上海市第六人民医院 shanghai sixth people’s hospital microtia shankai yin prof dept of...
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上海市第六人民医院Shanghai Sixth People’s Hospital
Microtia
Shankai Yin Prof Dept of Otolaryngology, the sixth hospital affilia
ted to Shanghai jiaotong university Otolaryngology institute at Shanghai jiaotong u
niversity
上海市第六人民医院Shanghai Sixth People’s Hospital
Epidemiology
Occurs 1 in 7,000 to 8,000 infants Occurs more often in right ears Occurs more often in males Higher incidence in Hispanics and Asians
than in blacks and whites Fewer than 15% with positive family history Associated with other congenital
malformations
上海市第六人民医院Shanghai Sixth People’s Hospital
Known causes Thalidomide( 啶酮 ) Isotretinoin() Genetic
Risk factor Diabetes
Etiology
The occurrence of microtia is usually a random, sporadic event, and it is important for the parents to understand that the deformity was not caused by anything the mother did before or during the pregnancy
上海市第六人民医院Shanghai Sixth People’s Hospital
Embryology of Auricle
From The Ear comprehensive otology:
上海市第六人民医院Shanghai Sixth People’s Hospital
Anatomy of auricle
From The Ear comprehensive otology:
上海市第六人民医院Shanghai Sixth People’s Hospital
Classification of Microtia
Many classification systems Grade I, II, III
Grade I: all anatomic subunits present but misshapen
Grade II: anatomic subunits either deficient or absent
Grade III: classic “peanut ear” and anotia
上海市第六人民医院Shanghai Sixth People’s Hospital
Grade I: A slightly small ear with identifiable structures and a small but present external ear canal
Grade II: A partial or hemi-ear with a closed off or stenotic external ear canal producing a conductive hearing loss
Grade III: Absence of the external ear with a small peanut vestige structure and an absence of the external ear canal and ear drum
Grade IV: Absence of the total ear or anotia
上海市第六人民医院Shanghai Sixth People’s Hospital
上海市第六人民医院Shanghai Sixth People’s Hospital
Microtia reconstruction
Dr. Tanzer 1959 1st article on auricular reconstruction with
autogenous rib cartilage, 6 stages procedure Dr. Brent 1974
4 stages procedure, foremost authority on auricular reconstruction
Dr. Nagata 1985 2 stages procedure
History
上海市第六人民医院Shanghai Sixth People’s Hospital
Principles
Hearing testing is first done to determine if the inner ear is int
act and hearing is normal. External canal
to determine if a canal exists, by CT scan. (if a canal is not visible externally)
Age The earliest age surgery can be attempted is age 3 for
Medpor and 6 for Rib Cartilage Grafts. However a later age recommend, 8-10 when the ear is full adult size.
上海市第六人民医院Shanghai Sixth People’s Hospital
Surgery options
canal reconstruction Ear canal reconstruction is unnecessary
and overcomplicated Very good hearing is possible with modern
hearing aids auricular reconstruction
Rib Cartilage Graft Reconstruction a polyethylene plastic implant
上海市第六人民医院Shanghai Sixth People’s Hospital
Rib Cartilage Graft
上海市第六人民医院Shanghai Sixth People’s Hospital
上海市第六人民医院Shanghai Sixth People’s Hospital
The ear frame before it is assembled
Photo of implant components on a surgical drape. Caution: The porous implant material should not be placed on surgical drapes or other fibrous material that may shed particles on the implant.
a polyethylene plastic
Ear frame assembly
上海市第六人民医院Shanghai Sixth People’s Hospital
Long term result
上海市第六人民医院Shanghai Sixth People’s Hospital
上海市第六人民医院Shanghai Sixth People’s Hospital
上海市第六人民医院Shanghai Sixth People’s Hospital
上海市第六人民医院Shanghai Sixth People’s Hospital
Tissue engineering