Background: The projection of the reconstructed auricle is an important step in ear reconstruction. The novel use of the vestigial cartilage can successfully replace the projection piece harvested from the costal cartilage, improve the three-dimensional contour of the reconstructed auricle, and help deepening of the concha, compensate for mastoid atrophy in patients with hemifacial microsomia. Methods: A total of 34 patients with microtia were included and classified according to the Nagata classification. Anotia and atypical cases with deficient cartilage are excluded. Two-stage auricle reconstruction was performed. The first stage included retroposition of the vestigial cartilage, framework implantation and lobule transposition. After 3 to 6 months, the second stage was performed and included elevation of the reconstructed auricle and coverage by split-thickness skin graft. Results: The results were satisfactory regarding the shape, symmetry, maintenance of the auriculocephalic angle, and stability of the reconstructed ear. The vestigial cartilage was classified into 3 different types according to its shape. Type 1 (V1) cartilage is a sausage-shaped cartilage that can be directly used as a projection piece. Type 2(V2) cartilage is a flat-shaped cartilage that should be folded upon itself. Type 3(V3) cartilage is an atypical type where the cartilage does not have a specific shape. This type can be used as it is or reconfigured with sutures according to the amount of projection needed. Moreover, 87% of patients were satisfied with the appearance of their new ears, 90% of patients can wear their glasses or sunglasses, and 94% of patients can easily clean their new ear. Conclusions: According to the shape and amount of the available vestigial cartilage, it can be used as a projection piece either alone or with an augmentation piece from the costal cartilage.
Background: Orbital septum plication provides various benefits, including eliminating the necessity for a septal incision and the ability to relocate infraorbital fat in a more anatomically suitable manner. This study aimed to compare the results of traditional lower blepharoplasty with fat excision and the orbital septal plication method using orbital grey scale analysis as a new objective method for assessment. Methods: We conducted a prospective cohort study on patients with bilateral baggy lower eyelids who underwent traditional lower blepharoplasty with fat excision or fat-sparing technique using orbital septal plication. All patients were followed up closely for 1 week and then after 1, 3, and 6 months postoperatively to evaluate the study’s outcomes. Results: The study was conducted using 40 patients (20 patients per group). The total (medial, central, and lateral) orbital grey scale analysis showed a significant reduction in the fat-sparing and traditional groups (P < 0.001, each). However, the percentage of reduction was significantly higher in the fat-sparing group (34.6 ± 2.9 versus 15.5 ± 3.3 in the traditional groups; P < 0.001). Conclusions: The application of the fat-sparing technique is associated with favorable cosmetic outcomes and a lower complication rate than those of the traditional technique with fat excision. Further studies with a longer duration of follow-up and a larger sample size are required to estimate the risk of recurrence and the need for a revision procedure.
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