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Objective: To analyze the sectional anatomical features of auricular and middle ear malformation in patients with microtia so as to improve the clinical classification and the instruction of surgery., Methods: From Jun. to Dec. 2009, 36 cases with microtia were selected in the center of auricular reconstruction in Plastic Surgery Hospital, including 22 cases of unilateral microtia and 14 cases of bilateral microtia. 22 patients with unilateral microtia were studied with the contralateral healthy ears as controls. Spiral CT was performed for high-resolution scan of the temporal bone. The coronal, sagittal and 3D reconstruction images were created with Mimic software. Several distances and degrees were measured., Results: The patients were classified by Max classification. The anteroposterior diameter and the vertical diameter of tympanic cavity were (7.75 +/- 1.92) mm and (14.66 +/- 4.75) mm for type I; (6.17 +/- 2.56) mm and(14.35 +/- 5.12) mm for type II; (6.31 +/- 3.40) mm and (9.97 +/- 4.36) mm for type III (P = 0.001). The mastoid pneumatization degree for type I, II, III were 13.33%, 13.64%, 30.77% in sclerotic type, 13.33%, 18.18%, 7.69% in diploe type, 0, 9.09%, 38.46% in composite type, 73.33%, 59.09%, 23.08% in pneumatic type (chi2 = 24.11, P = 0.002). The cover of fenestra vestibuli by facial nerve was 21.43%, 47.62%, 54.55% (chi2 = 23.44, P = 0.002) for type I, II, III. There was a statistical difference between the microtia group and the control group., Conclusions: According to the Max classification, the middle ear malformation changed along the auricular malformation. The anatomical variations was complicated in type II microtia, which should be sub-classified.

Objective: To explore the methylation of CpG islands in promoter of eye absent gene 1 (EYA1) in microtia., Methods: The methylation of CpG islands in EYA1 gene in 64 microtias and 36 healthy controls were measured using the technique of matrix-assisted laser desorption/ionization-time of flight., Results: The methylation of CpG_Unit3 and CpG_Unit5 of EYA1 gene in microtia were 0.09258 +/- 0.033846 and 0.0922 +/- 0.02379, respectively, which were significantly lower than those in control., Conclusions: Hypomethylation in microtia may be related to the pathogenesis of the disease.

Objective: To explore the application of the remnant in repairing the reconstructed ear in microtia., Methods: From October 2000 to July 2006, 1,823 patients with reconstructed ear underwent the second operation for repairing. The remnants were used to reconstruct tragus, antitragus, crus of helix, concha cavum, or relax the adhesion between the reconstructed auricle and cranio wall, or insert into the reconstructed lobule or under the basement of the costal cartilage frame to restore the cranio-auricular angle or to the preauricular subcutaneous to correct the facial local depression., Results: In 1,823 cases, the tragus, antitragus and concha cavum was reconstructeded by remnant auricle in 1,180 cases; helix crus was repaired by remnant auricle in 743 cases; the wound was repaired by remnant auricle flap resulted from relaxing the adhesion between the reconstructed auricle and cranial wall in 68 cases; Subcutaneous and cartilage flap was formed and transferred in 95 cases, and among them the flap was transferred under the basement of the frame to restore the cranio-auricular angle in 77 cases and was transferred to the preauricular subcutaneous to correct the facial local depression in 18 cases; the skin flap was formed by remnant auricle to repair the lobule in 37 cases. All flaps survived completely. The appearance of reconstructed ear was satisfied., Conclusion: The remnant is very useful in repairing the reconstructed ear in microtia. It should be preserved propriately in auricular reconstruction.

Objective: To classify the blood vessel distribution of the expanded skin in the mastoid region and its relevance to reasonable and reliable design of the expanded flap for auricular reconstruction in congenital microtia., Methods: The blood vessel distribution of the expanded skin in the mastoid region was observed by light permeation test. The expanded flaps with different ratio of length to width were designed according to their blood vessel distribution types., Results: The vascular distribution of the expanded skin in 403 cases was divided into five types. All the flaps survived completely., Conclusions: The blood vessel distribution type of the expanded skin in mastoid region has great significance for the design of post-auricular expanded flap in auricular reconstruction.

Objective: To investigate the psychologic status of congenital microtia patients and related influential factors., Methods: In a cross-sectional survey for congenital microtia, 410 patients, 314 males and 96 females, aged 12 +/- 6 (5 - 37), underwent psychological survey with the symptom checklist-90 (SCL-90) or Achenbach child behavior checklist (CBCL), centering on the 3 main psychological problems: depression, interpersonal sensitivity or social difficulties, and hostility or aggression. A questionnaire was designed to investigate the influencing factors, such as the patients' own factors, and psychological factors of the patients' families Chi square test and logistic regression analysis were performed to find the factors contributing to those psychological problems., Results: Psychological status of congenital microtia patients were depression existed in 83 patients (20.2%), interpersonal sensitivity or social difficulties existed in 150 patients (36.6%), and hostility or aggression existed in 108 patients (26.3%). The factors, such as age (OR = 1.75), microtia grade (OR = 2.77), mother's education (OR = 2.49), having been subjected to ridicule (OR = 2.58), pressure of family affection (OR = 1.96), family attitude to patient (OR = 2.45), and deficiency of family harmony (OR = 2.57) were risk factors contributing to depression of patients. The factors, such as age (OR = 1.62), having been subjected to ridicule (OR = 3.34), and pressure of family affection (OR = 1.89) were risk factors contributing to interpersonal sensitivity or social difficulties of the patient. The factors, such as having been subjected to ridicule (OR = 2.47), and pressure of family affection (OR = 1.80) were risk factors contributing to hostility or aggression of the patient., Conclusion: Having been subjected to ridicule, deficiency of family harmony, and pressure of family affection are mainly risk factors of psychological problems of congenital microtia patients. Early education and early operation for the patients are necessary.

Objective: To study the psychologic status and their influencing factors in congenital microtia patients and their families., Methods: Totally one hundred and two congenital microtia patients (79 men, 23 women, mean age 13.62 +/- 7.2 years) were enrolled. The patients and their families answered the questionnaire written by ourselves to identify the psychosocial problems., Results: (1) 23.5% patients were found to have severe psychosocial problems, such as lack of self-confidence, close and fear and so on. (2) With the growth of age, psychosocial problems of the patients were rated high (P < 0.05). (3) For patients who found their deformations early, psychosocial problems also were rated low. (4) For patients who found their deformations by themselves, psychosocial problems also were rated low. (5) The education and psychosocial impact for parents all affected patients deeply., Conclusions: To prevent psychosocial problems, we should operate for patients as early as possible. And correct guidance is very important for youngsters.

Objective: To evaluate a new reliable surgical technique for correction the congenital cupped ear., Methods: With 96 patients, a stainless steel wire was introduced to suspend auricular cartilage on the pericranium after the cupped ear was corrected. The follow-ups were carried out after the operation., Results: Up to 3 years follow-ups with 52 cases, the results were satisfactory and durable., Conclusions: The above mentioned technique could be a reliable way to correct mild and moderate cupped ear abnormalities.

Objective: To introduce a new technique for the treatment of helical keloid., Methods: The procedure consisted of two steps. In the first step, a kidney-shaped expander of 50 ml was placed subcutaneously in the retroauricular area. Routine inflation with normal saline followed. In the second step, about two months afterwards, the expander was taken out and the helical keloid was excised. The expanded flap was advanced to cover the wound., Results: The operation has been performed on 12 patients of 16 sites of helical keloid since 2000. Postoperative follow-up from 3 months to 2 years revealed satisfactory results. The reconstructed ear maintained a good contour., Conclusion: The technique creates a retroauricular flap rich in blood supply, which can be used to close the defect left by helical keloid excision. It provides a good treatment for the helical keloid replaced with normal skin from the mastoid region.