Due to the variety of abnormalities, surgery of the auricle is one of the most complex challenges in facial plastic surgery. They reach from mild protruding ears or isolated abnormalities of the supporting structures, mainly the helical rim and antihelix, over cup ear deformities and miniears all the way to severe microtia and anotia. In this article, the authors present a short overview of auricular abnormalities and malformations and their treatment options based on their experiences gained over three decades of special service for patients with auricular malformations.
Although the use of autogenous cartilage is the gold standard in auricular reconstruction, its main disadvantage is the morbidity due to harvesting the cartilage. This includes postoperative pain, visible scar, and possibly asymmetry and reduced stability of the thorax. To reduce all of these drawbacks, we describe some modifications that reduce pain to a low tolerable level, hide the scar invisibly in the submammary fold in females, and induce regeneration as well reestablish stability of the rib defect.
Although several techniques can be used for microtia repair, some standard procedures have been developed over the past few decades. In specialized centers, these techniques are performed most frequently. They include two to four operative steps using autogenous rib cartilage for the framework and local skin for its tegument. We have been using this technique presented here in more than 800 cases over the past two decades with good and mostly stable results.
Objective The objective of the present study was to investigate the application of the water‐jet dissection method in parotid surgery by way of animal experiments, paying particular attention to the clinical and histological reactions of the facial nerve. Study Design An animal experimental study. Methods Total bilateral parotidectomies with retention of the facial nerve were performed on 19 beagle dogs by means of the Hydro‐Jet device (Andreas Pein Medizintechnik Company, Schwerin, Germany) using different jet diameters and operating pressures. All operations were performed with continuous intraoperative facial monitoring (Neurosign 100, Inomed Company, Teningen, Germany). The dogs were monitored postoperatively over an average period of 20.3 days (range, 14–35 d). Local findings and facial nerve status were documented daily. In a second phase, the dissected nerves were resected and the animals were killed. Samples of water‐jet–dissected parotid tissue, as well as all dissected nerve branches, underwent histological examination and were compared with clinical and electrophysiological findings. Results It was possible to perform operations easily on all parotid glands by means of the Hydro‐Jet using the small, 120‐μm jet at operating pressures of 40 to 60 bar and to dissect the facial nerve quickly and safely with retention of its functional capability (n = 34). The dissection of nerves using larger‐diameter jets (150 and 200 μm [n = 64]) resulted in a total of two reversible and seven irreversible partial pareses. Conclusions The study has shown that it is possible to perform tissue‐selective operations on the parotid gland by means of the Hydro‐Jet using the 120‐μm jet at operating pressures of 40 to 60 bar, ensuring safe, atraumatic dissection of the facial nerve with retention of its functional capability. The advantages of the new Hydro‐Jet method offer a valuable alternative compared with the normal dissection methods adopted in parotid surgery. Thus the results of the present investigation currently are being checked within the framework of a clinical study at our clinic.
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