Ear reconstruction stage I: Minor modifications in sculpting the auricle support using the 7th and 8th costal cartilages.

BACKGROUND: The verisimilitude of the reconstructed auricle and its long-term stability largely depends on the framework sculpting. This study described three kinds of minor modifications based on Firmin's way of sculpting the auricle framework and reported the clinical outcomes achieved with them. METHODS: We conducted a retrospective study of congenital microtia patients undergoing detail-improved auricular reconstruction from June 2016 to June 2020. The three kinds of minor modifications included: (1) fabricating the base frame using the 7th costal cartilage, (2) fabricating the helix and the antihelix complex using the 8th costal cartilage, and (3) fabricating the helix using the combination of the 8th and 9th costal cartilage. RESULTS: Ninety-eight patients (aged 9-27 years, 62.2% male) were included. Ninety-five patients (97.0%) adopted minor modifications 1, 2, and 3 patients (3.0%) adopted minor modifications 1, 2, and 3. All patients achieved an excellent auricle appearance and a well-laid foundation for subsequent operations. During the follow-up period, 89 patients (90.8%) were satisfied with the reconstructed auricles, 6 (6.1%) complained of hypertrophic scars in the retroauricular sulcus or pigmentation in the skin graft area, and 3 (3.1%) developed surgery-related complications. CONCLUSIONS: Three minor modifications of the auricle framework sculpting can make more satisfactory use of cartilage and adjust with the flexibility of the reconstructed auricle in different situations, making it similar to the contralateral auricle, thus, improving patients' satisfaction.

Craniofacial multi-point fascial suspension combined with tongue-shaped flap for correction of cryptotia deformity.

BACKGROUND: In this article, we will introduce a modified surgical approach to correct cryptotia (by suspending the auricular cartilage to the temporal region), which allows for a more visible and consistent surgical benefit than previous techniques that simply used flap accumulation. METHODS: We use several stitches to suspend the released auricular cartilage from the root of the auricular cartilage (approximately deep in the cavum conchae and the cymba conchae cartilage) to the temporal bone periosteum in a higher position, presumably similar to the principle of leverage, thus obtaining a larger auriculocephalic sulcus and a higher superior auricular pole. RESULTS: Over the past 5 years, this new technique was applied to the auricles of 20 patients between the ages of 15 and 40 years. They all obtained a satisfactory height of the upper pole of the auricle, the auriculocephalic sulcus, and the amount of skin tissue behind the auricle. CONCLUSIONS: In response to the failure of previous techniques to provide a satisfactory auriculocephalic sulcus and superior auricular pole height, this modified technique provides more consistent support directly to the auricle by means of suspension, allowing for a deeper head sulcus and higher superior auricular pole. The main features of this technique are the convenience and stability of the results, and the ability to adjust the sulcus and the height of the auricle as needed during the surgery.