo de procederes quirúrgicos en varios tiempos operatorios que garantizaran un buen aporte sanguíneo de los tejidos y adecuados resultados estéticos finales(AU)

The exposed position of the ear makes it vulnerable to many types of injuries, including traumas. It is our purpose to present a clinical case in which reconstruction was performed of a partial traumatic auricular loss. A 42-year-old male patient presents at the emergency service of General Calixto García; University Hospital and reports having lost a piece of his ear in a fight. It was decided to perform hemostasis and fixation by stitching the remaining section of the auricle to the temporal region, after making an incision in the area. Three months after the traumatic event re-evaluation was conducted with a view to planning reconstructive surgery. It was decided to carry out the reconstruction placing a pocket-shaped rib cartilage graft in the temporal region. One month after the operation, auricular release, advancement of a temporary flap and placement of a free skin graft on the back of the reconstructed area were performed under local anesthesia. Excellent postoperative evolution was observed. The patient reported great satisfaction with the esthetic results obtained. The case herein presented was based on a diagnostic and therapeutic sequence of actions determined by the surgeons involved with a view to correcting a partial traumatic defect of the upper and middle thirds of the auricle. This type of traumatic sequel required the use of surgical procedures at several operative moments ensuring good blood supply to tissues and appropriate final esthetic results(AU)

Complicações em Otoplastia / Complications of otoplasty surgeries

INTRODUÇÃO: Orelha em abano é caracterizada pelo pobre desenvolvimento da anti-hélice, hiperplasia da concha, ângulo céfalo-auricular anormal, lóbulo grande e proeminente ou qualquer combinação dos itens citados. MÉTODOS: Foi realizado um estudo prospectivo, em que foram acompanhados 60 pacientes submetidos à otoplastia, no período de janeiro de 2014 a janeiro de 2015, no Hospital Municipal Barata Ribeiro. RESULTADOS: Entre as complicações precoces, citamos infecção (0%), hematoma (1,6%) e necrose de pele (3,3%). Entre as complicações tardias: assimetria (10%), recidiva (3,3%), extrusão de pontos (10%), granuloma, cicatriz hipertrófica (0%) e queloide (0%). Quando os pacientes foram questionados quanto aos resultados obtidos com a otoplastia, 3,3% responderam que o resultado foi ruim, 3,3% regular, 3,3% bom, 3,3% ótimo e 86,8% excelente. CONCLUSÃO: As taxas de complicações precoces e tardias são semelhantes às descritas na literatura.

INTRODUCTION: Protruding ears are caused by poor development of the antihelix, hyperplasia of the concha, abnormal cephaloauricular angle, a large and prominent lobule, or any combination of the above. METHODS: A prospective study was performed, in which 60 patients who underwent otoplasty were followed up from January 2014 to January 2015 at the Hospital Municipal Barata Ribeiro. RESULTS: Early complications included infection (0%), hematoma (1.6%), and skin necrosis (3.3%). Late complications included asymmetry (10%), recurrence (3.3%), extrusion of sutures (10%), granuloma formation (0%), hypertrophic scarring (0%), and keloid formation (0%). When patients were asked to rate the otoplasty, 3.3% stated that it was poor, 3.3% fair, 3.3% good, 3.3% very good, and 86.8% excellent. CONCLUSION: The rates of early and late complications are similar to those described in the literature.

Tratamento de fissuras de lóbulo de orelha / Lobuloplasty Torn earlobe repair

INTRODUÇÃO: O uso de ornamentos auriculares é uma prática multicultural. Considerando a grande incidência de fissuras de lóbulo de orelha (FLOs) no mundo inteiro, é surpreendente a escassez de avaliações objetivas na literatura nacional e internacional. OBJETIVO: Avaliação dos resultados do fechamento de FLO's por meio de simples remoção de suas bordas e fechamento usando adesivo tissular. MÉTODOS: Estudo prospectivo no qual FLOs (36) foram tratadas por simples excisão de suas bordas epitelizadas e fechamento usando cianoacrilato como adesivo tissular. RESULTADOS: Foram tratadas FLOs causadas por brincos (91,7%) e por trauma (8,3%). Achatamento (14,8%), cicatriz inestética (13,9%), entalhe (11,1%), alongamento lobular (7,4%) e deiscência (5,6%) foram os problemas encontrados. Não houve casos de necrose ou queloides. CONCLUSÕES: O tratamento proposto mostrou-se seguro e com resultados cosméticos satisfatórios em 92,6% das pacientes.

INTRODUCTION: The use of ear ornaments is a multicultural practice. The lack of objective evaluations published in the national and international literature is surprising considering the high incidence of torn earlobe (TEL) worldwide. OBJECTIVE: Evaluation of the results of torn earlobe repair with simple marginal excision and closure using a tissue adhesive. METHODS: This was a prospective study in which TELs (36) were treated by simple excision of epithelialized edges and closure using cyanoacrylate as tissue adhesive. RESULTS: TELs caused by earrings (91.7%) and trauma (8.3%) were treated. The following issues were found: flatness (14.8%), unsightly scar (13.9%), notching (11.1%), stretched earlobe (7.4%), and dehiscence (5.6%). No cases of necrosis or keloid scars occurred. CONCLUSIONS: The proposed treatment proved safe and had satisfactory cosmetic results in 92.6% of patients.

Reconstrucción en un tiempo del pabellón auricular en amputación parcial traumática con preservación del pedículo inferior: revisión de la literatura y presentación de dos casos / One-stage auricular replantation in traumatic partial ear amputation with inferior pedicle preservation: review of the literature and presentation of two cases

La amputación parcial traumática del pabellón auricular con preservación del pedículo inferior corresponde a una patología infrecuente. Su reconstrucción incluye el uso de diversas técnicas quirúrgicas. Presentamos dos casos de reimplante inmediato, sin uso de microcirugía, con resultados favorables y sin necesidad de reintervenciones, junto a una revisión de la literatura. La revisión bibliográfica realizada apoya el uso de esta técnica, basándose en la preservación del puente cutáneo bajo el tragus que incluye una rama de la arteria temporal superficial y que sería responsable de la irrigación del reimplante.

Partial auricle amputation with preservation of the inferior pedicle is an unusual pathology. The reconstruction in these cases includes many surgical techniques. We present two cases of immediate replantation, without the use of microsurgery, with favorable outcomes and without need of new interventions. The revision of the literature supports this technique based in the preservation of the cutaneus bridge under the tragus that includes a branch of the superficial temporal artery that is responsible of the perfusion of the reimplant.

Una novedosa técnica para corregir la oreja en copa grado I-IIA / A novel technique for correting cup ear grades I-IIA deformuty

Objetivo: Presentar una nueva técnica quirúrgica con soporte posterior de injerto de cartílago para la corrección de la oreja contraída grado I - IlA. Método: Se describe la técnica quirúrgica. Una vez denudado el cartílago del polo superior del pabellón auricular; se secciona la porción doblada del cartílago para ser reposicionada hacia la cara posterior del cartílago y suturada con un injerto de cartílago auto logo como un entablillado. Resultados: Se contonea y mejora la forma redondeada del hélix. Se pierde la forma encriptado de la oreja y se da una apariencia normal. La nueva forma tiene una permanencia en el tiempo tras el seguimiento a un Año. Conclusiones: La técnica de la trasposición del borde doblado del cartílago en el hélix más la fijación posterior con un auto injerto de cartílago para mantener la forma ha demostrado ser de fácil reproducción y de larga duración en el resultado.

Objective: To present a new surgical technique using cartilage transposition and cartilage auto graft for the correction of constricted ear grades 1- HA. Method: Once the cartilage on the upper pole of the ear helix has been set free of skin, the constricted portion is cut and transposed to the posterior face of the cartilage, suturing in place adding a hard cartilage auto graft obtained from the same patient's nasal septum. Results: The shape of the helix becomes round, no more constriction is seen, and these results are sustained over a year of follow up. Conclusions: This is a new, reproducible technique which gives good long term results.

Earlobe reconstruction by the Gavello technique and bilobed flap / Reconstrução do lóbulo auricular pela técnica de Gavello e retalho bilobado

The earlobe is an anatomical structure that has a significant aesthetic role. Its surgical repair places a challenge due to the difficulty of obtaining a natural appearing and durable outcome. The authors present two options: the Gavello technique and the bilobed flap, after the excision of malign neoplasms of the earlobe. The Gavello technique makes use of a bilobed flap with an anterior base to mold the new earlobe. D'Hooghe's bilobed flap with a pre and post-auricular lobe allows the reconstruction of small earlobes. Both techniques, although old, acquire an important and current interest in earlobe reconstruction, by reason of the moderate degree of difficulty, the use of a single time surgical act and under local anesthesia, with a proper aesthetic result.

O lóbulo auricular é uma estrutura anatómica com uma importância estética significativa. O desafio inerente à sua reconstrução relaciona-se com a dificuldade em obter um resultado duradouro e cosmeticamente aceitável. Os autores apresentam duas opções: a técnica de Gavello e o retalho bilobado, após excisão de neoplasias malignas do lóbulo auricular. A técnica de Gavello, recorre a um retalho bilobado com base anterior, para constituir o novo lóbulo auricular. O retalho bilobado de D'Hooghe, com lobos pré e pós-auriculares, permite a reconstrução de defeitos de pequenas dimensões. As duas técnicas descritas, apesar de antigas, mantém-se actuais pela execução de grau de dificuldade média, em tempo cirúrgico único, sob anestesia local com a obtenção de resultados cosmeticamente aceitáveis.

Reconstrucción auricular con expansión tisular / Auricular reconstruction with tissular expansion

Existe una multitud de técnicas quirúrgicas para la corrección de orejas micróticas. Sin embargo, uno de los factores que regula la calidad de los mismos son las condiciones iniciales en el área y la habilidad quirúrgica para tallar el marco cartilaginoso. En las técnicas convencionales, las primeras etapas de reconstrucción sólo brindan dos dimensiones lo que siempre implica un tiempo quirúrgico posterior para la proyección del marco, que conlleva mayor cantidad de cicatrices totales, de tiempo quirúrgico y de cirugías, con pérdida de sensibilidad en el área retroauricular. Se presenta la técnica clásica de Tanzer en 1959 posteriormente modificada por Brent en 1980, brinda características únicas, ya que el marco en sí tiene altura, profundidad y anchura determinados, así como cierto grado de movimiento y proyección de la oreja neoformada desde un inicio, dando una apariencia en tres dimensiones y recrea el surco aurículo-cefálico sin necesidad de otro tiempo quirúrgico, con un resultado estético adecuado.

There is a great number of surgical techniques for microtic ear correction. However, one factor that regulates the quality of these is the initial conditions in the area and surgical skill to carve the cartilage frame-work. In conventional techniques, the early stages of reconstruction only provide two dimensional which always involves a posterior surgical time of surgery, with loss of sensation in the retroauricular area. The technique presented is the classic technique of Tanzer in 1959 and subsequently amended by Brent in 1980, offers unique features such as the frame itself has height, depth and width determined and a degree of movement and projection of the newly formed ear from the beginning, giving a three dimensional appearance and recreates the atrium-ventricular groove head once without surgery, with an adequate cosmetic result.

Protesis de pabellón auricular elaborada en silicona y retenida con implantes de titanio osteointegrados / Auricular prosthesis retained with titanium osteoimplants

Los casos de falta de desarrollo congénito de pabellón auricular (microtia), o ausencia congénita total de pabellón auricular (anotia), trae consecuencias estéticas, funcionales y psicológicas, por lo que es importante buscar la forma de reparar estas deformidades. En muchos casos, no es posible lograr resultados por medio de cirugía reconstructiva, que debe ser el primer método de elección. En tales situaciones puede optarse por la rehabilitación a través de prótesis, (restitución de una parte faltante del cuerpo por medios artificiales). Este artículo tiene como objetivo dar a conocer el tratamiento alternativo en la reparación de defectos de la región maxilofacial, además, se describen los procedimientos clínicos y de laboratorio para la fabricación de una prótesis auricular elaborada en silicona grado médico para un paciente que presenta microtia derecha; fue sometido a varias intervenciones quirúrgicas con el fin de reconstruir su deformidad, sin lograr el éxito esperado; también se muestran los resultados estéticos obtenidos. Uno de los principales desafíos en este tipo de procedimiento es la retención de las prótesis, por lo que se decidió colocar implantes de titanio extra orales. La conexión entre prótesis e implantes se logró por medio de una barra y clips insertados en la prótesis; se pudo optar por retención con adhesivos, pues este tipo de prótesis es aceptable para el paciente debido al excelente soporte,capacidad de retención, seguridad y la apariencia del paciente o de la prótesis...

Cirugía reconstructiva del desgarro completo del lóbulo auricular / Reconstructive surgery of complete tear of the ear lobe

Se presenta el caso de una mujer de 51 años de edad, que presenta una fisura irregular completa del lóbulo auricular izquierdo, con bordes cicatrizados, con un tiempo de evolución de cinco años, ocasionado por el uso de aretes pesados. La fisura principal, presenta otra accesoria pequeña en el borde anterior ocasionado por el uso de otros aretes, que terminó originando otra fisura que desemboca en la principal, razón por la cual el trayecto fue irregular. El tratamiento consistió en una cirugía reparadora, seguimiento posterior, con un buen resultado estético. Se presenta este caso para ver el manejo quirúrgico efectuado, en el campo de la cirugía dermatológica.

A case of a woman 51 years old, presenting a full irregular fissure left ear lobe, with healed edges, with a duration of 5 years, caused by the use of heavy earrings. The main fissure presents another small accessory on the leading edge caused by the use of other earrings, which ended causing another rift that leads to the main reason why the trip was irregular. The treatment consisted of surgical repair, follow up, with a good aesthetic result. We present this case for surgical management made in the field of dermatological surgery.