Application And Optimization Of Otoplastic Techniques Based On Auricular Abnormalities Characteristics

Background:Auricular abnormalities are a common problem in plastic surgery,with a wide range of severity and complex clinical manifestations.Currently,there are numerous classification methods for various types of auricular deformities,each with different diagnostic principles and treatment methods,and without a general consensus.This has resulted in differences in treatment outcomes.How to classify existing auricular abnormalities in a comprehensive and therapeutically guided manner,and how to improve and innovate clinical techniques on this basis,has always been the goal of clinicians dedicated to otoplasty.This study proposes investigating the classification of auricular abnormalities based on their characteristics,and the optimization and innovation of otoplastic techniques for different types of auricular abnormalities.Objectives:To comprehensively cover various causes and types of auricular deformities,the auricular abnormalities are categorized according to their characteristics and the corresponding treatment principles are adopted.Optimization and innovation of otoplastic techniques for common and representative auricular abnormalities are discussed.Methods:Based on their characteristics,auricular abnormalities are classified into two main categories,namely,anomaly of tissue and structure(anatomical structures are present but morphologically abnormal)and deficiency of tissue and structure(anatomical structures are missing),and are treated with “tissue and structure contouring techniques” and “tissue and structure loss supplementation techniques” respectively.The study is divided into five sections.Sections 1 to 3 discuss auricular abnormalities characterized by “anomaly of tissue and structure” and are treated with “structure contouring techniques”.Sections 4 and5 discuss the management of auricular anomalies characterized by tissue loss,focusing on the technique of tissue loss augmentation and strategies for the repair of acquired auricular defects,leading to a preliminary exploration of the management of complex auricular defects with more severe injuries when conventional protocols are not feasible.Section 1 discusses the feasibility and effectiveness of using the vertical mattress suture technique for contouring the antihelix.Malpresentation of the antihelix is a common issue associated with prominent and cup ears.The study investigated the effectiveness of applying the vertical mattress suture technique,commonly used for skin incision closure,to fixating auricular cartilage for antihelix contouring.The study involved 104 patients who underwent antihelix contouring using the vertical mattress suture technique as a ’tension band’ to fixate auricular cartilage between January 2017 and December 2020.The results were evaluated and rated based on the appearance of the antihelix,bilateral symmetry,surgical traces,and overall morphology of the auricle during postoperative follow-up.Section 2 discusses the tragus reconstruction technique for managing accessory auricle.The morphology of the tragus is often overlooked,but surgery can be unsatisfactory for shaping the tragus after excision of the accessory auricle and concealing the surgical incision.The study included 110 cases of accessory auricle and tragus reconstruction performed by the author between January 2018 and May 2021.The classification of the accessory auricle is based on its morphological characteristics and the involvement of the tragus.Surgical plans are then designed accordingly.The tragus cartilage misshape and skin incision design were resolved using the “diamond-shaped cartilage resection technique” and “Flipped Flaps technique”,respectively.Section 3 discusses the treatment of complex auricular deformity using the "hybrid technique," which is a combination of otoplastic techniques,using the "question mark ear" as an example of this particular deformity.A total of 12 patients with question mark ear deformity who underwent surgery by the author between January 2017 and December 2022 were included in the study.The complex deformities are treated by targeting specific anatomical subunits involved in the deformity,and the surgery is performed using a combination of three techniques: antihelix contouring,scapha reduction,and helical rim composite tissue flap advancement.Postoperative outcome assessment consisted of both objective and subjective assessments.The objective evaluation consisted of a comparison of the preoperative and postoperative auricular measurements,and the subjective evaluation was performed using the Visual Analog Scale(VAS).Section 4 discusses the repair protocol for traumatic auricular defects.A total of 34 cases of auricular defect repair performed by the author between January 2018 and May2023 were included in the study.Defects are classified based on the number and location of involved anatomical subunits.Different methods of flap expansion and transfer,as well as cartilage scaffolding fabrication,are used for repair.The improvement of the technique balances the appearance of the reconstructed auricle,the rational articulation with the original auricle,and the preservation of the normal shape of the back of the ear.The evaluation of the postoperative results consisted of both objective and subjective evaluations.The postoperative results were evaluated objectively by comparing preoperative and postoperative auricular measurements.Subjective evaluations were also conducted using the VAS scale,which included scoring for the repair effect of the defect site,bilateral symmetry,postauricular morphology,and overall auricle morphology.Section 5 explores microsurgical techniques for managing complicated auricular defects.This type of repair surgery is challenging and has a limited number of cases performed.The technique is still in the exploratory stage.Two cases of auricular reconstruction using different techniques were completed and participated in by the author.One case utilized superficial temporal fascia free grafting combined with cartilage scaffolding,while the other utilized prefabricated flap free grafting combined with reexpansion and cartilage scaffolding through a sequential treatment protocol.Various aspects of surgical design,choice of surgical protocols,and postoperative outcomes are comprehensively discussed in the context of the literature review on methods of repairing auricular defects using microsurgical techniques.Results:1.The vertical mattress suture applied as "tension band fixation" technique can provide stable fixation of the auricular cartilage,forming a natural shape of the antihelix.This technique has a wide range of indications and can be used to address poor compliance of the auricular cartilage by increasing the number of sutures.The operation is relatively simple.In the postoperative evaluation,98 out of 104 patients(94.2%)reported being“satisfied” or “very satisfied”.This technique is a practical and stable method for antihelix contouring.2.The classification of the accessory auricle based on its morphological characteristics can effectively guide tragus reconstruction.The cartilage flip technique for deformed cartilage and the flap flip technique for hiding the skin incision helped to improve the surgical results.In the postoperative evaluation,the surgical result was evaluated as good with a Likert 4-point scale score of 3.7.3.For complex auricular deformities,such as the question mark ear,a hybrid treatment plan was utilized to achieve successful correction.The surgical results were objectively evaluated by comparing auricular morphometric data with the preoperative and postoperative data.VAS scores were performed before and after surgery,and the results showed a significant improvement in auricular deformity correction.4.Defect classification based on the number and location of anatomic subunits involved in the defect,combined with the use of flaps and cartilage scaffolds corresponding to each classification method,resulted in improved surgical repair.The comparison of auricular measurements before and after defect repair indicated significant differences,providing objective evidence of the surgical results.There was a significant difference in the VAS scores before and after the surgery,indicating that the auricular defects were repaired with good results.5.Summarizing the two completed cases of deformity repair using microsurgical techniques,it is evident that both surgeries were successful despite their complexity and lengthy treatment period.In cases of complex auricular defects where conventional repair techniques are not feasible,defect repair based on microsurgical techniques may be a promising direction to explore.After conducting a literature review of microsurgical techniques for repairing auricular deformities and drawing on the author’s experience,this study proposes techniques and directions that may merit further research in the future as a preliminary exploration.Conclusions:A comprehensive coverage of all types and causes of auricular abnormalities is provided by classification methods based on auricular characteristics.This classification provides guidance in the selection and application of otoplastic techniques.Based on this,auricular anomalies are categorized and discussed,along with treatment principles and otoplastic techniques.Improvements and innovations in a variety of techniques have resulted in better deformity correction results.