Plastics - Otoplasty And Microtia

Front 1

what is the incidence of prominotia?

Back 1

5% of the population

Front 2

what percent of otoplasties are complicated by hematoma?

Back 2

1%

Front 3

what is the inheritance of prominotia?

Back 3

autosomal dominant with 25% penetrance

Front 4

what are the anatomic abnormalities of prominotia?

Back 4

absence of antihelical fold
prominent conchal bowl
conchoscaphoid angle greater than 90 degrees

Front 5

what pre op photos need to be obtained prior to repair?

Back 5

frontal, right and left oblique, right and left lateral. close up right and left lateral (g'kan does posterior)

Front 6

at what age is the auricle 90% of the adult size?

Back 6

age 6

Front 7

what is a mustarde suture? what levels are the sutures placed?

Back 7

permanent conchoscaphal mattress suture

- at the level of the helical root to create the superior crus
- and the level of the jxn of the superior and inferior crus. Additional sutures placed as needed.

loss of correction is as much as 40%, so need to overcorrect. worst as the level of the superior crus

G'kan uses 4-0 mersilene, uses a 27 g need placed through the cartilage to mark the place of the sutures.

Front 8

what is the post operative care after otoplasty?

Back 8

dressing down on day 1 to look for hematoma.
Then back up for 2 weeks.
Then at night for another 4-6 weeks

Front 9

whats a furnas suture? how is it placed? what are the pitfalls?

Back 9

- permanent conchomastoid suture
- remove tissue to allow a well for the concha to sit
- placed at the lateral third of the concha cavum and concha cymba parallel with the natural curve of the auricular cartilage
- atleast 3 sutures are needed for adequate set back

pitfalls: not setting choncha posteriorly (results in EAC stenosis). not getting a bite of mastoid periosteum (results will not last)

Front 10

how much skin do you excise?

Back 10

about 1 cm wide (but is a guess).
inferior most aspect of your ellipse should be at the level of the antitragus

Front 11

how is a prominent lobule reduced?

Back 11

wedge excision. can be done under local. permanent suture, remove in 6 days

Front 12

how do you treat spock ears/elf ears?

Back 12

elliptical incision on the lateral helix, undermine, shave cartilage, close

Front 13

when you do you see onset of infection after otoplasty? what bugs do you target?

Back 13

day 3-4. can result from hematoma, and result in chondritis and destruction of cartilage.

Treat: staph, strep, and pseudomonas

Front 14

what other complications occur?

Back 14

suture extrusion
suture granuloma
keloid formation
cold parethesias (typically resolve in 4-6 months)

Front 15

what degree of similarity between the ears is necessary to be unnoticeable?

Back 15

3 mm

Front 16

what correction errors occur?

Back 16

telephone ear - over corrected middle thirt

reverse telephone ear - over corrected sup/inf regions or no conchal setback

hidden helix - isolated helical over correction

all can be addressed with a revision case

Front 17

what weeks of gestation are affected that cause microtia?

Back 17

4-12 altered development of the hillocks of his

Front 18

what populations have a higher rate of microtia? what is the rate?

Back 18

Latin America and Navajo indians

General: 1: 5-20,000
Navajo: 1:1000
Japanese 1:4000

Front 19

what teratogens are associated with microtia?

Back 19

isotreninion and thalidomide

Front 20

Mictrotia
Which is more prevalent males or females?
Unilateral or bilateral?
Right or left?

Back 20

males 2.5:1
unilateral 4:1
right 3:2

Front 21

what arches do the hillocks arise from?

Back 21

1-3 = 1st branchial arch
- give rise to the tragus, helical crus and helix,

4-6 = 2nd branchial arch
- Hillocks 4 and 5 form the antihelix, and hillock 6 forms the antitragus

Front 22

divide the ear into thirds by structure?

Back 22

helix to upper concha cymba
concha cymba to the top of antitragus
antitragus to the inf lobule

Front 23

Ear Angles

Auriculocephalic angle?
Inclination of the ear

Back 23

auriculocephalic angle is 15°–20°

Inclination of the ear (line from lobule, through tragal groove, to superior most helix) is 20° from the frankfort plane (the nose is about 30° from the franfort plane)

Front 24

the width of the ear is what % of the height? what are the average height and width measurements?

Back 24

width is 55% of the height
Average Height 55-65 mm
Width 33 mm and 35 mm

Front 25

there are 3 grades of microtia

Back 25

Grade 1 microtia is characterized by an abnormal auricle with all identifiable landmarks.
Grade 2 microtia consists of an abnormal auricle without some identifiable landmarks.
Grade 3 microtia is recognized by a very small auricular tag
Grade 4 microtia is anotia.

Front 26

what are the advantages of autologous cartilage vs implant for microtia reconstruction?

Back 26

less resorption
less extrusion
ability to grow
ability to withstand trauma

Front 27

what aspects are weighed pertaining to timing of microtia repair?

Back 27

maturity - ability to care for and not destroy the repair

teasing - social maturity. teasing issues usually start around age 7

size of cartilage - child needs to be atleast 5 for enough cartilage present with enough strength in the cartilage.

size of the other ear - for the ears to match, wait until 5-6 yrs old for the other ear to act as a template

* make sure hearing is addressed early

Front 28

what are the key component shapes to microtia repair?

Back 28

oval with flattened side
helical rim from root to lobule
line defining choncha, antitragus, and tragus
highlight to triangular fossa

Front 29

what's important about ear positioning?

Back 29

88% of microtia patients have facial assymtery, avoid measurements from the inferior 3rd of the face

Front 30

what are the 4 stages of auricular reconstruction

Back 30

The first stage involves harvesting the rib cartilage, carving, and creating an auricular framework, and placing it under a subcutaneous pocket (relatively precise -2 cm too big).

The second stage involves rotating the lobule from the microtia remnant and positioning it inferiorly on the helical rim. Can be performed 6-8 weeks after stage 1

The third stage encompasses creating an auriculocephalic angle by elevating the framework off the skull and placing a skin graft on the undersurface of the framework. Cartilage bolster can help increase the angle (banked in stage 1)

The fourth and final stage involves forming the tragus, and possibly the conchal bowl.

Front 31

what ribs do you harvest from?

Back 31

6-7 for the main framework and conchal bowl
8 for the helical rim

Front 32

what are the advantages of the Porex implant?

Back 32

allows tissue to grow into it
good tissue compatibility.
pliable during inset with heating.

- is rigid and prone to fracture.
- extrusion and infection are risks.