Results of Modified Stenströms Technique Otoplasty and Patients' Satisfaction at King Fahad Armed Forces Hospital (KFAFH).

Background Globally, the prevalence of protruding ears is relatively frequent. Ear deformities manifest due to underdevelopment of the antihelical fold, conchal hypertrophy, and/or an obtuse conchoscaphal angle. The availability of multiple approaches proves that there isn't a single optimal accepted procedure. The Modified Stenström otoplasty technique supports the surgeon in the management of underdeveloped antihelix fold, conchal hypertrophy, and obtuse conchoscaphal angle among other deformities. We are the first to evaluate the clinical effects and measure the satisfaction rate post-otoplasty using the modified Stenström technique with a case series study. Methods Six patients were included in the study with a total of 12 ears operated on between February 2021 and July 2022. Utilizing the modified Stenström technique for bilateral protruding ears. All patients had six postoperative follow-up visits with fixed intervals; one week, three weeks, six weeks, three months, six months, and one year. During their one-year postoperative follow-up appointment, all patients completed the satisfaction survey questions. Results Six individuals were studied, three males and three females with a mean age of 23.1 (range, 7-53 years old). There were no complications or recurrences observed. Based on the responses we collected, all patients reported a high satisfaction rate at one-year postoperative follow-up. Conclusion The modified Stenström technique yields good naturally appearing ears. It is an easy and safe technique to apply. It has a short recovery period, and no hospital stay is required. All contribute to a high satisfaction rate among studied patients.

Otoplasty in Adults: Psychological Impacts on Quality of Life.

Psychological distress, emotional trauma, and behavioral problems related to prominent ears can cause complicated situations in children and adults. This study aimed to investigate the changes in the psychological impact on quality of life after Otoplasty. The study used several measures, including the Glasgow Benefit Inventory, Social Appearance Anxiety Scale (SAAS), Body Image Scale (BIS), Rosenberg Self-Esteem Scale (RSES), and Visual Analogue Score (VAS), which were completed before and six months after the surgery. The GBI questionnaire was used to detect the health-related quality of life changes after Otoplasty, as it is a reliable, valid, and responsive measure. Six months after the surgery, BIS total scores, VAS scores, and SAAS scores decreased significantly, while RSES scores were not significantly different. These results suggest that Otoplasty can significantly impact adult patients' psychological well-being and quality of life and that the surgery should be considered regardless of age.

Advantages of the Cartilage-Sparing Technique in Prominent Ear Deformity Surgery: Comparison of a New Technique.

OBJECTIVE: Ear cartilage, crucial for maintaining ear shape and function, can sometimes undergo damage or deformation, requiring surgical intervention. This study aimed to compare the efficacy of a novel, less invasive cartilage-protective method with the traditional, more invasive cartilage-removal technique. METHODS: Our study included 64 patients (128 ears). The first group of 32 patients (64 ears) received the new cartilage-protective technique, while the second group of an equal number of patients and ears underwent the traditional method. The newer technique endeavors to retain as much healthy cartilage as possible, addressing only the issue at hand, while the traditional technique requires the removal of a substantial portion of cartilage. RESULTS: The cartilage-protective method demonstrated several notable advantages over the traditional one. First, it significantly reduced the operation duration due to its less invasive nature. Second, it caused less pain to the patients by minimizing trauma to surrounding tissues. Furthermore, this technique significantly lowered the risk of complications, probably due to the minimal disturbance or removal of healthy cartilage, hence reducing the likelihood of post-operative complications such as infections or deformities. CONCLUSION: The findings of our study propose the cartilage-protective method as a superior treatment option when surgical intervention becomes necessary to repair or restore the function of ear cartilage. This technique, being less invasive, not only results in less pain for the patients but also reduces the risk of complications. It promotes quicker patient recovery without any loss of sensation in the ear. Thus, it could potentially revolutionize the approach to dealing with ear cartilage issues. LEVEL OF EVIDENCE: Level four.

Benefits of medially based perichondrio-adipo-dermal flap in cartilage sparing prominent ear surgery.

BACKGROUND: Cartilage-cutting and cartilage-sparing techniques are the two types of otoplasty procedures. Because of the significant risk of haematoma, skin necrosis, and ear deformity, cartilage-cutting techniques have been questioned. As a result; suture-based cartilage-sparing procedures such as Mustarde and Furnas suture procedures have grown in popularity. However, these techniques have a tendency for deformity recurrence due to cartilage memory and suture fatigue, as well as the possibility of suture extrusion and pinpricking sensation of the sutures. METHODS: In this study, we used a medially based adipo-dermal flap including perichondrium which is elevated from the back of the auricle to cover and support a cartilage-sparing otoplasty, thirty-four patients (14 female and 20 male) were operated using this technique. The medially based perichondrio-adipo-dermal flap is advanced anteriorly and fixed to the helical rim under cover of the distal skin flap. This procedure sought to cover the suture line preventing suture extrusion and support in the repair of the deformity preventing its recurrence. RESULTS: The average operative time was 80min, ranging from 65 to 110min. The patients passed the early postoperative period uneventfully except for 2 patients; one patient (2.9%) developed haematoma, and the other patient developed a small area of necrosis on the new antihelical fold. In late the postoperative period recurrence of the deformity developed in one patient. No patients developed suture extrusion or granuloma. CONCLUSION: The treatment to repair prominent ears is easy and safe, with benefits such as a natural-looking antihelical fold and minimal tissue stress. The medially or proximally based adipo-dermal flap may help to lower recurrence rates and suture extrusion.

Benefits of medially based perichondrio-adipo-dermal flap in cartilage sparing prominent ear surgery / Ventajas del colgajo pericondrial-adipo-dérmico con base medial en la cirugía de remodelación del cartílago de oreja prominente

Background: Cartilage-cutting and cartilage-sparing techniques are the two types of otoplasty procedures. Because of the significant risk of haematoma, skin necrosis, and ear deformity, cartilage-cutting techniques have been questioned. As a result; suture-based cartilage-sparing procedures such as Mustarde and Furnas suture procedures have grown in popularity. However, these techniques have a tendency for deformity recurrence due to cartilage memory and suture fatigue, as well as the possibility of suture extrusion and pinpricking sensation of the sutures.MethodsIn this study, we used a medially based adipo-dermal flap including perichondrium which is elevated from the back of the auricle to cover and support a cartilage-sparing otoplasty, thirty-four patients (14 female and 20 male) were operated using this technique. The medially based perichondrio-adipo-dermal flap is advanced anteriorly and fixed to the helical rim under cover of the distal skin flap. This procedure sought to cover the suture line preventing suture extrusion and support in the repair of the deformity preventing its recurrence.ResultsThe average operative time was 80min, ranging from 65 to 110min. The patients passed the early postoperative period uneventfully except for 2 patients; one patient (2.9%) developed haematoma, and the other patient developed a small area of necrosis on the new antihelical fold. In late the postoperative period recurrence of the deformity developed in one patient. No patients developed suture extrusion or granuloma.ConclusionThe treatment to repair prominent ears is easy and safe, with benefits such as a natural-looking antihelical fold and minimal tissue stress. The medially or proximally based adipo-dermal flap may help to lower recurrence rates and suture extrusion. (AU)

Antecedentes: El recorte y la remodelación del cartílago son los dos tipos de técnicas en los procedimientos de otoplastia. Debido al riesgo considerable de hematoma, necrosis cutánea y deformidad de la oreja, las técnicas de recorte del cartílago han sido cuestionadas. Como resultado, los procedimientos de remodelación del cartílago basados en sutura, tales como las técnicas de Mustarde y de Furnas, han ganado popularidad. Sin embargo, dichas técnicas tienden a recidivar la deformidad debido a la memoria del cartílago y a la fatiga de la sutura, así como hay la posibilidad de extrusión y de la sensación de pinchazo en ellas.MétodosEn el presente estudio utilizamos un colgajo pericondrial-adipo-dérmico con base medial que se eleva desde el dorso auricular para cubrir y soportar la otoplastia de remodelación del cartílago, habiendo operado a 34 pacientes con esta técnica (14 mujeres y 20 varones). El colgajo pericondrial-adipo-dérmico con base medial se avanza anteriormente y se fija al borde helical inferior para cubrir el colgajo cutáneo distal. El objetivo de este procedimiento fue cubrir la línea de la sutura, impidiendo la extrusión de la misma, y soportar la reparación de la deformidad previniendo su recidiva.ResultadosEl tiempo quirúrgico medio fue de 80min, fluctuando de 65 a 110min, transcurriendo el periodo postoperatorio temprano de los pacientes con normalidad, excepto en dos pacientes: uno de ellos (2,9%) desarrolló hematoma y el otro desarrolló una zona pequeña de necrosis en el nuevo pliegue antihelical. En el periodo postoperatorio posterior un paciente desarrolló recidiva de la deformidad. Ningún paciente desarrolló extrusión de la sutura ni granuloma. (AU)

Vertical mattress suture applied as "tension band fixation" for the antihelix creation and prominent ear treatment: 104 case reports.

BACKGROUND: Prominent ears were the most common auricular deformity. Different surgical techniques, such as cartilage-cutting techniques and suturing techniques, are available for treatment. The horizontal mattress suture technique, represented by the Mustard technique, is widely accepted, while the vertical mattress suture technique is rarely discussed in otoplasty. METHOD: A total of 104 cases of prominent ear deformities were treated from January 2017 to December 2020. Several hypothetical "tension bands" perpendicular to the natural curvature of the antihelix were introduced for the surgical design and determination of the position of the antihelix fixation, and vertical mattress sutures were placed accordingly for the auricular cartilage fixation. RESULT: Follow-up ranged from 3 months to 2 years. No complications, such as hematoma, infection, or poor wound healing, were observed. Three patients had recurrence within two months post operation, and one complained about the overfolded antihelix. Three cases had suture exposure, but the shape of the auricle was not affected after suture removal. The surgical result was evaluated according to the overall shape of the auricle, including the shape of the antihelix, the improvement of the prominent, the surgical marks, and the bilateral symmetry. A total of 98 patients (94.23%) rated the results as "very satisfactory" or "satisfactory". CONCLUSION: The vertical mattress suture applied as "tension band fixation" could provide stable cartilage fixation with the natural appearance of the antihelix formation. In addition, the technique could fit a wide range of indications with a low risk of complication and reoccurrence.

Modified bilateral fasciaperichondrial flap for prominent ear correction.

OBJECTIVE: Various techniques have been described in the literature for prominent ear correction. These cartilage-preserving or cartilage-shaping techniques have their own advantages and disadvantages. We aim to achieve aesthetic and stable results with low complication rates using combinations of these methods. Herein, we present our results of prominent ear surgery with a modified bilateral fasciaperichondrial flap in combination with concha-mastoid and concha-scaphal sutures. METHODS: Patients whose surgeries included a modified bilateral fasciaperichondrial flap for prominent ear deformities were included in the study. Patients' demographic data, pre- and postoperative Concha-Mastoid Angle (CMA) and upper-middle Helix-Mastoid Distances (HMD), follow-up time, complications, secondary operations, and postoperative Visual Analogue Scale (VAS) results were evaluated. With a postauricular fish-mouth incision, the bilateral fasciaperichondrial flap was planned into two: proximal- and distal-based. They were then elevated from the cartilage subperichondrially on the proximal side and supraperichondrially on the distal side. Concha-scaphal sutures were used to form an antihelical rim along with concha-mastoid sutures to reduce the concha-mastoid angle. Conchal cartilage resection was done if needed. Then, the bilateral fasciaperichondrial flaps were sutured together to cover the concha-mastoid and concha-scaphal sutures. RESULTS: Between May 2017 and May 2021, 32 ears of 17 patients were operated on due to prominent ear deformity. No hematoma or infection was observed in any patient, and there were no instances of recurrence, suture exposure, hypertrophic scars, or keloids. The satisfaction level of all patients was 8.2 ±â€¯0.9 points on average according to the VAS. In the anthropometric measurements, a statistically significant difference was found between preoperative and postoperative sixth month CMA and HMD values. CONCLUSION: A combination of suture techniques and a modified bilateral fasciaperichondrial flap may be used in prominent ear cases, with low recurrence rates and high patient satisfaction. LEVEL OF EVIDENCE: III.

Comparison of Transcutaneous Fixation-Assisted Method with Classical Needle-Assisted Method in Prominent Ear Surgery.

BACKGROUND: Prominent ear deformity is an autosomal dominant inherited deformity. Surgery is the most effective treatment method for prominent ear patients. Different prominent ear operations have been described in the literature. In this study, it is aimed to compare the transcutaneous fixation-assisted method that we described in prominent ear repair with the classical needle-assisted method. METHODS: Patients who were operated for bilateral prominent ear deformity between January 2017 and January 2020 were included in the study. Two different approaches were used in the operations. In the first group, conventional needles were used to adjust the position of the concha-scaphal sutures. In the second group, transcutaneous suturing was used to adjust the position of the concha-scaphal sutures. The duration of the operation was recorded. Patients were called for controls in 1-3-6 and 12th months; photographs were taken. Measurements were made in the preoperative period, in the intraoperative and at the postoperative 12th month. SPSS program was used for statistical analysis. RESULTS: A total of 52 patients were included in the study. There were 27 patients in Group 1and 25 patients in Group 2. There was no significant difference between the groups in terms of demographic characteristics (p>0.05). While the average operation time was 80.37 minutes in Group 1, the average operation time was 60.40 minutes in Group 2. The operative times between the groups were statistically significant (p<0.05). There was no statistically significant difference between the groups in preoperative, intraoperative and postoperative measurements (p>0.05). CONCLUSIONS: As a result, transcutaneous fixation-assisted method is performed faster than the classical needle-assisted method and the results are understood right at the beginning of the operation. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Modified bilateral fasciaperichondrial flap for prominent ear correction

Abstract Objective: Various techniques have been described in the literature for prominent ear correction. These cartilage-preserving or cartilage-shaping techniques have their own advantages and disadvantages. We aim to achieve aesthetic and stable results with low complication rates using combinations of these methods. Herein, we present our results of prominent ear surgery with a modified bilateral fasciaperichondrial flap in combination with concha-mastoid and concha-scaphal sutures. Methods: Patients whose surgeries included a modified bilateral fasciaperichondrial flap for prominent ear deformities were included in the study. Patients' demographic data, pre- and postoperative Concha-Mastoid Angle (CMA) and upper-middle Helix-Mastoid Distances (HMD), follow-up time, complications, secondary operations, and postoperative Visual Analogue Scale (VAS) results were evaluated. With a postauricular fish-mouth incision, the bilateral fasciaperichondrial flap was planned into two: proximal- and distal-based. They were then elevated from the cartilage subperichondrially on the proximal side and supraperichondrially on the distal side. Concha-scaphal sutures were used to form an antihelical rim along with concha-mastoid sutures to reduce the concha-mastoid angle. Conchal cartilage resection was done if needed. Then, the bilateral fasciaperichondrial flaps were sutured together to cover the concha-mastoid and concha-scaphal sutures. Results: Between May 2017 and May 2021, 32 ears of 17 patients were operated on dueto prominent ear deformity. No hematoma or infection was observed in any patient, and there were no instances of recurrence, suture exposure, hypertrophic scars, or keloids. The satisfaction level of all patients was 8.2 ± 0.9 points on average according to the VAS. In the anthropometric measurements, a statistically significant difference was found between preoperative and postoperative sixth month CMA and HMD values. Conclusion: A combination of suture techniques and a modified bilateral fasciaperichondrial flap may be used in prominent ear cases, with low recurrence rates and high patient satisfaction. Level of evidence: III.

Otoplastia en oreja prominente / Otoplasty in prominent ear

La oreja alada es la deformidad congénita más frecuente en cabeza y cuello, con una incidencia de 5% en la población caucásica. Queda definida por una distancia entre el hélix y la mastoides mayor a 21 mm o un ángulo mayor a 90° entre la concha auricular y la fosa escafoidea, siendo causada en el 70% de los casos por un antihélix mal plegado. Su corrección, a través de la otoplastia, se vuelve fundamental en prevenir los impactos psicológicos, siendo indicada antes de los 6 a 7 años, cuando la oreja ha alcanzado un ancho similar a la oreja adulta. El abordaje quirúrgico se divide en aquellas técnicas incisionales y no incisionales, cuya tasa de éxito y complicaciones como el otohematoma, necrosis de cartílago y deformidad irreversible, entre otras, son variables. La recidiva varía entre 6% a 12,5%, según el abordaje, no existiendo a la fecha una única técnica de elección. En el presente trabajo se discutirán cuatro técnicas principales: Incisionless, Furnas, mustardé y técnica de los pilares.

The prominent ear is the most common congenital deformity in head and neck, with an incidence of 5% in the Caucasian population. It is defined by a distance between the helix and the mastoid greater than 21 mm or an angle greater than 90° between the concha and the scaphoid fossa, being caused in 70% of the cases by a misfolded antihelix. Its correction, through the otoplasty, becomes essential in preventing psychological impact, being indicated before the age of 6 or 7, when the ear has reached a similar width of an adult ear. The surgical access is classified on incisionless and non-incisionless techniques, where the success rate and complications like hematoma, cartilage necrosis and irreversible deformity, among others, are variables. Recurrence varies between 6%-12.5%, depending on the approach, and to date there is no single technique of choice. In this revision, we will discuss the four principal techniques: Incisionless, Furnas, Mustardé and the abutment technique.

Comparison of Prominent Ear Recurrence in Different Age Groups.

AIM: Although many prominent ear deformity (PED) surgery techniques have been described to date, there have been few comprehensive studies evaluating the recurrence rates in different age groups. Previous studies have focused either on the young or the elderly. The present clinical study compares recurrence rates among patients of different age groups undergoing PED repair and discusses cartilage morphology. PATIENTS AND METHODS: A total of 380 patients with a mean age of 24.2 years underwent PED repair surgery between 2001 and 2019. The patients were divided into five subgroups according to age. Group I (5-10 years) was composed of 44 patients, Group II (10-20 years) was composed of 47 patients, Group III (20-30 years) was composed of 166 patients, Group IV (30-40 years) was composed of 90 patients, and Group V (over 40 years) was composed of 33 patients. The cephaloauricular angle (CAA) and the distance between the helix (upper, middle, lower) and mastoid were measured and recorded prior to surgery. The patients were all treated with three concha-mastoid sutures to achieve concha reduction and to narrow the cephaloauricular angle. The anterior aspect of the cartilage was thinned with a rasp, and an antihelix was created using non-absorbable sutures in patients with an inadequate antihelix. RESULTS: The CAA and the upper pole-mastoid distance were measured immediately after surgery and at 15 days, 3 and 6 months after surgery. Recurrence was observed in a total of 18 patients, with PED recurring in one patient in Group I (2.3%), three patients in Group II (6.38%), 10 patients in Group III (6.8%), three patients in Group IV (3.3%) and one patient in Group V (3.03%). Although the difference in the recurrence rate among the age groups would appear to be clinically significant, the difference was not significant, statistically. Clinically, the differences among the groups could be attributed to intragroup numerical differences. CONCLUSIONS: In the present study, no significant relationship was identified between the patient age and recurrence rate. Although PED repair is recommended in the preschool period, prominent ear repairs can be carried out in any age group, although the degree of cartilage scoring should differ depending on the age group. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Securing Posterior Auricular Incision with Button Headbands in Prominent Ear Patients Wearing Surgical Masks for Self-protection in the Pandemic.

In this letter, we describe an attachment on conventional headbands recommended for the postoperative period in prominent ear patients to confidently wear surgical masks without disturbing the posterior auricular incision. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Prospective Evaluation of Psychological Healing in Adults Who Underwent Otoplasty for Prominent Ear.

BACKGROUND: Otoplasty is performed to heal the psychological discomfort caused by the appearance of prominent ear by bringing the ear to its anatomical position. However, there have been few studies with limited numbers of patients that have prospectively evaluated psychosocial recovery following otoplasty in adults. The purpose of this prospective study was to evaluate the versatile psychological recovery that can be achieved in adults following otoplasty. METHODS: In this prospective cohort study, a single-group, pretest-posttest model was used as the experimental research model. Patient satisfaction status was measured, and the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory I-II (STAI I-II), Rosenberg Self-Esteem (RSES), and Body Cathexis Scale (BCS) tests were performed on patients before and after surgery. RESULTS: A total of 66 patients with a mean age of 20.7 ± 3.1 years, 66.7% of whom were women, were included in the study. While 97% of the patients were satisfied with the results of the operation, 3% were undecided. The mean values of the BDI, STAI-I, STAI-II, and BCS before and after surgery were 11.4 ± 5.7, 40.9 ± 6.7, 43 ± 9.4, 74.2 ± 20.5, and 8.5 ± 5.5, 38.6 ± 7.4, 39.5 ± 9.2, 63.5 ± 17.6, respectively. While the proportion of patients with a high RSES score before surgery was 42.42%, the proportion after surgery was 96.96%. The differences in the mean scores of all tests before and after surgery were also statistically significant (p < 0.05). CONCLUSION: Our study demonstrated that otoplasty made positive contributions to body perception, self-esteem, anxiety, and depression in adults. Otoplasty is as beneficial in adults as it is in pediatric patients. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Postcode lottery? Do clinical commissioning groups differ in their funding of prominent ear correction surgery.

In 2013 Clinical Commissioning Groups (CCGs) were created and became responsible for the planning and commissioning of health care services in their area. The Royal College of Surgeons and the British Association of Plastic, Reconstructive and Aesthetic Surgeons created guideline for the CCGs in 2013 for the surgical treatment of prominent ears. By looking at each of the CCGs' websites, we aim to review their equity and how well they adhere to standards to determine whether there is a regional variation for funding of this procedure. We found that 47% of the CCGs will fund this procedure only on an exceptionality basis, compared to 26% who had set criteria and would allow funding if these criteria were met. There was significant variation in the age at which funding would be considered with some CCGs allowing funding from 5 years of age and others not providing it until as old as 11 years. Only 11 policies made any reference to cartilage moulding and only 3 mentioned funding to allow correct fitting of hearing aids. Unfortunately, despite recommendations from the Royal College of Surgeons and the British Association of Plastic and Reconstructive Surgery, there is still variation in funding criteria between CCGs for correction of prominent ear surgery. This may result in patients being treated differently depending on their postcode. We would urge commissioners to apply more consistent and uniform guidelines for the funding of surgical correction of prominent ears.

An intragenic duplication of TRPS1 leading to abnormal transcripts and causing trichorhinophalangeal syndrome type I.

Trichorhinophalangeal syndrome type I (TRPSI) is a rare disorder that causes distinctive ectodermal, facial, and skeletal features affecting the hair (tricho-), nose (rhino-), and fingers and toes (phalangeal) and is inherited in an autosomal dominant pattern. TRPSI is caused by loss of function variants in TRPS1, involved in the regulation of chondrocyte and perichondrium development. Pathogenic variants in TRPS1 include missense mutations and deletions with variable breakpoints, with only a single instance of an intragenic duplication reported to date. Here we report an affected individual presenting with a classic TRPSI phenotype who is heterozygous for a de novo intragenic ∼36.3-kbp duplication affecting exons 2-4 of TRPS1 Molecular analysis revealed the duplication to be in direct tandem orientation affecting the splicing of TRPS1 The aberrant transcripts are predicted to produce a truncated TRPS1 missing the nuclear localization signal and the GATA and IKAROS-like zinc-finger domains resulting in functional TRPS1 haploinsufficiency. Our study identifies a novel intragenic tandem duplication of TRPS1 and highlights the importance of molecular characterization of intragenic duplications.

Psychosocial effects of otoplasty in adult patients: a prospective cohort study.

OBJECTIVE: This prospective study investigated changes in psychosocial status following otoplasty. METHODS: All patients who participated in the study filled a sociodemographic form that included age, gender, educational status and job preoperatively. Body Image Scale (BIS), Social Appearance Anxiety Scale (SAAS) and Rosenberg Self-Esteem scale (RSES) were completed prior to surgery and 6 months postoperatively. RESULTS: A total of 20 patients completed psychometric measures of body image, social appearance anxiety, and self-esteem. Of the patients (6 males, 14 females) whose charts were reviewed, the mean age was 24.05 ± 8.25 years (median 22 years: range 18-49) years. Six months post operatively BIS total scores were increased significantly relative to that of the baseline values (p = 0.005).SAAS scores were decreased significantly relative to that of the baseline values (p = 0.003). Although the postoperative RSES score tended to improve, it was not significantly different from the baseline value. The RSES scores showed significantly strong correlation with the SAAS scores (p < 0.001) and moderate correlation with the BIS scores at baseline (p = 0.013). None of the patients admitted for surgery had low self-esteem at baseline, with all patients categorized as having either moderate (n = 10, 50%) or high (n = 10, 50%) self-esteem. Following surgery, only one patient improved from moderate to high self-esteem. The baseline and postoperative BIS, SAAS, and RSES scores did not significantly differ between women and men. None of the other sociodemographic characteristics showed significant relationships with the three scales. CONCLUSIONS: Otoplasty can provide significant positive psychosocial benefits, even in an adult population. Therefore, this type of surgery should be offered to any patient seeking a solution to prominent ear-related psychosocial problems regardless of age.

Helix free otoplasty for correction of prominent ear.

BACKGROUND: Prominent or bat ear is not uncommon deformity as it affecting 5% of population. Plenty of procedures were reported for its correction. Being plenty means it is still a subject of research. The current procedures could be summarized as cartilage sparing and cartilage splitting ones. METHODS: During a period of 35 months a total of 31 patients were presented with bilateral prominent ears so the included a total of 62 ears. Their average age was 8 years (ranging from five to 18 years). All deformities were corrected using helix free otoplasty technique which included skin paddle excision, separation of helical cartilage (hence the name helix free), anterior scoring, backward folding, mattress and simple suturing of the folded cartilage, proper definition of antitragus and earlobe and concha-mastoid sutures. Outcomes including patient's and/or guardians' satisfaction were determined. RESULTS: The postoperative period was uneventful except two cases that developed early postoperative hematomas, one case shows late postoperative antihelical fold irregularity in one ear and other case developed ill defined superior helix in one ear. The average follow up period of two years shows no recurrences. Almost all patients (96.85%) and their guardians were satisfied with the aesthetic results while only one (3.2%) was dissatisfied. CONCLUSION: Helical free otoplasty technique addresses the deformity through a posterior approach with under vision correction. It has very low incidence of complications, high patient's satisfactions, no visible scars and no recurrences. It is a simple, short duration procedure, reliable and good option for correction of prominent ear.

In-frame de novo mutation in BICD2 in two patients with muscular atrophy and arthrogryposis.

We describe two unrelated patients, a 12-yr-old female and a 6-yr-old male, with congenital contractures and severe congenital muscular atrophy. Exome and genome sequencing of the probands and their unaffected parents revealed that they have the same de novo deletion in BICD2 (c.1636_1638delAAT). The variant, which has never been reported, results in an in-frame 3-bp deletion and is predicted to cause loss of an evolutionarily conserved asparagine residue at position 546 in the protein. Missense mutations in BICD2 cause autosomal dominant spinal muscular atrophy, lower-extremity predominant 2 (SMALED2), a disease characterized by muscle weakness and arthrogryposis of early onset and slow progression. The p.Asn546del clusters with four pathogenic missense variants in a region that likely binds molecular motor KIF5A. Protein modeling suggests that removing the highly conserved asparagine residue alters BICD2 protein structure. Our findings support a broader phenotypic spectrum of BICD2 mutations that may include severe manifestations such as cerebral atrophy, seizures, dysmorphic facial features, and profound muscular atrophy.

[Current progress of laser-assisted cartilage reshaping for prominent ear].

Objective: To summarize the current progress of laser-assisted cartilage reshaping (LACR) for prominent ear. Methods: The domestic and abroad article concerning the LACR in treatment of prominent ear was reviewed and analyzed. Results: As a new technique, there were three types of LACR therapies that been used for prominent ear. LACR with the 1 064 nm Nd/YAG laser is painful and the penetration depth of the 1 064 nm Nd/YAG laser is greater than that of the 1540 nm Er/Glass laser which is caused more tissue injury. LACR with the 1 540 nm Er/Glass laser has high absorption by the ear cartilage and produce less injury to the surrounding tissue. Use of the CO 2 laser permitted cartilage reshaping combined with both vaporization and incisions, which complicates the technique, although, with low recurrence rate and definite effect. Insisting on wearing ear mold is the key to get satisfactory effectiveness for postoperative patients. The complications of LACR for prominent ear, such as the dermatitis, perforation of the skin, hematoma, or infection, should be noticed. Conclusion: Application of LACR for prominent ear just has a short period of time, limited number of cases, and few relevant literature reports. Its effectiveness needs to be further studied and clarified.

Earfold: A New Technique for Correction of the Shape of the Antihelix.

An absent or poorly defined antihelix often plays a central role in the perception of the prominent ear. A wide variety of otoplasty techniques have been described over the last 50 years that aim to reshape, create, or enhance the definition of the antihelix, which can, in turn, help to reduce the prominence of an ear. In addition to conventional suture and cartilage-scoring techniques, a permanent implantable clip system (Earfold® ) has recently become available that is placed using a minimally invasive approach performed under local anesthesia. In this review, we summarize conventional otoplasty techniques to correct the antihelix and compare these with the Earfold implantable clip system. Laryngoscope, 128:2282-2290, 2018.