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Head and Neck / CF > Ear - Congenital Anomalies & Correction > Flashcards

Ear - Congenital Anomalies & Correction Flashcards

1
Q

Describe anatomy of ear

A

Antihelix antitragus complex helix lobule complex concha/scapha/tringular fossa depressions Crus of helix

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2
Q

What is the vascular supply to the ear

A

posterior auricular STA

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3
Q

What is the innervation to the ear

A
  • Greater auric (C2,3) - lower 1/2
  • ATN (V3) - tragus and crus
  • Lesser occipital Arnold’s nerve CNX - EAM
  • Jacobson CNIX - posterior EAC
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4
Q

What are antropometric landmarks/rules for the position of the ear

A

20’ off axis from line parallel to nasal dorsum Top of ear in line with lateral brow Bottom of ear in line with columella Ear should be one ear length behind lateral orbital rim Ear should protrude 1-2cm from skull with angle 20-25degrees at level of tragus

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5
Q

Describe the embryology of the ear

A

Ear development is divided into Inner and MIddle/External

Inner ear - ectoderm - otic placode->pit->otocyst-> semicircular canals, endolymph sacs, organ of corti

Middle extenal - derived from branchial structures 3wks->6mths

Branchial arch 1: Merckel cartilage (Incus Malleus), anterior hillocks (tragus, crus, helix)

Branchial arch 2: Recikert cartilage (stapes), posterior hillocks (antihelix, antitragus, lobule)

Branchial cleft 1: EAC and meatus

Branchial pouch 1: Eustachian tube

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6
Q

Classify congenital ear anomalies

A

Nagata classification

  1. Lobule-type microtia (no concha/meatus/tragus)
  2. Choncal-type microtia (includes concha/tragus)
  3. Small-concha type (less developed than type 2)
  4. Anotia
  5. Atypical microtia
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7
Q

Define microtia

A

defined as a small ear - includes spectrum of ear abnormalities from small ear to complete anotia

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8
Q

What is the epidemiology of congenital ear deformities?

A

M>F 3:2 Bilateral most common in syndromic cases R>L>Bi 6:3:1 Highest incidence in navajo and japan

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9
Q

What is the hereditary patterns of microtia?

A
  • variable penetrance or dominant/recessive traits - dominant inheritance for protruding, appendages/preauricular pits
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10
Q

What are associated abnormalities with microtia?

A
  • middle ear abnormalities (half of normal hearing)
  • congenital syndromes (TC, HFM, G, T18, BOR)
  • CN7 weakness
  • Branchial arch deformities**** (1/3)
  • Cleft lip/palate
  • CV, renal
  • Macrostomia
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11
Q

What congenital syndromes are associated with microtia?

A

MAINLY bilateral

  • Treacher collins
  • HFM
  • Goldenhar syndrome
  • Trisomy 18
  • Brachi-otorenal syndrome
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12
Q

What syndromes should you think of when you seen bilateral microtia?

A

TC HFM G T18 BOR

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13
Q

What are options for management of microtia

A

Non-surgical

  • camouflage
  • prosthesis

Surgical

  • autologous recon
  • alloplastic recon (silicone, medpor)
  • prefabricated engineered frameworks (remain experimental)
  • prothesis with OI implant
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14
Q

What are the ADv/Disad of autologous vs alloplastic recon vs prostheis w OII

A

Autologous - lower comx rate (exposure/infection) - multiple OR, donor site mrbidity Alloplastic - high exposure/infectionr ate - may eliminate chance of autologous recon Prosthesis - need replacements over lifetime

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15
Q

What are the difference between brent and nagat techqnieues for autologous microtia recon

A
  1. Timing
  2. # stages
  3. Cartilage harvested
  4. Suture material

BRENT

  • 4 stages, age 5-8
  • Contralateral rib 6-8, clear nylon suture

NAGATA

  • 2 stages, age 10 or chest circum >60cm
  • Ipsilat 6-9, steel wire
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16
Q

What are criticism of brent technique

A
  • too many stages(4)
  • poor definition concha, antitragal region
  • loss of auriculocephalic contour
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17
Q

What are criticism of nagata technique

A
  • chest wall defomirty
  • flap necrosis
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18
Q

Describe the 4 stages of Brent Technique (starts at age 5-8)

A
  1. Cartilage Harvested, Framework carved and positioned in pocket between dermis and TPF, ala, commisure, canthus used for position
  2. Lobule transposition with z-plasty
  3. Create auricolocepahlic sulcus with banked wedge and skin graft
  4. Tragus reconstruction with conchal graft from normal ear
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19
Q

Describe Nagata Technique (2stages, starting from 5-10yrs when chest circumf >60cm)

A
  1. Cartilage harvest, framework carved including tragus and placed, Lobule transposed.
  2. Create auriculocephalic sulcus with TPF flap
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20
Q

Describe Nagata framework

A

Multilayer

Base framework

+ Helix + crus helicis

+ Antihelix

+ Superior crus + Inferior Crus

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21
Q

Describe complications of autologous reconstruction for microtia repair

A

EARLY

  • PTX
  • Wound dehiscence, skin flap loss
  • infection, hematoma, seroma
  • graft loss

LATE

  • chest wall deformity
  • malposition
  • framework resorption
  • poor scarring
  • suture/framework exposure
22
Q

What are your options for failed reconstruction

A

1- Re-attempt autologous recon (excise scar, use TPF is not used by nagata techqnieue

2- prosthesis with or not OIimplant

23
Q

Classify congenital ear abnormalities

A

1- Microtia

2- Prominent ear

3- Constricted ear

4- Cryptotia

5- Stahl’s ear

6- Preauricular tags/sinuses

24
Q

Define Ear Prominence

A
  • Helical rim to mastoid distance at level of tragus >2cm
  • Conchoscaphal angle >35 degrees
  • Adequate helical rim/length (as oppose to constricted ear)
25
Q

Describe the inheritance pattern/etiology

A

Variable penetrance of AD trait

Due to high estrogen levels and cartilage plaibilty

26
Q

Describe the pathophysiology of the prominent ear

A

1- Poorly develop anti-helical fold

2- Overly developed conchal wall

3- Combination of both

27
Q

Describe Anatomic characteristis (5)

A
  1. Poor definition of antihelix w flat superior crus
  2. Conchal height excess
  3. increase angle from helical rim to scalp
  4. Scaphoconchal angle >90
  5. normal helical length
28
Q

What do you manage ear prominence?

A

Non-surgical

  • camouflage
  • moulding ***initiate with 72hrs of birth to tak eadv of circulatinghormones

Surgical

  • Antihelix manipulation (Mustarde, Stenstorm, Luckett or Converse-Wood)
  • conchal manipulation (Furnas Cm sutures)
  • Conchal excision
29
Q

Describe technique for antihelix manipulation

A
  1. Mustarde: recreate antihelix fold and reduce scophoconchal angle (posterior approach
  2. Stenstrom: scoring anterior surface
  3. Luckett or COnverse-wood: Full thickness excision
30
Q

Describe technique for Conchal manipulation

A
  1. Furnas: (CM sutures) Reduce of conchal prominence with excision of skin, postauric muscle and ligament and conchomastoid sutures
  2. Conchal excision: used ofen in combo with furnas CM suture
31
Q

Describe post-operative course after prominent ear correction surgery

A

Close f/u to assess for complications

Head wrap/band for 3-6wksto protect during sleep/activity

32
Q

What are complications of ear prominence correction surgery

A

EARLY

  • hematoma, infection, chondritis, necrosis

LATE

  • poor scarring
  • recurrence
  • suture exposure
  • injury to GAN
  • sharp edges, poor correction
33
Q

Define Constricted ear

A

Inadequate helical rim/circumference

34
Q

What is a lop ear and cup ear

A

Older terms for Constricted ear

  • Lop ear: inadequate helical rim + missing scapha, poor antihelix
  • Cup ear: inadequate helical rim + poor antihelix+ deep concha
35
Q

How do you classify Constricted ear?

A

Tanzer classification

  1. Type 1 - Helix involved only
  2. Type 2A - Helix and scapha invovled, sufficient skin
  3. Type 2B - Helix and scapha involved, NOT sufficient skin
  4. Type 3 - Helix, scapha and concha invovled, - some classify as microtia
36
Q

How do you manage constricted Type 1 (Helical rim involved only)

A

Mark where normal Height of helix should be

1- Lid of extra skin excised

2- Prominent upper pole set back with scapho-mastoid suture

37
Q

How do you manage constricted type 2A (helix and and scapha invovled with enough skin)

A

Deglove upper cartilage structures

Cartilage graft for increasing helical rim

38
Q

How do you manage constricted type 2B (helix and and scapha invovled with NOT enough skin)

A
  • Split ear at middle 1/3 to open ear up
  • chondrocutaneous flap from conchal bowl for anterior defect and retroauricular skin for posterior skin defect created
39
Q

How do you manage constricted type 3 (helix scapha antihelix concha invovled )

A

Reconstruciton as per microtia (too small of an ear - needs framework)

40
Q

Defien Cryptotia

A

Upper pole of ear fails to stand out from head (helical rim is buried superiorly under temporal tissues ) - lack of fold superiorly)

41
Q

What are anatomic characteristics of Cryptotia?

A
  • buried superior pole of helix
  • scapha underdeveloped
  • sharp antihelix

common in asians

42
Q

How do you manage cryptotia

A

Non surgical

  • camouflage
  • early splinting

Surgical

  • recreate auriculocephalic sulcus w zplasty, VY adv
43
Q

Define Stahl ear

A

Deformity with a third crus traversing traingular fossa forcing rim up at the jx point

44
Q

How do you manage stahl ear

A

non-surgical - splinting

Surgical

-direct excision/rotation and suturing

45
Q

Define preauricular sinus/cyst

A

INcomplete fusion of 6Hillocks with extodermal invagination/entrapment

Located anterior to EAC, at ascending crus of helix

46
Q

How to do you manage preauricular cyst/fistula/sinus

A

Usually asymptomatic

Conservative if no infection

If symptomatic

complete excision of sinus/tract + part of helical cartilage

47
Q

Define preauricular tag

A

mound of epithelium pedunculated in preauric area

Do not contian cartilage/bone and are not connected to ear structures

48
Q

What syndromes/disorders are associated with preauricular tags?

A

BOR syndrome brachio-otorenal

OAV syndrome oculoauriculovertebral

49
Q

What are complications associated with OIimplants

A

CSf leak, open mastoid air cells

skin irritation

50
Q
A

Head and Neck / CF (27 decks)

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