FPRS otoplasty and auricular reconstruction

Question 1

Describe the ideal orientation of the auricle relative to the skull.

Answer 1

The distance from the mastoid skin to the lateral helical rim
is 2 to 2.5 cm. The average height of the ear is 5.9 cm in
women and 6.4 cm in men. On superior view, the ear should protrude 20 to 30 degrees from the skull (auriculocephalic angle).

Question 2

Describe the Mustarde technique of otoplasty.

Answer 2

A postauricular incision is made and supraperichondrial
dissection performed. The ear is folded into the desired
configuration, and sutures are passed from the posterior
surface of the auricle through the anterior surface but not
through dermis. The distance between the medial and
lateral aspect of each mattress suture is 16 mm. The vertical
distance between the superior and inferior aspect of each
mattress suture is 10 mm. Individual mattress sutures are
placed 2 mm apart.

Question 3

Describe the Furnas technique of otoplasty.

Answer 3

Permanent horizontal mattress sutures are used to tack the
posterior conchal bowl to the mastoid periosteum, with or
without trimming of conchal cartilage.

Question 4

A patient undergoes a conchal setback procedure for treatment of prominent ear deformity. Post-operatively, the patient has narrowing of the external ear canal. What is the most likely cause of
this complication?

Answer 4

The mastoid periosteal suture was placed too anteriorly,

causing the conchal bowl to impinge on the external auditory meatus.

Question 5

What are the causes of telephone ear deformity?

Answer 5

Over-correction of the middle third of the prominent ear during otoplasty

Question 6

What are the subunits of the ear?

Answer 6

Helix, antihelix, scaphoid fossa, triangular fossa, concha cymba, concha cavum, tragus, anti-tragus, lobule

Question 7

What embryonic structures give rise to the pinna?

Answer 7

The six hillocks of His. Hillocks 1 through 3 develop from
the first branchial arch, hillocks 4 through 6 arise from the
second branchial arch.
● Hillock 1: Tragus
● Hillock 2: Helical crus
● Hillock 3: Helix
● Hillock 4: Antihelix
● Hillock 5: Antitragus
● Hillock 6: Lobule

Question 8

What arteries supply the auricle?

Answer 8

Superficial temporal artery, posterior auricular artery, and

the deep auricular artery (minor contribution)

Question 9

Describe the classification system for grading

microtia.

Answer 9

● Class I: All structures of the external ear are present with
slight underdevelopment.
● Class II: Structures are smaller and more dysmorphic than
in type I microtia.
● Class III: Only a small vestigial structure (peanut) is
present.
● Class IV: The external ear is absent (anotia).

Question 10

What congenital syndromes are associated with

microtia?

Answer 10

Goldenhar syndrome, hemifacial microsomia, Treacher Collins syndrome, Robinow syndrome, and branchio-otorenal syndrome

Question 11

At what age is a patient considered an acceptable

candidate for microtia repair?

Answer 11

At 6 years old, when the ear has neared full adult size and

the quantity of rib cartilage is sufficient

Question 12

Describe the stages microtia repair using autologous costal cartilage.

Answer 12

● Stage 1: Harvest costal cartilage from the sixth, seventh,
and eighth ribs; carve into auricular framework; and place
in subcutaneous pocket posterior to the external auditory
canal.
● Stage 2: Auricular remnant is rotated inferiorly to recreate
the lobule.
● Stage 3: Elevation on neoauricle off mastoid and place-
ment of a postauricular skin graft
● Stage 4: Tragal reconstruction

Question 13

When do most authorities recommend atresia
repair in patients with microtia who desire
autologous cartilage microtia repair?

Answer 13

Usually after the costal cartilage framework has been placed and elevated off the mastoid with a posterior skin
graft. This sequence is preferred to optimize blood supply during initial microtia repair.