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Plastic Surgery - Craniofacial > Microtia/Prominent Ear > Flashcards

Microtia/Prominent Ear Flashcards

1
Q

What structures develop from the hillocks of the first branchial arch?

A

Tragus, helical crus, and helical root

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2
Q

What is the lymphatic drainage associated with the structures from the first branchial arch?

A

Parotid nodes

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3
Q

What structures develop from the three hillocks of the second branchial arch?

A

Helix, scapha, concha, antihelix, antitragus, and lobule.

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4
Q

What is the lymphatic drainage associated with the structures from the second branchial arch?

A

posterior auricular nodes

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5
Q

What embryologic structure gives rise to the external auditory meatus?

A

First branchial groove

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6
Q

What is the lymphatic drainage of the first branchial groove?

A

Both parotid and posterior auricular nodes

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7
Q

What is the normal size of the ear?

A

5.5 to 6.5cm height, 3 to 4.5cm for width, width can be varied from 66% in children to 55% in adults; in children 4 YOA a subnormal height is below 4.5cm

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8
Q

Describe normal ear growth

A

85% of ear development occurs by 3 years of age with full development achieved between 6-15 years

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9
Q

What is the normal position of the ear?

A
  1. One ear length posterior to the lateral orbital rim (lateral canthus)
  2. Mean inclination from vertical of 20 degree posteriorly
  3. Lobule at the level of the base of the columellla
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10
Q

What is the normal scalp-to-helix distance for each third of the ear?

A
  1. Upper 1.0-1.2cm
  2. Middle 1.6-1.8cm
  3. Lobule 2.0-2.2cm
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11
Q

How is the concha subdivided?

A

The concha cavum and concha cymba, which are separated by the helical root (also referred to as the root of the helical crus)

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12
Q

The superior crus of the antihelix is bordered by which structures?

A

Scapha and triangular fossa

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13
Q

The inferior crus of the antihelix is bordered by which structures?

A

Triangular fossa and concha cymba

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14
Q

What is the triangular fossa?

A

The concave area between the superior crus and inferior crus.

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15
Q

Blood supply for anterior surface of the ear

A

Superficial temporal artery

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16
Q

Blood supply to the posterior surface of the ear, lobule, and retroauricular skin

A

Posterior auricular artery

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17
Q

Describe the venous drainage of the anterior ear

A

Anterior ear is drained by the superficial temporal and the retromandibular veins.

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18
Q

Describe the venous drainage of the Posterior ear is

A

Posterior ear is drained by the posterior auricular veins into the external jugular vein

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19
Q

Sensory innervation of the anterior surface of the ear

A

Auriculotemporal (V3) and great auricular (CN II-III)

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20
Q

Sensory innervation of the posterior surface of the ear

A

Great auricular nerve, mastoid branches of the lesser occipital nerve

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21
Q

Sensory innervation of the meatus and medial concha

A

Nerve of Arnold from the Vagus nerve (gets referred pain from head and neck cancer)

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22
Q

Microtia is seen in which syndromes?

A
  1. Hemifacial microsomia (first and second branchial arch syndrome)
  2. Goldenhar syndrome (oculoauriculovertebral dysplasia; characteristic has bilateral ear deformities)
  3. Treacher-Collins Syndrome (bilateral deformities)
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23
Q

What is the proposed pathogenesis of unilateral microtia?

A

Obliteration of the stapedial artery.

24
Q

What is the proposed pathogenesis of bilateral microtia?

A

Event during gastrulation

Also associated with thalidomide

25
Q

For microtia, what is the recommended age for total ear reconstruction?

A

6-7 years for social reasons, but better results if postponed until 9-10

26
Q

How many stages in Nagata technique?

A

2

27
Q

How many stages in Brent technique?

A

4

28
Q

What is the first stage of reconstruction in microtia?

A

Harvest of cartilage, creation of framework, elevation of flap and placement of framework into pocket. May also rotate lobule.

29
Q

What is the second stage of reconstruction in microtia?

A

Elevation of the ear, placement of banked cartilage graft and coverage with TPF flap/skin graft

30
Q

Which ribs are harvested for the framework?

A

6-9 ipsilateral or contralateral (depending on preference)

31
Q

What morbidities are associated with the cartilage grafting?

A

Chest wall deformity (can be prevented by delaying until age 10 and preserving perichondrial margin), scarring, pain

32
Q

What regional flap can be utilized when the standard skin flaps are unsuitable for ear reconstruction?

A

Tempoparietal fascia flap based on the superficial temporal artery and a skin graft

33
Q

What are the advantages to using polyethylene (Medpor) implants?

A

Excellent definition and contour, contralateral ear matching, reconstruction in younger age, shorter duration of treatment (4 mo), no chest wound

34
Q

What are the disadvantages to using polyethylene (Medpor) implants?

A

Higher rate of infection and extrusion, implant exposure commonly results in the loss of the TPF coverage

35
Q

In microtia patients, what must be present for canal and middle ear reconstruction?

A

Good cochlear function and no imaging evidence of malformed inner ear (air in middle ear /mastoid must be present)

36
Q

When should BAHA be performed?

A

After ear reconstruction (to avoid compromising posterior auricular skin); can coordinate transcutaneous bone conduction implants (tBCI) with ENT surgeon at any stage

37
Q

What are the characteristics of prominent ear deformity?

A

Hypertrophy of the concha
Effacement of the antihelical fold
Can be influenced by skull base (plagiocephaly)

38
Q

What is the role of ear taping and splinting in the management of prominent ear deformity?

A

Up to 6 mo of age, molding the ear with taping and splinting may improve ear appearance and prevent need for surgical correction. The younger the patient the shorter the treatment.

39
Q

Why is ear molding limited to the first 3-6 months?

A

Circulating maternal estrogens increases hyaluronic acid in the cartilage rendering it more deformable.

40
Q

What procedures are done to better define the effaced antihelical fold?

A
  1. Score or thin the antihelix (anterior or posterior surface)
  2. Accentuate fold with sutures
41
Q

What procedures are done to correct conchal hypertrophy?

A
  1. Cartilage excision

2. Setback of conchal bowl

42
Q

What is the effect of conchomastoid sutures?

A

Reduction of conchal projection. Conchal reduction can also be achieved by direct excision through an anterior or posterior incision.

43
Q

What is the effect of the Mustarde sutures?

A

Permanent conchoscaphal sutures are placed to recreate the antihelical fold

44
Q

Conchomastiod sutures are associated with what complication?

A

Meatus distortion

45
Q

What is the most common complication following otoplasty?

A

Recurrence (10-25% require revision)

46
Q

What are the common unfavorable results following otoplasty?

A
  1. Undercorrection

2. Overcorrection (telephone ear deformity)

47
Q

What is the cause of telephone ear deformity?

A

Over resection of the skin on the middle third of the ear resulting in a promience of the upper and lower thirds, it is accentuated when lobular hypertrophy is not recognized or incompletely treated

48
Q

A post otoplasty “pinned back” appearance is attributed to what technical shortcomings?

A

Inadequate resection of the hypertrophic conchal bowl and over accentuation of the antihelix, resulting in lost visibility of the helical rim

49
Q

What is cryptotia?

A

“Hidden ear” deformity is characterized by the absence of the superior auriculocephalic sulcus and results from overaccentuation of the superior and inferior crusm tipping the upper pole of the ear beneath the adjacent scalp.

50
Q

How is cryptotia treated?

A

Release of abnormal cartilage adhesions on both posterior and anterior surfaces of the ear and coverage of the defect with both auricular and posterior auricular flaps

51
Q

What are the 4 features of constricted ear (lop ear/cup ear)?

A
  1. Lidding
  2. Protrusion
  3. Decreased ear size
  4. Low ear position
    The majority of constricted ears have decreased radius of curve of the helical rim and some degree of deficiency
52
Q

What is Stahl’s ear?

A

“Spock ear”; characterized by a third crus or abnormal angulation of the superior crus, projecting helical rim upwards or outward. Easiest deformity to correct with neonatal splinting.

53
Q

A 5 year old girl has an ear anomaly showing poor definition of the superior helix without retroauricular sulcus. What is the most likely diagnosis?

A

Cryptotia

54
Q

5 year old boy has an ear anomaly showing pointed helix and third crus of the antihelix. What is the most likely diagnosis?

A

Stahl ear

55
Q

What is the most ideal time to initiate non-surgical molding to correct prominent ear deformity?

A

2-4 weeks

56
Q

Which operative technique is used to recreate the antihelical fold in a patient with prominent ear?

A

Mustarde (scapha-concha) sutures

57
Q

Which operative technique is used to set back the middle ear in a patient with prominent ear?

A

Cartilage excision

Plastic Surgery - Craniofacial (7 decks)

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