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Journal of the Korean Society of Plastic and Reconstructive Surgeons 1998;25(3):383-393.
Published online April 1, 1998.
Ear elevation using mastoid fascia flap and silicone block.
Young Jin Park, Myoung Soo Shin, Jae Jung Kim, Weon Jin Park, Bomjoon Ha, Jae Seung Lee, In Chul Song
Department of Plastic and Reconstructive surgery, Sung Kyun Kwan University College of Medicine, Samsung Medical Center, Korea.
Abstract
Tanzer introduced the auricular reconstruction using autologous rib cartilage & full thickness skin graft for congential microtia correction in 1959. After then, many surgeons adapted various modified methods for total ear reconstruction. However, there are some problems in the stage of ear elevation with the conservative technique. Due to scar contracture, the auriculocephalic angle cannot be maintained with the skin graft alone. Nagata tried to overcome this problem by inserting rib cartilage covered by temporoparietal fascia to the elevated cartilage frame. However, this technique also induced several problems. 1st, it leaves a long scar and alopecia on the temporal scalp. 2nd, Nagata method requires a lot of cartilage in order to fabricate the 3-dimensional framework, sometimes leaving no cartilages to be used for the semilunar pillow in the ear elevation procedure. 3rd, this method cannot be used if the temporoparietal fascia was already used for another reason such as cartilage framework exposure. To overcome these problems, we used the silicone block and mastoid fascia flap instead of semilunar cartilage pillow and temporoparietal fascia flap. Since silicone is not an absorbable material, it can maintain good auriculocephalic angle. Furthemore, due to the excellent blood circulation of the mastoid fascia flap, there is a strong resistance to postoperative complications such as infection and extrusion. Other advantages are that it leaves short scars and is esthetically tolerable. This method may preserve the temporoparietal fascia and therefore, may be prepared for the 2ndary operation in case of the exposure of framework. From March 1995 to July 1997, 18 patients (14 males and 4 females) who ranged in age from 9 to 23 years underwent ear elevation using the silicone block and mastoid fascia flap. These patients had previous rib cartilage graft operations at 6 months before these operations. We did not find any complications such as infection, silicone implant extrusion and decreased auriculocephalic angle. During 6 to 26 months follow-up period (average follow-up period; 12 months), there was no case of decreased auriculocephalic angle. The clinical result of this technique was excellent at the stage of ear elevation.
Keywords: Microtia; Ear elevation; Mastoid fascia flap; Silicone block
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