Otoplasty

Question 1

Most otoplasty procedures are best performed e:3 years old
when most ear growth is completed

Answer 1

T

Question 2

Simple otoplasty techniques are considered before more
complicated reconstructive procedures.

Answer 2

T

Question 3

About 50% of newborns have an auricular deformity that persists
in 33% by 1 month old

Answer 3

T

Question 4

50% of deformities continue to
improve over the first year of life

Answer 4

F 84% of deformities continue to
improve over the first year of life

Question 5

prominent ears, decrease from birth to 1 year old,

Answer 5

The exception is prominent ears, which increase from birth to 1 year old, suggesting that postnatal deformation can contribute to this condition (e.g., infant sleep position may push the ear outward)

Question 6

Half of children have a bilateral
deformity,

Answer 6

T

Question 7

when the deformity is unilateral, the right and left sides
are affected equally. no difference in the prevalence or type of ear
deformity exists among males and females.

Answer 7

T

Question 8

The most common type of ear anomaly

Answer 8

A helical anomaly/constricted ear is the most common disorder at birth (15%)

Question 9

Risk factor for ear anomaly

Answer 9

Vaginal delivery and increased birth weight increase the risk of ear anomalies, likely due to forces on the ear causing deformations

Question 10

The primary morbidity ofan ear deformity is psychosocial

Answer 10

T

Question 11

THE IS ZERO TOLERANCE FOR EAR ASYMMETERY

Answer 11

F The ears are particularly tolerant of asymmetry because of their
lateral position over the temporal bones

Question 12

it is most important to have
the ears as symmetrical as possible on frontal view.

Answer 12

T

Question 13

It is important that families understand that asymmetries between the ears are common in the general
population

Answer 13

T

Question 14

The height of the ear is 6.5 (±1) cm

Answer 14

T

Question 15

width is 4.0 (±0.5 cm).

Answer 15

T

Question 16

greater than 18 mm at the top of the helix and 21 mm at the midhelix.

Answer 16

Considred abnormal protrusion from the mastoid

Question 17

some anomalies improve during the first week
of life

Answer 17

T

Question 18

molding can be initiated from birth

Answer 18

molding should not be initiated until at least 1 week old to
allow for possible spontaneous correction

Question 19

Ideally, molding is
started between 1 and 3 weeks old when maternal estrogens in the
child facilitate cartilage manipulation.

Answer 19

T

Question 20

Patient can still have good respopnce from molding after 3 month

Answer 20

At 6 weeks old, estrogens in the child equal
that of an adult and ifear molding is initiated after this time, patients
are likely to have a poor response.

Question 21

If the mother is breast-feeding,
initiation of ear molding can be attempted up to 8 to 10 weeks old

Answer 21

T

Question 22

After 12 weeks old, ear molding give acceptable results

Answer 22

F After 12 weeks old, ear molding is not effective.

Question 23

The ear deformity
that is most amenable to molding is a prominent ear.

Answer 23

T The antihelical
fold is recreated to set back the ear

Question 24

A mildly constricted ear with
overhanging helical cartilage can be improved by lifting the helical
cartilage into better alignment

Answer 24

T

Question 25

A Stahl deformity can be corrected by flattening the abnormal crus.

Answer 25

T

Question 26

many parents decide to correct an ear anomaly when the child is between 3 and 4 years old why?

Answer 26

Because long-term memory and self-esteem begin to form at approximately 4 year old At this time, the ear has achieved 85% of its size and the risk of scar limits ear growth is reduced the ear is larger to facilitate the procedure and (2) it is not urgent to intervene before this time

Question 27

Most ear growth is completed by 6 years old

Answer 27

T

Question 28

data have shown that operating on ears before 3 years old does not inhibit growth

Answer 28

T

Question 29

I prefer to wait until at least 3 years old because (1) the ear is larger to facilitate the procedure and (2) it is not urgent to intervene before this time because memory and self-esteem have not yet formed

Answer 29

T

Question 30

An advantage of early intervention

Answer 30

is that children tolerate the procedure more favorably than older patients who are more anxious about the operation and are busier with activities such as sports and school

Question 31

Children between 5 and 8 years old typically are bothered by a deformity, but fear of the operation outweighs their desire to improve their appearance

Answer 31

T

Question 32

At 9 to l0 years old, the child's interest in correcting the anomaly begins to outweigh the anxiety about the operation.

Answer 32

T

Question 33

Approximately 5% of the population has a prominent ear caused by an absent or weak antihelical fold and/or overgrown concha

Answer 33

T

Question 34

Most patients patient will have a normal antihelix and only require a procedure on the concha.

Answer 34

F Most patients will require recreation of the antihelical fold and setback of the concha. Rarely, a patient will have a normal antihelix and only require a procedure on the concha

Question 35

all patients will need to have the upper and/or middle third of the ear setback

Answer 35

T

Question 36

All of the patients in my practice will benefit from having their lobule setpack as well.

Answer 36

T

Question 37

Three-fourths of patients in my experience undergo bilateral setback otoplasty, whereas one-fourth of individuals have prominence of only one ear.

Answer 37

T

Question 38

There is no need for antibiotics in otoplasty

Answer 38

F one dose of intraoperative antibiotics because I am placing permanent foreign bodies (merseline sutures) and exposing cartilage

Question 39

No need to excise skin in otoplasty

Answer 39

F skin excision necessary because it facilitates the procedure by enhancing exposure, and once the ear is set back, there is sufficient skin to reapproximate.

Question 40

recreation of the antihelical fold by wich technique

Answer 40

(1) placement of scapha-concha sutures (Mustarde technique), (2) cartilage scoring (Stenstrom technique)

Question 41

I prefer scapha-concha sutures because it gives greater control and more predictability compared to scoring the cartilage

Answer 41

T

Question 42

scoring the cartilage can cause damage to the cartilage and contour abnormalities

Answer 42

T

Question 43

scoring may be considered as an adjunct to weaken the cartilage to facilitate its bending during the placement of sutures.

Answer 43

T

Question 44

On front view, the antihelix should have a gentle curve and the helix should be visible behind the antihelix

Answer 44

T

Question 45

measure the distance from the most superior point of the helix to the mastoid and achieve a distance of 15 mm (±3 mm). after correction

Answer 45

T

Question 46

If superior third remains prominent despite scapha-concha sutures

Answer 46

In this situation, one or two sutures can be placed from the scapha to the temporal fascia or conchal cartilage Alternatively, scapha and helical cartilage can be excised

Question 47

Middle Third correction

Answer 47

Options to set back the middle third of the ear include excision of concha or concha-mastoid sutures (Furnas technique)

Question 48

cartilage excision is not preferred because it distorts the concha

Answer 48

F cartilage excision preferred because it reduces the risk of recurrence and weakens the area to facilitate the antihelix contour provided by the scapha-concha sutures.

Question 49

suturing the hard cartilage to the weak mastoid fascia/periosteum has an increased risk of recurrence of prominence because of suture dehiscence and/or stretching of tissue

Answer 49

T

Question 50

An approximately2.0 to 2.5 cm long piece ofsuperior conchal cartilage is removed just below the scapha-concha sutures

Answer 50

T

Question 51

the width ofthe area can be2 to 7 mm

Answer 51

T

Question 52

If more than a 15 mm width of cartilage is removed, then it is possible that the excess skin anteriorly might be bothersome to the patient and require excision

Answer 52

F If more than a 7 mm width of cartilage is removed,

Question 53

Care must be taken to not overcorrect the middle third of the ear to prevent a telephone deformity

Answer 53

T

Question 54

Lobule prominence is present in approximately one-fourth of patients and is often not appreciated preoperatively.

Answer 54

T

Question 55

If the lobule remains prominent after setting back the superior and middle third of the ear What you will do?

Answer 55

first place a aMersilene suture through the area of the tail of the helix to the base of the conchal bowl. Another option is to extend the conchal cartilage excision inferiorly. A posterior lobule skin excision also can be performed. Finally, a suture can be placed from the posterior lobule to the conchal cartilage

Question 56

The goal is to prevent the appearance of a hockey stick appearance of the ear.

Answer 56

T

Question 57

the superior distance of the helix to the mastoid must be 15 (±3 mm) and the middle distance 18 (±3 mm).

Answer 57

T

Question 58

These measurements should have a difference of <2 mm between the ears to ensure adequate symmetry.

Answer 58

T

Question 59

Patients then are instructed to wear a soft headband at night for 1 weeks postoperatively

Answer 59

F Patients then are instructed to wear a soft head band at night for 6 weeks postoperatively

Question 60

Six weeks postoperatively scar tissue is strong enough to maintain the shape of the ear.

Answer 60

T

Question 61

spectrum of constricted (e.g., lop, cup) ear

Answer 61

(1) lidding of the helix, (2) prominence, and/or (3) reduced size from deficient structures.

Question 62

Minor deformities of the helix in cryptocia can be improved with simple excisions

Answer 62

T

Question 63

Moderately constricted ears that contain a sufficient amount of structures may be improved using techniques employed for prominent ear deformities

Answer 63

T

Question 64

the primary morbidity of a constricted ear is that it is small.

Answer 64

F the primary morbidity of a constricted ear is that it is prominent.

Question 65

If the ear is set back by strengthening the antihelical fold and placing sutures from the cartilage to the mastoid and temporal fascia to lengthen the vertical dimension of ear, the appearance of the child can be significantly improved

Answer 65

T

Question 66

Severely constricted ears that approximate conchal-type microtia require partial or total auricular construction using cartilage grafts

Answer 66

T

Question 67

Patients with cryptotia have a superior helix that is attached to the postauricular skin without a sulcus

Answer 67

T

Question 68

tissue expansion can be used in cryptosia

Answer 68

T

Question 69

STAHL DEFORMITY cause psychosocial morbidity

Answer 69

Usually, the anomaly is minor and does not cause psychosocial morbidity

Question 70

Operative intervention may be indicated to treat a severe deformity

Answer 70

T

Question 71

Patients with Stahls ear always have prominent ear

Answer 71

Occasionally, patients may have a prominent ear deformity as well requiring setback otoplasty techniques.

Question 72

Accessory cartilage in the preauricular area is the most common ear anomaly.

Answer 72

T

Question 73

Indication of Accessory cartilage removal under GA

Answer 73

If an infant has a large lesion with a wide cartilage base that cannot be easily excised and closed Patients who present after 12 months old as well are managed in the operating room because it is difficult to restrain the child in the clinic.

Question 74

The scar of split ear lope can be re-pierced 3 months later when it has achieved its maximal strength.

Answer 74

T

Question 75

The advantages ofrepiercing along the scar

Answer 75

that the scar is camouflaged and if the earring pulls through again, a second scar is not formed.

Question 76

The disadvantage of piercing the scar

Answer 76

is thatit is not as strong as the adjacent lobule and thus has a higher risk of pulling through again

Question 77

The ear lobe has a greater risk of forming keloid scars from piercings, compared to other parts of the ear

Answer 77

T

Question 78

Small lesions can be treated with pressure only.

Answer 78

T

Question 79

The pressure device is worn at night when sleeping

Answer 79

T

Question 80

A pressure earring is a good first-line intervention for minor keloids in young children who are less tolerant of undergoing a corticosteroid injection in the clinic

Answer 80

T

Question 81

without close follow-up and the use of postoperative compression and corticosteroid injections, the keloid will return and can be worse

Answer 81

T

Question 82

After rcsccting the keloid, the patient wears a pressure earring beginning 2 weeks following the procedure at night

Answer 82

T

Question 83

Four weeks postoperatively, the patient returns for monthly evaluations and possible corticosteroid injections. After 6 months, the patient follows up as needed

Answer 83

T

Question 84

he lobule can be constructed using staged skin flaps from the adjacent neck, or by placing a conchal cartilage graft

Answer 84

T

Question 85

using cartilage gives the most favorable outcome

Answer 85

T

Question 86

Rarely, a skin abrasion or full-thickness wound can occur with ear molding;

Answer 86

T

Question 87

The most common aesthetic ear surgery complication

Answer 87

most common problem is an unfavorable "cosmetic" outcome

Question 88

Infection, hematoma, extrusion of sutures, or wound dehiscence is uncommon

Answer 88

T

Question 89

the primary goal is to improve their appearance on frontal view

Answer 89

T

Question 90

the simplest technique often is preferred.

Answer 90

T

Question 91

Ear molding may correct all anomalies during the neonatal period.

Answer 91

F Ear molding may correct some anomalies during the neonatal period.

Question 92

Ear abnormalities can be broadly separated into malformations (absence of part of the ear) or deformations (fully developed ear but misshapen).

Answer 92

T

Question 93

1be axis of the ear is angled approximately 20° more posterior than a vertical line.

Answer 93

T

Question 94

The top of the helix is at the level of the eyebrow and the lobule is at the base of the columella

Answer 94

T

Question 95

The ear deformity that is most amenable to molding

Answer 95

a prominent ear. The antihelical fold is recreated to set back the ear mildly constricted ear with overhanging helical cartilage can be improved by lifting the helical cartilage into better alignment A Stahl deformity can be corrected by flattening the abnormal crus.

Question 96

Timing of intervention falls into three categories: infancy, 3 to 4 years old, and late childhood or adolescence

Answer 96

T

Question 97

Simple excisions of excess structures can be performed during infancy with local anesthesia as early as 4 to 6 weeks old.

Answer 97

T

Question 98

Occasionally, the helical cartilage may be significantly deformed and require scoring, sutures, and/or grafts to improve its shape in cryptia

Answer 98

T

Question 99

Rarely, a patient can have an absent lobule on the spectrum of microtia

Answer 99

T