Downloaded 198 times
Uploaded byAjay Manickam
Defect based reconstruction of ear
This document discusses reconstructive techniques for ear defects. It begins with the anatomy and importance of the auricle. Historical techniques are described from 600 BC to modern methods developed in the 1920s. Congenital and acquired ear anomalies are classified. Reconstruction methods include stick-on prosthetics, osseointegrated implants, synthetic frames, and total autologous reconstruction using costal cartilage grafts. The popular Brent and Nagata techniques for microtia repair are explained. Reconstructive options are provided for defects in the upper, middle, and lower thirds of the ear. Local flaps are commonly used and cartilage frameworks are increasingly utilized for partial ear defects.
More Related Content
Similar to Defect based reconstruction of ear
More from Ajay Manickam
Defect based reconstruction of ear
- 1. DEFECT BASED RECONSTRUCTION: EAR Dr.Ajay Manickam Junior Resident ENT & Head neck surgery R. G. Kar Medical College
- 2. The Auricle Thecomplex 3 dimensional shapes of any human appendages – skin & cartilage Emotional & psychological distress
- 3. The auricle Cosmeticallyimportant structure
- 4. History Susruta reconstructedear lobules using local flaps 600BC Autogenous costal cartilages – modern era – Harold Gillies 1920 RanfordTanzer 1950 laid foundation for current ear technique.
- 5. Anatomy Blood supply(1) posterior branch of superficial temporal artery & (2) posterior auricular artery Anatomy of periauricular area – most important
- 6. Anatomic axis ofthe ear
- 7. Ear anomalies Congenital Acquired
- 8. Congenital ear anomalies Tanzer’sclassification Cosman’s classification Anotia Complete hypoplasia Hypoplasia of middle third of auricle Hypoplasia of superior third of auricle Prominent ears Lidding Smaller ear Low ear position
- 9. Reconstruction of ear Stick on ear prosthesis Osseo integerated ear prosthesis Use of synthetic auricular frames Total autologous reconstruction
- 10. Stick on earprosthesis Prosthetic pieces attached using skin adhesives Limitations – may not attach strongly in mean time, skin reaction
- 11. Osseontegerated ear prosthesis Pliablesilicone – shaped & colour matched with opposite ear Anchorage by bone anchored osseointegerated titanium plates Limitations – daily cleaning, risk of local tissue unflamation
- 12. Synthetic auricular frames Synthetic frame used to recreate shape of ear Frames burried in subcutaneous pocket or covered with superficial temporal fascia Silicone or PTFE Better success with temporalis fascia flap Significant risk of infection
- 13. Total autologous reconstruction Earframes from autologous costal cartilage Burried in subcutaneous pocket or temporalis fascial flap Popular methods are BRENT and NAGATA
- 14. Microtia Nagata’s classification Lobuletype Concha type Small concha type Anotia Atypical microtia
- 15. Microtia repair Brent techniqueNagata technique 5 years of age Four stages 6th, 7th, 8th, costal cartilages harvested Nylon sutures Auricular projection involves only skin graft 10 – 12 years of age Two stages 6th, 7th, 8th, costal cartilages harvested Stainless steel sutures Auricular projection involves cartilage wedge sup temporal artery flap
- 16. Acquired ear defects Partial defects – direct closure, local tissues, autologous reconstruction Total defects – congenital total defect Skin only defects – full thickness skin flap, local flaps
- 17. Reconstructive options Upperthird – local flaps –VY technique . Post auricular flap defects involving helical rims Middle third – Antia Buch reconstruction & dieffenbach flap Lower third – lobule. Local flaps are used Defects of the concha – trapdoor flaps Defects upto 1.5cm wide can be excised as a wedge and closed directly
- 18. Upper third localflaps VY flaps – helical rims or marginal reconstruction defect Pedicled flap based on post auricular artery
- 19. Middle third We canuse post auricular artery based flaps Dieffenbach flap – staged reconstruction of pinna Antia buch advancement flap – incorporates chondrocutaneous segment – but smaller ear
- 20. Lower third Local flapsare used one or two stage procedure Often Non anatomical cartilage graft can give support for reconstructed ear lobule
- 21. Defects of concha Trapdoor flaps are used for this purpose Flap is inset after tunnelling through post part of the auricular defect
- 22. Partial ear defects Local flaps , skin only flaps may not deliver best results Bespoke cartilage frames are increasingly used in reconstruction.
- 23. Cartilage framework for pinnareconstruction upper 1/3
- 24.
- 25. Conclusion There isyet no ideal alloplastic implant Scalp skin grafts provide best texture and colour match Costal cartilage provide best framework reconstruction
- 26.