Correction of microtia with constriction features using a superficial temporal fascial flap combined with a rib cartilage graft

Background Microtia with constricted features is characterized by a short helical length of variable severity, upper antihelical or scaphal deficiency, and a downfolded upper ear. No consensus has been reached regarding the most appropriate surgical method for this condition. In this study, we aimed to introduce a simple and safe surgical method for the correction or reconstruction of upper helix ear deformities.

Methods Between February 2011 and June 2014, eight patients with microtia with constricted upper helix ear deformity underwent reconstruction of the ear deformity. The upper ear helical framework was constructed by carving and curving the eighth rib cartilage harvested from the ipsilateral chest wall, covering this cartilage with a superficial temporal fascial flap, and adjusting the skin graft to align with the ear contour. To evaluate their satisfaction, patients were asked to complete a questionnaire regarding ear shape, symmetry, position, color, and overall outcome scored on a 5-point scale at 12 months postoperatively.

Results None of the patients experienced severe complications in the reconstructed ear. The preoperative and postoperative vertical ear length ratios were 0.88 and 1.02, respectively. And the mean patient satisfaction scores for shape, symmetry, position, color, and overall outcome were 4.2, 4.5, 4.7, 4.4, and 4.6 out of 5 points, respectively. All patients expressed a high level of satisfaction at 12 months postoperatively.

Conclusions Our technique provides a good alternative method for the reconstruction of moderate constricted upper helix ear deformities in patients who meet the surgical indications with satisfactory outcomes and few complications.

Keywords

Ears prominent and constricted - Congenital microtia - Ear auricle

This research was supported by the Kyungpook National University Research Fund in 2018.

Publication History

Received: 04 October 2018

Accepted: 20 March 2020

Article published online:
25 March 2022

• REFERENCES

• 1 Janz BA, Cole P, Hollier Jr LH. et al. Treatment of prominent and constricted ear anomalies. Plast Reconstr Surg 2009; 124 (1 Suppl) 27e-37e
• 2 Tanzer RC. The constricted (cup and lop) ear. Plast Reconstr Surg 1975; 55: 406-15
• 3 Elsahy NI. Technique for correction of lop ear. Plast Reconstr Surg 1990; 85: 615-20
• 4 Kaye BL, Lotuaco GG. A simplified technique for correction of the congenital lop ear. Plast Reconstr Surg 1974; 54: 667-70
• 5 Brent B. The correction of microtia with autogenous cartilage grafts: II. atypical and complex deformities. Plast Reconstr Surg 1980; 66: 13-21
• 6 Horlock N, Grobbelaar AO, Gault DT. 5-Year series of constricted (lop and cup) ear corrections: development of the mastoid hitch as an adjunctive technique. Plast Reconstr Surg 1998; 102: 2325-35
• 7 Park C. A new corrective method for the Tanzer’s group IIB constricted ear: helical expansion using a free-floating costal cartilage. Plast Reconstr Surg 2009; 123: 1209-19
• 8 Egemen O, Ozkaya O, Barutca SA. et al. Tanzer group IIB constricted ear repair with helical advancement and superior auricular artery chondrocutaneous flap. J Craniofac Surg 2012; 23: 728-31
• 9 Bi Y, Lin L, Yang Q. et al. Surgical correction of constricted ear combined with Stahl’s ear. J Plast Reconstr Aesthet Surg 2015; 68: 895-901
• 10 Kim YS, Chung S. A simplified method for correcting Tanzer’s group II constricted ears: construction of the superior crus as a strut with cartilage expansion grafting. J Plast Reconstr Aesthet Surg 2016; 69: e71-6
• 11 Park C, Park JY. Classification and algorithmic management of constricted ears: a 22-year experience. Plast Reconstr Surg 2016; 137: 1523-38
• 12 Park C, Park JY. Reconstruction of microtias with constricted ear features: a 22-year experience. Plast Reconstr Surg 2018; 141: 713-24
• 13 Al-Qattan MM, Al-Omawi M. Z-plasty for Tanzer type IIb constricted ears. Ann Plast Surg 2009; 63: 285-7
• 14 Nagata S. Alternative surgical methods of treatment for the constricted ear. Clin Plast Surg 2002; 29: 301-15
• 15 Siegert R, Magritz R. Reconstruction of the auricle. GMS Curr Top Otorhinolaryngol Head Neck Surg 2007; 6: Doc02
• 16 Mohammadi AA, Imani MT, Kardeh S. et al. Non-surgical management of congenital auricular deformities. World J Plast Surg 2016; 5: 139-47
• 17 Woo T, Kim YS, Roh TS. et al. Correction of congenital auricular deformities using the ear-molding technique. Arch Plast Surg 2016; 43: 512-7
• 18 Ono I, Gunji H, Sato M. et al. A method of treatment of constricted ears with a conchal cartilage graft to the posterior auricular plane. Plast Reconstr Surg 1993; 92: 621-7
• 19 Xiaogeng H, Hongxing Z, Qinghua Y. et al. A new method for correcting type I and type II constricted (cup and lop) ears. Aesthetic Plast Surg 2006; 30: 449-54
• 20 Fisher DM, Kasrai L. Extension of autologous ear reconstruction techniques for management of the constricted ear. Paper presented at 4th International Congress on Auricular Reconstruction; October 10-12, 2007; Edinburgh, UK