Department of Otorhinolaryngology Head and Neck Surgery

Faculty of Medicine - Andalas University

Dr. M. Djamil Hospital, Padang 2014

Reconstruction of the Ear

Chandra - Nur
Facial Plastic and Reconstructive Surgery SubDivision
 Microtia
• Congenital malformation of variable severity
of the external and middle ear
• Microtia commonly involves the external canal
and middle ear; hence, hearing can be
affected

Facial Plastic & Reconstruction Surgery SubDivision

 Microtia
• Approximately 3 in 10,000 live births
• Ratio of right-to-left-to-bilateral of approximately
5:3:1
• The affected ear usually has conductive hearing loss
(about 40–60 dB) secondary to lack of an external
auditory canal and to ossicular fixation
• Etiology: hereditary factors and vascular accidents in
utero have been suggested as factors in the etiology,
maternal rubella during first trimester of
pregnancy, thalidomide exposure
Facial Plastic & Reconstruction Surgery SubDivision
 classified
1. all anatomic subunits present but misshapen,
grade
2. anatomic subunits either deficient or absent
3. Classic ‘‘peanut ear’’ and anotia

Facial Plastic & Reconstruction Surgery SubDivision

 Procedure
• First Stage
– Cartilagious portion of
the six, seven and eighth
rib is harvested
according to the
previously measured
template.
– Ear position was marked
using the film template
and preoperatively
determined
measurements
 Procedure
• A small incision was made along the ear vestige
dissecting the skin pocket and removing the
cartilage remnant beneath the skin
 Procedure
• Second stage
– cartilaginous spare part
banked at the first stage
is retrieved and placed in
a pocket created under
the framework by
elevation of the mastoid
periosteum. The ear
framework is lifted from
the base and lined with a
full thickness skin graft
from the groin
 Procedure
• Third stage
– This stage involves procedures like deepening the
concha, revision of post auricular graft
contractures, debulking and correction of minor
rotational and positional defects of the
reconstructed ear

Facial Plastic & Reconstruction Surgery SubDivision

 Pseudocyst
• Endochondral pseudocyst, intracartilaginous
cyst, cystic chondromalacia, and benign
idiopathic cystic chondromalacia
• Male > female
• Unilateral >>

Facial Plastic & Reconstruction Surgery SubDivision

 Pseudocyst
• Pathophysiology
– Engel postulated that lysosomal enzymes might be
released from chondrocytes and cause damage to
the auricular cartilage (IL1IL6)
– A defect in auricular embryogenesis  formation
of residual tissue planes within the auricular
cartilage

Facial Plastic & Reconstruction Surgery SubDivision

 Pseudocyst
• Symptom
– Painless swelling on the lateral or anterior surface
of the pinna, developing over a period of 4-12
weeks
– History of trauma may accompany the clinical
history, including rubbing, ear pulling, sleeping on
hard pillows, or wearing of a motorcycle helmet or
earphones

Facial Plastic & Reconstruction Surgery SubDivision

 Pseudocyst
• Sign
• Noninflammatory, asymptomatic swelling on
the lateral or anterior surface of the pinna,
usually in the scaphoid or triangular fossa
• Range from 1-5 cm in diameter and contain
clear or yellowish viscous fluid

Facial Plastic & Reconstruction Surgery SubDivision

 Pseudocyst
• Aspiration
Needle aspiration of pseudocyst fluid followed
by placement of a compressive dressing is one
of the most commonly performed methods.
However, without use of a pressure dressing,
recurrence is common

Facial Plastic & Reconstruction Surgery SubDivision

 Pseudocyst
• Surgical
– Combined procedure using surgical incision and
drainage of the lesion, replacement of the anterior skin
surface, and the application of a pressure dressing or
bolster
– Intralesional injections of minocycline hydrochloride
(1 mg/mL) 2-3 times at 2-week intervals has shown
efficacy. Minocycline is thought to work as a sclerosant
through its anti-inflammatory and immunomodulatory
mechanisms

Facial Plastic & Reconstruction Surgery SubDivision

 Preauricular sinus
• Common congenital malformations
• Inherited in an incomplete autosomal dominant pattern
• May be bilateral in 25-50% and more likely hereditary. In
unilateral cases, the left side is more commonly
• Usually found lateral, superior, and posterior to the facial nerve
and the parotid gland. In almost all cases, the duct connects to
the perichondrium of the auricular cartilage

Facial Plastic & Reconstruction Surgery SubDivision

 Preauricular sinus
• Auricle arises from the first and second branchial arches
during the sixth week of gestation
• First and second branchial arches each give rise to 3
hillocks; these structures are called the hillocks of His
• Three hillocks arise from the caudal border of the first
branchial arch, and 3 arise from the cephalic border of
the second branchial arch. These hillocks should unite
during the next few weeks of embryogenesis.
Preauricular sinuses are thought to occur as a result of
incomplete fusion of these hillocks

Facial Plastic & Reconstruction Surgery SubDivision

 Preauricular sinus
• History
– Most asymptomatic
– Chronic intermittent drainage of purulent material
from the opening
– Facial cellulitis or ulcerations located anterior to
the ear.
• Physical
– a small dell adjacent to the anterior margin of the
ascending limb of the helix
Facial Plastic & Reconstruction Surgery SubDivision
 Preauricular sinus
• Surgical
– extirpation of the sinus

Facial Plastic & Reconstruction Surgery SubDivision

Thank You

Facial Plastic & Reconstruction Surgery SubDivision