ABSTRACT
A cauliflower ear is an auricular deformity characterized by thickened soft tissue and cartilage. A subperichondrial hematoma or fluid collection causes this malformation. As a result of being cut off from the perichondrium blood supply, the ear cartilage becomes ischemic, developing scar tissue, fibrous tissue, new cartilage overgrowth, or necrosis beneath the skin, resulting in a permanent alteration in the shape of the external ear resembling that of a cauliflower. To properly fix defects, the surgeon must grasp ear anatomy and be familiar with a variety of reconstructive alternatives. It requires meticulous attention, due to the intricate design of the ear. Simple and complex techniques for treating cauliflower ears have been developed. However, in severe cases, simple techniques are often insufficient. As a result, complex techniques such as replacement with an auricular prosthesis or implant or autogenous costal cartilage framework were developed. We present a case of a 25-year-old man who experienced a severe cauliflower ear as a result of an infection during adolescence. The patient was concerned about the shape of his ear and was depressed. Ear reconstruction was accomplished using the costal cartilage framework engraved according to a three-dimensional cutting guide for surgical planning. Costal cartilage is chosen to provide a framework for reconstruction as it is strong and rigid, and its curved shape is similar to that of the external ear. There were no complications after surgery. The ear projection and shape have performed admirably. The patient was pleased with the outcome and felt more confident after surgery.
ABSTRACT
Lateral proboscis is a rare congenital condition characterized by a cylindrical protuberance on the nasofrontal region accompanied by abnormal nasal development on the affected side. We aimed to describe the management of the lateral proboscis in staged repair. A 7-year-old girl came with a tube-like projection on the left medial canthal region and nasal agenesis on the ipsilateral side. She was diagnosed with lateral proboscis, left microphthalmia, lower eye lid coloboma, and asymmetry in the orbital region. The patient has undergone 3 major surgeries at our institution. The first surgery involved the deconstruction of the tube to form the left nasal body and nostril. The second operation involved trimming of the new nose form and the excision of the bony protrusion directly beneath the base of the pedicle through bifrontal craniotomy. The remaining bone defect was closed using a pericranial flap. The orbital floor was reconstructed using titanium mesh. The third operation involved nasal reconstruction using a costal cartilage graft to create a dorsal nasal and alar framework. The patient healed with no complications, had become less reserved and her grades improved significantly after the operation. Further appointments are being scheduled to evaluate growth distortion and the resulting facial asymmetry. Surgical correction will be planned thereafter to further reconstruct the facial features. Evaluation of patient is necessary to explore possible clinical outcomes and corresponding treatment options. Multidisciplinary management is highly recommended, involving plastic surgeons, neurosurgeons, ophthalmologists, pediatricians, and pediatric psychiatrists in order to improve patient's quality of life.
