Comparison of cartilage scoring and cartilage sparing techniques in unilateral otoplasty: a ten-year experience.

We identified the optimal operative technique of unilateral otoplasty among cartilage-scoring or posterior-suturing methods. All unilateral otoplasties repaired in South East Scotland in 10 years were analyzed. Using visual analog scale, outcomes were scored by blinded professional panel and by patients. Case notes were interrogated for postoperative complications. Of 81 patients, 40 with full photographic records were included in the study. Cosmetic outcomes and symmetry scores in patients who underwent posterior suturing with fascial flap were significantly better than cartilage scoring and posterior suturing without fascial flap. Early complications were significantly more common in cartilage-scoring and posterior-suturing techniques without fascial flap than posterior suturing with fascial flap. In conclusion, posterior suturing with fascial flap represents cosmetically superior technique in unilateral otoplasty. It allows for intraoperative adjustment of posterior sutures, resulting in symmetric ears. The technique seems to be associated with fewer short-term complications, often responsible for pediatric patient distress.

Revision otoplasty: an algorithm.

BACKGROUND: The purpose of this study was to propose a surgical algorithm for revision otoplasty, based on an evaluation of patient concerns, desires, and clinical findings. A series of instructive cases is presented. METHODS: Thirty-six patients with an average age of approximately 15 years (range, 6 to 61 years), who underwent revision otoplasty between 2006 and 2011, were included. Demographic data, complications, indications for revision surgery, and operative details were retrieved from case notes and preoperative and postoperative photographs. Aesthetic outcomes were assessed by three independent plastic surgery consultants using a survey with 15 questions. RESULTS: Indications for revision otoplasty included recurrent prominence/undercorrection, distortion of scaphoid fossa, distortion of antihelical fold, hypertrophic conchal bowl, and telephone ear. The relevant surgical technique was performed according to the patient's concerns and aspirations in line with the proposed protocol of treatment and included the following: posterior suturing, conchal bowl reduction, reconstruction with conchal cartilage, or reconstruction with costal cartilage. CONCLUSIONS: Otoplasty is performed frequently in young patients, and unsuccessful surgery can have a negative impact on their quality of life. Suturing techniques are safer than sculpting techniques, which can cause permanent ear deformity. Complications after sculpting techniques can lead to ear reconstruction. The proposed algorithm for revision otoplasty addresses the whole variety of ear deformations, providing the surgical options available to address these abnormalities.

International trends in the treatment of microtia.

BACKGROUND: Microtia is a well-known craniofacial malformation treatable with numerous different treatment strategies and techniques. The purpose of this study was to analyze the current international trends in microtia repair. METHODS: All surgeons attending the fourth International Ear Reconstruction Congress in Edinburgh received a questionnaire by e-mail about their current surgical practice in microtia care. RESULTS: Thirty-one questionnaires were received. Most primary reconstructions are performed at ages 8 to 10 years using autologous cartilage from the ipsilateral sixth to eighth ribs. Most surgeons make a multilayer framework, leaving a subcutaneous pedicle. Suction drainage was used in all patients. On average, the second stage was performed more than 6 months later using a mastoid flap. Most surgeons do not reconstruct the middle ear. CONCLUSIONS: Microtia reconstruction is performed in many different ways, with numerous treatment and postoperative possibilities.

The tip of the iceberg: a giant pelvic atypical lipoma presenting as a sciatic hernia.

BACKGROUND: This case report highlights two unusual surgical phenomena: lipoma-like well-differentiated liposarcomas and sciatic hernias. It illustrates the need to be aware that hernias may not always simply contain intra-abdominal viscera. CASE PRESENTATION: A 36 year old woman presented with an expanding, yet reducible, right gluteal mass, indicative of a sciatic hernia. However, magnetic resonance imaging demonstrated a large intra- and extra-pelvic fatty mass traversing the greater sciatic foramen. The tumour was surgically removed through an abdomino-perineal approach. Subsequent pathological examination revealed an atypical lipomatous tumour (synonym: lipoma-like well-differentiated liposarcoma). The patient remains free from recurrence two years following her surgery. CONCLUSION: The presence of a gluteal mass should always suggest the possibility of a sciatic hernia. However, in this case, the hernia consisted of an atypical lipoma spanning the greater sciatic foramen. Although lipoma-like well-differentiated liposarcomas have only a low potential for recurrence, the variable nature of fatty tumours demands that patients require regular clinical and radiological review.