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In this study, the optimal engraving parameters were determined through the analysis of scanning electron microscopy (SEM) data, as follows: a laser power density of 5.5 × 105 W/cm2, an irradiation rate of 0.1 mm/s, a well radius of 60 μm, a distance between well centers of 200 μm, and a number of passes for each well of 20. After 1 week of in vitro cultivation, chondrocytes were located on the surface of the scaffolds, in the sockets and lacunae of decellularized cartilage. When implanted into animals, both cellular and acellular scaffolds were able to support cartilage in-growth and complete regeneration of the defect without clear boundaries with normal tissue. Nevertheless, the scaffolds populated with cells exhibited superior biocompatibility and were not subject to rejection, in contrast to cell-free constructs. [ABSTRACT FROM AUTHOR]

Cartilage tympanoplasty is a fast growing technique used to restore hearing in chronic suppurative otitis media. The technique has misnomers such as limited applicability in only small size perforations, interference with sound conducting mechanism and durability. Our experience in out tertiary care Institution with over 100 retrospective study cases prove that there is a scope of proving it to be well established technique. That could be used in par with other tympanoplasty techniques. Our retrospective case series of 100 operated between 2021 and 2024 were taken, having unilateral perforation convenience data collection purpose. The overall success rates of cartilage / button tympanoplasty of varying perforation sizes, having a wide range of pure tone audiometry statuses having successful results were discussed, which is indicated as a percentage format. In our retrospective case series, out of our 100 cases we had 90 successful graft uptake cases. The 10% cases were later followed up in our study. It was analysed and concluded that the technique was not the inhibiting factor but the post operative care had prevented the patients from having the desired results. Our results are in accordance with previous case studies for support. Pure tone audiometry were taken pre operatively and post operatively that support cartilage / button tympanoplasty. Cartilage tympanoplasty is a commonly misunderstood technique which if corrected has a wide scope to be used a s a common treatment modality. Data collected and inference were in concordance with previous studies conducted. Tragal cartilage due to its durability, low inflammatory reaction to tympanic membrane, lesser chances of retraction and long term assurance of withstanding environmental conditions has proven to be technique which can be used in regular basis. Cartilage / button tympanoplasty is a technique that has a shorter learning curve for surgeons. With a high demand of cases in chronic suppurative otitis media-Tubotympanic type, button tympanoplasty technique is an assest. [ABSTRACT FROM AUTHOR]

In recent years, the advancement of technology and the pursuit of time efficiency have increased people's interest in online shopping. Various models of helmets are preferred by motorcycle riders, including those that fully cover the face, only enclose the chin, or are half-faced. However, a common feature in all models is that the earlobes remain within the helmet. Anatomically, considering the possibility of changes in the structure of the auricle (pinna) due to helmet usage and the potential impact on the transmission of sound to the middle ear in the future, our study is designed to identify alterations that may occur in the earlobes of motorcycle couriers as a result of helmet use. Participants in our study were selected from individuals working as couriers. A total of 200 participants, comprising 100 individuals who regularly use helmets and 100 individuals who do not use helmets, were included based on voluntary participation. Individuals with a history of earlobe surgery or auricular anomalies were excluded from the study. The selection criteria for helmeted couriers included a minimum of five years of helmet usage. Morphometric measurements were conducted through a photometric method using a digital camera, which is an indirect measurement technique.The distance between the landmark points marked on the auricle and the attachment distance of the auricle to the head were calculated using the MB Ruler program. According to the statistical analysis of the morphometric data obtained, it was observed that the cymba concha height, as well as the width and height of the auricle, were significantly lower in both the right and left ears of couriers. As a result, it can be speculated that prolonged helmet usage may affect the cartilaginous structure of the ear, thereby altering the distance values between landmark points. [ABSTRACT FROM AUTHOR]

Background: Biomaterials and surgical techniques for reconstructive tympanic membrane surgery are under development. Objectives: The objective of this study is to analyze the functional and surgical outcomes of a novel fascia with cartilage reinforcement technique for anterior tympanic membrane perforation in tympanoplasty. Methods: Records of 198 patients with anterior tympanic membrane perforation who underwent tympanoplasty between August 2018 and March 2021 were prospectively reviewed. Patients with dry anterior quadrant perforations of the tympanic membrane were included and underwent tympanoplasty using two methods: Type 1 tympanoplasty with temporalis fascia only, and tympanoplasty with fascia and cartilage reinforcement. Postoperative functional and surgical outcomes were analyzed. Results: Comparing the pre-operative and post-operative air conduction levels and air-bone gaps showed significant improvement in both groups (P < 0.001). Additionally, no significant difference was observed between air-bone gap closure (P = 0.316) and increase in air conduction levels (P = 0.222) according to graft type. Conclusions: Both temporalis muscle fascia and temporalis muscle fascia with cartilage reinforcement revealed satisfactory functional and surgical outcomes. Furthermore, the novel combined cartilage-fascia technique had a comparable graft take rate and hearing results in anterior perforations, with no significant change in tympanic membrane vibratory properties. [ABSTRACT FROM AUTHOR]

Objective: Unusual clinical course Background: A 52-year-old male patient presented with symptoms of chronic cough and persistent tracheal irritation 26 years after surgical closure of a tracheostoma, supported by an autologous auricular cartilage graft and cutaneous transplant. At the initial clinical presentation, the patient was an active smoker, with a cumulative dose of 31 pack years. Case Report: Bronchoscopy revealed endotracheal hair growth and local inflammation at the graft site. Initial anti-inflammatory, antimycotic, and antibacterial therapy was administered, followed by endoscopic structure remodeling. There were multiple recurrences with similar symptoms, showing isolated hair growth, without inflammation. Annual endoscopic restructuring sessions were indicated, and the patient experienced them as highly relieving. Recurrent hair growth was finally terminated by argon plasma laser-coagulation and after smoking cessation. We hypothesize that the onset of hair growth was triggered by the patient's cigarette smoking. Conclusions: Endotracheal hair growth is a potential complication of autograft-supported tracheal restructuring. The initial administration of antimicrobial and anti-inflammatory medication, combined with endoscopic restructuring, could have contained the active inflammation; the application of argon plasma laser-coagulation finally stopped the hair growth. Smoking is associated with the upregulation of molecular signaling pathways in the respiratory epithelium, which can stimulate hair follicles, such as sonic hedgehog protein, WNT-1/β-catenin, and epidermal growth factor receptor. [ABSTRACT FROM AUTHOR]

The aim of this report was to evaluate the efficacy of nasal reconstruction using auricular cartilage combined with auricular full-thickness skin graft and a local flap from the right nasal ala for correcting complex nasal defects, and its impact on the patient's quality of life and psychological well-being. We present the case of a 50-year-old female with a severe nasal deformity due to a car accident, characterized by a missing right alar flap and an exposed right nostril. The patient underwent nasal reconstructive surgery using auricular cartilage combined with an auricular full-thickness skin graft and a local flap from the right nasal ala. Detailed records of the patient's postoperative recovery, surgical outcomes, and satisfaction were made at follow-up. The survival rate of the grafted skin and flaps on the nasal ala, septum, and dorsum was high. The reconstructed right nasal ala closely resembled the left, and the patient was very satisfied. In patients with complex nasal deformities, nasal reconstruction using ear cartilage combined with auricular full-thickness skin grafts and local flaps can achieve satisfactory aesthetic and functional outcomes. The high level of postoperative satisfaction suggests that this technique significantly improves patients’ quality of life and psychological well-being.

Background: Lower lateral cartilage reshaping is one of the basic steps in rhinoplasty. Hemitransdomal suture is frequently used for dome narrowing. Different suture materials can be used for hemitransdomal suture. In this study, we investigated the effectiveness of polypropylene and polydioxanone in hemitransdomal suture by designing a new experimental model in the rabbit ear cartilage. Methods: Twelve young adult male New Zealand White rabbits were used. The bipedicled inverted-U-shaped cartilage was elevated in each ear of the rabbits. Two hemitransdomal sutures were applied using 5-0 polypropylene on one ear and 5-0 polydioxanone on the other ear randomly. A 5 mm high cartilage mound was created with two hemitransdomal sutures on each side. The sample size was twelve both in the polypropylene group and the polydioxanone group (n = 12). All animals were sacrificed after three months. Cartilage mound heights were measured. The samples were examined histologically regarding fibroadipose tissue, inflammation, foreign body granuloma, cartilage degeneration, and the presence of inclusion cyst. Results: Cartilage mound height was significantly higher in the polypropylene group than in the polydioxanone group at the end of the third month [3.75 mm (± 0.68) vs. 3.03 mm (± 0.69); p < 0.05]. There was no significant difference between the two groups in histological analysis (p > 0.05). Conclusions: Polypropylene suture may be more effective in maintaining the shape given to the dome by hemitransdomal sutures in rhinoplasty. No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 [ABSTRACT FROM AUTHOR]

Empty nose syndrome is an uncommon complication of turbinoplasty and other nasal operations. It presents with various manifestations, with the most common symptom being paradoxical nasal obstruction. Here, we report the case of a 67-year-old male patient diagnosed with empty nose syndrome 20 years after turbinoplasty. Autologous auricular conchal cartilage was harvested and implanted into the lateral wall of the inferior turbinate to reduce nasal volume. The patient experienced significant relief from subjective nasal obstruction symptoms immediately after surgery. Over a 23-month follow-up period, no side effects or symptom recurrence was reported.

A major obstacle for tissue engineering ear-shaped cartilage is poorly developed tissue comprising cell-scaffold constructs. To address this issue, bioresorbable scaffolds of poly-ε-caprolactone (PCL) and polyglycolic acid nanofibers (nanoPGA) were evaluated using an ethanol treatment step before auricular chondrocyte scaffold seeding, an approach considered to enhance scaffold hydrophilicity and cartilage regeneration. Auricular chondrocytes were isolated from canine ears and human surgical samples discarded during otoplasty, including microtia reconstruction. Canine chondrocytes were seeded onto PCL and nanoPGA sheets either with or without ethanol treatment to examine cellular adhesion in vitro. Human chondrocytes were seeded onto three-dimensional bioresorbable composite scaffolds (PCL with surface coverage of nanoPGA) either with or without ethanol treatment and then implanted into athymic mice for 10 and 20 weeks. On construct retrieval, scanning electron microscopy showed canine auricular chondrocytes seeded onto ethanol-treated scaffolds in vitro developed extended cell processes contacting scaffold surfaces, a result suggesting cell-scaffold adhesion and a favorable microenvironment compared to the same cells with limited processes over untreated scaffolds. Adhesion of canine chondrocytes was statistically significantly greater (p ≤ 0.05) for ethanol-treated compared to untreated scaffold sheets. After implantation for 10 weeks, constructs of human auricular chondrocytes seeded onto ethanol-treated scaffolds were covered with glossy cartilage while constructs consisting of the same cells seeded onto untreated scaffolds revealed sparse connective tissue and cartilage regeneration. Following 10 weeks of implantation, RT-qPCR analyses of chondrocytes grown on ethanol-treated scaffolds showed greater expression levels for several cartilage-related genes compared to cells developed on untreated scaffolds with statistically significantly increased SRY-box transcription factor 5 (SOX5) and decreased interleukin-1α (inflammation-related) expression levels (p ≤ 0.05). Ethanol treatment of scaffolds led to increased cartilage production for 20- compared to 10-week constructs. While hydrophilicity of scaffolds was not assessed directly in the present findings, a possible factor supporting the summary data is that hydrophilicity may be enhanced for ethanol-treated nanoPGA/PCL scaffolds, an effect leading to improvement of chondrocyte adhesion, the cellular microenvironment and cartilage regeneration in tissue-engineered auricle constructs.

BackgroundMicrotia is an inherited condition that results in varying degrees of external ear deformities; the most extreme form is anotia. Effective surgical reconstruction techniques have been developed. However, these usually require multistage procedures and have other inherent disadvantages. Tissue engineering technologies offer new approaches in the field of external ear reconstruction. In this setting, chondrocytes are cultured in the laboratory with the aim of creating bioengineered cartilage matrices. However, cartilage engineering has many challenges, including difficulty in culturing sufficient chondrocytes. To overcome these hurdles, the authors propose a novel model of cartilage engineering that involves co-culturing chondrocytes and adipose-derived stem cells on an allograft adipose-derived extracellular matrix scaffold.MethodsAuricular chondrocytes from porcine ear were characterized. Adipose-derived stem cells were isolated and expanded from human lipoaspirate. Then, the auricular chondrocytes were cultured on the allograft adipose matrix either alone or with the adipose-derived stem cells at different ratios and examined histologically.ResultsCartilage induction was most prominent when the cells were co-cultured on the allograft adipose matrix at a ratio of 1:9 (auricular chondrocyte-to-adipose-derived stem cell ratio). Furthermore, because of the xenogeneic nature of the experiment, the authors were able to determine that the adipose-derived stem cells contributed to chondrogenesis by means of a paracrine stimulation of the chondrocytes.ConclusionsIn this situation, adipose-derived stem cells provide sufficient support to induce the formation of cartilage when the number of auricular chondrocytes available is limited. This novel model of cartilage engineering provides a setting for using the patient's own chondrocytes and adipose tissue to create a customized ear framework that could be further used for surgical reconstruction.

In cases of weak or deficient caudal septum, the caudal septum extension graft (CSEG) is the most commonly used reconstructive method. In the current study we introduce a newly-designed conchal cartilage CSEG and evaluate its cosmetic and functional outcomes. The graft has an average length of 3 ± 0.3 cm and composed of a distal double-layered part, which is 3 to 4 mm wide and a proximal single-layered part, which is 1.2 to 1.7 cm wide. The graft design allows the proximal single-layered part to be fixed on either sides of the caudal septum while keeping the distal double-layered segment in the midline. The study included 230 patients, of which 83% were revisions, all patients completed a validated patient-reported outcome measure (PROM) questionnaire pre- and postoperatively. The PROMs used were either the Nasal Obstruction Symptom Evaluation (NOSE) survey or the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). During the mean follow-up period of 18.2 months (range: 9–192 months) no serious complications were encountered and only six cases (2.3%) required minor revisions of the CSEG. Using the proposed conchal cartilage, CSEG resulted in an improved cosmetic and functional outcome as evidenced by the significant postoperative improvement in the NOSE, SCHNOS-O, and SCHNOS-C scores with a p -value <0.001, <0.05, and <0.0001, respectively. The graft provided adequate tensile strength and support to the nasal tip, which resulted in improved tip projection, rotation, definition, and symmetry, while maintaining a degree of flexibility and elasticity which is much more than that of the rib or even the septum thus resulting in the most natural feel of the nasal tip lobule. [ABSTRACT FROM AUTHOR]

To investigate auricular reconstruction by tissue engineering means, this study compared cartilage regenerated from human chondrocytes obtained from either microtia or normal (conchal) tissues discarded from otoplasties. Isolated cells were expanded in vitro, seeded onto nanopolyglycolic acid (nanoPGA) sheets with or without addition of bone morphogenetic protein-7 (BMP7), and implanted in nude mice for 10 weeks. On specimen harvest, cartilage development was assessed by gross morphology, histology, and RT-qPCR and microarray analyses. Neocartilages from normal and microtia surgical tissues were found equivalent in their dimensions, qualitative degree of proteoglycan and elastic fiber staining, and quantitative gene expression levels of types II and III collagen, elastin, and SOX5. Microarray analysis, applied for the first time for normal and microtia neocartilage comparison, yielded no genes that were statistically significantly different in expression between these two sample groups. These results support use of microtia tissue as a cell source for normal auricular reconstruction. Comparison of normal and microtia cells, each seeded on nanoPGA and supplemented with BMP7 in a slow-release hydrogel, showed statistically significant differences in certain genes identified by microarray analysis. Such differences were also noted in several analyses comparing counterpart seeded cells without BMP7. Summary data suggest a possible application for BMP7 in microtia cartilage regeneration and encourage further studies to elucidate whether such genotypic differences translate to phenotypic characteristics of the human microtic ear. The present work advances understanding relevant to the potential clinical use of microtia surgical remnants as a suitable cell source for tissue engineering of the pinna.

Background Proper nasal tip projection and rotation are essential for an aesthetically pleasing nose. However, East Asians usually have thicker skin and underdeveloped nasal cartilage compared to Caucasians. Thus, techniques such as the septal extension graft, columellar strut graft, and L-shaped alloplastic implants have been introduced for additional nasal tip support and projection. However, no consensus exists regarding the optimal method. Methods A hybrid columellar strut made of an osteochondral graft recombined with the nasal crest of the maxilla and conchal cartilage was devised. In a cadaveric study, changes due to an external bending force of the hybrid strut and costal cartilage in the same dimension were measured. In a comparative study, we divided 20 subjects into two groups according to the material used for the columellar strut graft: a hybrid columellar strut (experimental group) and a double-layered conchal columellar strut (control group). Preoperative, 1-month postoperative, and 1-year postoperative anthropometric measurements were compared between groups. Results In the cadaveric study, the hybrid columellar strut showed superior mechanical strength. In the comparative study, the average 1-year postoperative change of the columellar labial angle was significantly smaller in the experimental group (–0.7°±1.16° vs. 2.2°±1.32°, P=0.015). The hybrid columellar strut showed superior postoperative nasal tip stability. Conclusions We devised a new hybrid columellar strut and confirmed its superior mechanical firmness and stability. Considering the suggested indications and contraindications, the hybrid columellar strut graft can be a new modality for tip plasty in East Asian rhinoplasty that can provide sufficient long-term nasal tip stability.

Background: A dog bite causing an auricular avulsion is a rare cause of an outer ear defect. By nature of the high-energy trauma inflicted by canine bites and the anatomic variability of the outer ear, no two such avulsion injuries are the same. If the native cartilage cannot be preserved after trauma, placement of a graft capable of forming grooves and ridges is required to reconstruct the complex anatomy of the outer ear. Such intricacies often make postoperative results cosmetically disappointing. In select cases, the native cartilaginous framework of the avulsed ear segment may be preserved and used in reconstruction. Case Report: We report a case of a pediatric total auricular avulsion following a dog bite, reconstructed using prelaminated native ear cartilage. Conclusion: After traumatic avulsion of the outer ear when native cartilage is preserved, effective reconstruction can be achieved using a 2-stage technique of native cartilage lamination via posterior auricular pocket formation and placement of a skin graft. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To present a rare case of nasal tip schwannoma and describe its resection and reconstruction using combined cartilage grafts. Methods: Design: Case Report Setting: Tertiary Government Training Hospital Patient: One Results: A 13-year-old boy presented with a progressively enlarging nasal tip and severe left nasal obstruction causing breathing difficulties and psychosocial distress. There was a bulging septal mass obstructing 90% of the left nasal cavity. Septal incision biopsy revealed schwannoma and definitive surgery via open rhinoplasty approach was done. The non-encapsulated schwannoma extended from the subcutaneous nasal tip to the left septal mucosa. There was no evidence of skin or cartilage invasion, but prolonged pressure from the expansile schwannoma caused severe lower lateral cartilage and anterior septal atrophy leading to a collapsed and expanded nasal tip after resection. To correct this, a total reconstruction of the anterior tip complex was done using combined ear cartilage seagull wing graft, shield graft and septal extension graft. Conclusion: Nasal tip and septal schwannoma is rare and can cause significant nasal obstruction and deformity. Complete excision is vital to avoid recurrence. Total reconstruction of the lower lateral cartilages using autologous septal and ear cartilage grafts may be a safe and effective technique that yields acceptable aesthetic results.

ObjectiveTo reconstruct the auricle using a porous, hollow, three-dimensional (3D)-printed mold and autologous diced cartilage mixed with platelet-rich plasma (PRP).MethodsMaterialise Magics v20.03 was used to design a 3D, porous, hollow auricle mold. Ten molds were printed by selective laser sintering with polyamide. Cartilage grafts were harvested from one ear of a New Zealand rabbit, and PRP was prepared using 10 mL of auricular blood from the same animal. Ear cartilage was diced into 0.5- to 2.0-mm pieces, weighed, mixed with PRP, and then placed inside the hollow mold. Composite grafts were then implanted into the backs of respective rabbits (n = 10) for 4 months. The shape and composition of the diced cartilage were assessed histologically, and biomechanical testing was used to determine stiffness.ResultsThe 3D-printed auricle molds were 0.6-mm thick and showed connectivity between the internal and external surfaces, with round pores of 0.1 to 0.3 cm. After 4 months, the diced cartilage pieces had fused into an auricular shape with high fidelity to the anthropotomy. The weight of the diced cartilage was 5.157 ± 0.230 g (P > 0.05, compared with preoperative). Histological staining showed high chondrocyte viability and the production of collagen II, glycosaminoglycans, and other cartilaginous matrix components. In unrestricted compression tests, auricle stiffness was 0.158 ± 0.187 N/mm, similar to that in humans.ConclusionAuricle grafts were constructed successfully through packing a 3D-printed, porous, hollow auricle mold with diced cartilage mixed with PRP. The auricle cartilage contained viable chondrocytes, appropriate extracellular matrix components, and good mechanical properties.Levels of evidenceNA. Laryngoscope, 129:2467-2474, 2019.

Full-thickness deficiency of eyelid tissues can result in coloboma or retraction or both. Here we report our initial experience on the use of auricular skin-cartilage sandwich graft technique for full-thickness eyelid deformities. Five patients (4–32 years) underwent the procedure. Patients with full-thickness eyelid deformity were included. Three patients were operated for large-sized coloboma and two for eyelid retraction. One patient had congenital, and four patients had acquired etiology. The following parameters were specifically assessed: correction of deformity, ocular surface problems, graft status, and epithelization of skin-cartilage graft. All the patients had a good correction of eyelid position, except one patient who had severe eyelid retraction (8 mm) at presentation. None of our patients had corneal erosion/defect, persistent ocular surface redness, or graft loss. The auricular skin-cartilage sandwich graft technique produces optimal results with no graft loss. Advancement of orbicularis muscle in between the auricular skin and cartilage grafts (sandwich technique) is an imperative step that leads to the survival of both grafts.

Cervical chondrocutaneous branchial remnants are very rare congenital lesions of the lateral neck; thus, our knowledge of this condition derives almost entirely from occasional case reports in the literature. They are thought to originate from the branchial arches and, therefore, can be found anywhere on the pathway along which those branchial arches migrate during embryogenesis. We report the case of a 5-year-old girl presenting with a cervical chondrocutaneous branchial remnant on the right lateral neck that had existed since birth, with no other anomalies. [ABSTRACT FROM AUTHOR]

Background: Many studies recommend nonsurgical auricular correction during the early postnatal period, when cartilage plasticity is high; however, many patients are not eligible for the procedure. This study compared different timings of nonsurgical auricular correction to investigate benefit after the optimal period for correction., Methods: In this prospective study, 53 ears from 35 patients with congenital auricular anomaly were assigned to 2 groups according to age at correction: the early group, with correction within 2 weeks of birth, and the late group, with correction 8 weeks after birth. Aesthetic outcomes, caregiver satisfaction, detachment rates, and mean device-wearing periods were compared., Results: Thirty-one ears from 20 patients constituted the early group, and 18 ears from 12 patients constituted the late group. Mean time to treatment after birth was 9.09 days in the early group and 134.7 days in the late group. In the early group, detachment occurred in 4 of 31 ears (12.9%), and in the late group, detachment occurred in 12 of 18 ears (66.7%), which was statistically significant ( P < 0.01). The average period of applying devices was 4.7 ± 1.2 weeks in the early group and 8.5 ± 4.1 weeks in the late group, with a significantly longer treatment time in the late group ( P = 0.001). The early group had 87.1% good results versus 55.6% good results in the late group, with a statistically significant difference., Conclusions: The correction period was shorter, detachment rate was lower, and treatment outcome was better in the early group. However, successful correction was also present in the late group, showing that the patients who have passed the optimum correction period should proceed after counseling., Clinical Question/level of Evidence: Therapeutic, II., (Copyright © 2023 by the American Society of Plastic Surgeons.)

Backgrounds: For patients with concha-type microtia, surgical intervention and the degree of deformity may affect the growth rate of the auricular cartilage, which is different at different ages. This study aimed to explore the auricular growth potential of patients with concha-type microtia at different ages after auricular cartilage stretching surgery., Methods: A total of 66 patients with unilateral grade II and III concha-type microtia were involved in this prospective cohort study. All patients underwent auricular cartilage stretching surgery. Relevant data were collected before surgery, immediately after surgery, and at the last follow-up., Results: The perimeter, width, and length of auricle, between each follow-up, was statistically significant, which supported the effect of surgery and auricular development. For patients in the grade II group, no statistical significance was found in the difference in the perimeter, width, and length between the affected and normal auricle. For the patients in the grade III group, the difference in the relevant indexes of the affected auricle was significantly different from those of the normal auricle. Between subgroups divided according to their age, the growth potential of affected auricle with the same degree of deformity was statistically significant., Conclusions: Growth potential of the affected auricle of the grade II group was consistent with that of the normal auricle, which was significantly higher than that of the grade III group. For patients at different ages, auricles grew faster before 3 years of age. Surgical intervention improved the auricular aesthetics and released the auricular growth potential. Thus, surgical intervention should be recommend as early as possible., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

The aim of this report was to evaluate the efficacy of nasal reconstruction using auricular cartilage combined with auricular full-thickness skin graft and a local flap from the right nasal ala for correcting complex nasal defects, and its impact on the patient's quality of life and psychological well-being. We present the case of a 50-year-old female with a severe nasal deformity due to a car accident, characterized by a missing right alar flap and an exposed right nostril. The patient underwent nasal reconstructive surgery using auricular cartilage combined with an auricular full-thickness skin graft and a local flap from the right nasal ala. Detailed records of the patient's postoperative recovery, surgical outcomes, and satisfaction were made at follow-up. The survival rate of the grafted skin and flaps on the nasal ala, septum, and dorsum was high. The reconstructed right nasal ala closely resembled the left, and the patient was very satisfied. In patients with complex nasal deformities, nasal reconstruction using ear cartilage combined with auricular full-thickness skin grafts and local flaps can achieve satisfactory aesthetic and functional outcomes. The high level of postoperative satisfaction suggests that this technique significantly improves patients' quality of life and psychological well-being., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Zuo, Wang, Fan, Zhang, Zhai and Sun.)

Tissue engineering technology offers a promising solution for ear reconstruction; however, it faces the challenge of foreign body reaction and neocartilage malformation. This study investigates the impact of interleukin-4 (IL-4), an anti-inflammatory factor, on cartilage regeneration of hydrogel encapsulating autologous auricular chondrocytes in a rabbit subcutaneous environment. Initially, we assessed the influence of IL-4 on chondrocyte proliferation and determined the appropriate concentration using the CCK-8 test in vitro. Subsequently, we loaded IL-4 into gelatin methacryloyl (GelMA) hydrogel containing chondrocytes and measured its release profile through ELISA. The constructs were then implanted autologously into rabbits' subcutis, and after 3, 7, 14, and 28 days, cartilage matrix formation was evaluated by histological examinations, and gene expression levels were detected by qRT-PCR. Results demonstrated that IL-4 promotes chondrocyte proliferation in vitro, and maximum release from constructs occurred during the first week. In the rabbit subcutaneous implantation model, IL-4-loaded constructs (20 ng/mL) maintained a superior chondrocytic phenotype compared to controls with increased expression of anti-inflammatory factors. These findings highlight IL-4 as a potential strategy for promoting chondrogenesis in a subcutaneous environment and improving ear reconstruction., (© 2024 Wiley Periodicals LLC.)

Large tarsal plate defect reconstruction is one of the most challenging tasks for plastic surgeons. Based on our practical work and literature review, the techniques and postoperative results of the preserved sclera, ear cartilage, and acellular dermal matrix (ADM) as tarsal plate substitutes were investigated. Two cases were reviewed. Case 1 was a 22-year-old female who had total loss of the right lower eyelid. Ear cartilage (23 ​mm ​× ​25 ​mm) was implanted under the expanded skin during the forehead skin-expanding procedure to form a skin-cartilage-expander capsule compound structure for lower eyelid reconstruction. Case 2 was a 7-year-old boy with a unilateral divided nevus. The lid and conjunctiva of the lower eyelid were invaded. A piece of ADM (12 ​mm ​× ​4 ​mm) was used to repair the tarsal plate defect (12 ​mm ​× ​3 ​mm). The conjunctiva of ADM was covered by itself. An orbicularis oculi myocutaneous flap was used for anterior lamella reconstruction. In case 1, the compound tissue survived and supported the lower eyelid, the lid margin was clear, and the structure was complete over a 1-year follow-up. The aesthetic appearance of the eyelid improved after depilation. It is the first clinical research on the expander capsule as eyelid conjunctiva. In case 2, the conjunctiva completely covered the superior ADM, and the transplant merged with the surrounding tissues without complications after 5 months. The preserved sclera has the longest application history as a tarsal plate substitute. However, it should be preserved in an eye bank and transplanted with conjunctiva repair. Ear cartilage is an autologous tissue that requires conjunctival reconstruction. Our clinical practice was the first to prove the possibility of the expander capsule as eyelid conjunctiva. It is feasible to prefabricate the skin-tarsal conjunctiva complex during the skin expansion procedure. Allogeneic ADM is a common clinical material with advantages of good biological histocompatibility, supportive strength, conjunctivalization, and not requiring donor site surgery. Plastic surgeons are familiar with autologous ear cartilage and ADM, which are easy to obtain and treat. Both ear cartilage and ADM are expected to be the first-line choices in future studies.

Abstract Electrospinning is a common and versatile process to produce nanofibers and deposit them on a collector as a two-dimensional nanofiber mat or a three-dimensional (3D) macroscopic arrangement. However, 3D electroconductive collectors with complex geometries, including protruded, curved, and recessed regions, generally caused hampering of a conformal deposition and incomplete covering of electrospun nanofibers. In this study, we suggested a conformal fabrication of an electrospun nanofiber mat on a 3D ear cartilage-shaped hydrogel collector based on hydrogel-assisted electrospinning. To relieve the influence of the complex geometries, we flattened the protruded parts of the 3D ear cartilage-shaped hydrogel collector by exploiting the flexibility of the hydrogel. We found that the suggested fabrication technique could significantly decrease an unevenly focused electric field, caused by the complex geometries of the 3D collector, by alleviating the standard deviation by more than 70% through numerical simulation. Furthermore, it was experimentally confirmed that an electrospun nanofiber mat conformally covered the flattened hydrogel collector with a uniform thickness, which was not achieved with the original hydrogel collector. Given that this study established the conformal electrospinning technique on 3D electroconductive collectors, it will contribute to various studies related to electrospinning, including tissue engineering, drug/cell delivery, environmental filter, and clothing.

Objective/hypothesisTo develop an injection-based enzymatic technique that selectively softens cartilage tissue for reshaping cartilaginous structures in the head and neck.Materials and methodsTwo groups were formed using fresh rabbit ears: (1) whole rabbit ear group; (2) composite graft group (2.5mm×3.0cm specimens sectioned from the central region of the pinna). Subperichondrial injections using three enzymes (hyaluronidase, pronase, and collagenase II) in sequence were performed for the experimental specimens from both groups. In the control specimens, phosphate buffered saline was injected in a similar fashion. The whole ear specimens were then photographed while held upright in the anatomical vertical position to evaluate for buckling, which corresponds to the integrity of the cartilage. In addition, backlight photography was performed for all specimens to further evaluate the effect of the enzymes, such that increased light intensity represents increased cartilage digestion.ResultsThe application of the digestive enzymes resulted in marked reduction of cartilage tissue matrix resiliency, while preserving overlying skin layers. Enzymatically treated whole pinnae buckled at the site where enzymes were delivered. Backlit images revealed increased local light intensity at the regions of digestion. There was no obvious destruction of the overlying skin upon visual inspection.ConclusionsThis study demonstrates the feasibility of injectable chondroplasty as a potential alternative method to conventional surgery for auricular cartilage reshaping. Sequential injection of hyaluronidase, pronase, and collagenase II into the subperichondrial space can be performed to digest and soften cartilage structure with minimal involvement of surrounding tissue. Future studies will need to include chondrocyte viability testing and optimization of delivery techniques.

Full-thickness deficiency of eyelid tissues can result in coloboma or retraction or both. Here we report our initial experience on the use of auricular skin-cartilage sandwich graft technique for full-thickness eyelid deformities. Five patients (4-32 years) underwent the procedure. Patients with full-thickness eyelid deformity were included. Three patients were operated for large-sized coloboma and two for eyelid retraction. One patient had congenital, and four patients had acquired etiology. The following parameters were specifically assessed: correction of deformity, ocular surface problems, graft status, and epithelization of skin-cartilage graft. All the patients had a good correction of eyelid position, except one patient who had severe eyelid retraction (8 mm) at presentation. None of our patients had corneal erosion/defect, persistent ocular surface redness, or graft loss. The auricular skin-cartilage sandwich graft technique produces optimal results with no graft loss. Advancement of orbicularis muscle in between the auricular skin and cartilage grafts (sandwich technique) is an imperative step that leads to the survival of both grafts. [ABSTRACT FROM AUTHOR]

Objectives: Rhinoplasty with or without combined septoplasty is one of the most frequently performed procedures in facial plastic surgery. Patient satisfaction and improvement in quality of life (QoL) is the primary goal. This prospective study was conducted to analyse Qol outcome in revision rhinoplasty in regards to number of revision surgeries and cartilage donor site using patient-reported outcome measures (PROMs).Methods: Preoperative and at least 12-months postoperative scores on the Nasal Obstruction Symptome Evaluation (NOSE) questionnaire (range 0-100, lower scores indicate better outcome) and the Rhinoplasty Outcomes Evaluation (ROE) questionnaire (range 0-100, higher scores indicates better outcome) were obtained. Additionally, data on age, gender and number of previous rhinoplasties were assessed. All revision rhinoplasties were performed by one surgeon (author, F.R.) between 2014 and 2017.Results: Sixty-four patients (11 (17.2%) male, 53 (82.8%) female) prospectively enrolled in this study. In 41 (64.1%) cases septal cartilage and in 23 (35.9%) patients ear cartilage was the donor site in revision surgery. Patients with more than one previous surgery (n=18) started with a lower preoperative ROE score (28.2 ± 12.8) compared to patients who had received only one previous surgery. The difference however was not significant (p=0.06). This subgroup still showed significant postoperative improvement (ROE-postop 61.9 ± 24.2; p<0.05). Both cohorts (septal cartilage and ear cartilage) improved significantly in regards to their ROE and NOSE scores after surgery and therefore showed improved health-related QoL. We could not detect any differences in health-related QoL postoperatively in regards to cartilage donor site in revision surgery.Conclusion: Revision rhinoplasty improves health-related QoL. There are no differences in ROE- or NOSE-scores postoperatively in regards to graft material (ear- versus septal cartilage). Both subgroups show significantly higher scores postoperatively. [ABSTRACT FROM AUTHOR]

Background Ear cartilage is a preferred graft material in rhinoplasty. However, after harvest, instability of the auricular framework may arise as a form of donor site morbidity. In the harvest of ear cartilage, the posterior auricular ligament (PAL) is usually sacrificed in order to obtain as much cartilage as possible. Since damage to the PAL may cause auricular instability, we studied the periauricular anatomy using cadavers and evaluated auricular stability during surgery. Methods Six ears from hemifacial cadavers were studied to clarify the exact anatomy of the PAL. Then, the recoil force of the auricle was serially measured to evaluate the stability of the auricular framework in 30 patients during surgery: before making the skin incision (M1), before and after cutting the PAL (M2, M3), and after harvesting the cymba concha (M4). The differences in force observed after cutting the PAL (ΔM2–M3) and after harvesting the cymba concha (ΔM3–M4) were statistically analyzed. Results In the cadaveric study, the PAL was identified between the superficial and deep mastoid fasciae and connected the caudal aspect of the cymba concha to the deep mastoid fascia. During surgery, the PAL accounted for 16.20% of the total auricular recoil force. The recoil force decreased by 13.61 N and 11.25 N after cutting the PAL and harvesting the cymba concha, respectively. These decreases were statistically significant (P

Current techniques for autologous auricular reconstruction produce substandard ear morphologies with high levels of donor-site morbidity, whereas alloplastic implants demonstrate poor biocompatibility. Tissue engineering, in combination with noninvasive digital photogrammetry and computer-assisted design/computer-aided manufacturing technology, offers an alternative method of auricular reconstruction. Using this method, patient-specific ears composed of collagen scaffolds and auricular chondrocytes have generated auricular cartilage with great fidelity following 3 months of subcutaneous implantation, however, this short time frame may not portend long-term tissue stability. We hypothesized that constructs developed using this technique would undergo continued auricular cartilage maturation without degradation during long-term (6 month) implantation. Full-sized, juvenile human ear constructs were injection molded from high-density collagen hydrogels encapsulating juvenile bovine auricular chondrocytes and implanted subcutaneously on the backs of nude rats for 6 months. Upon explantation, constructs retained overall patient morphology and displayed no evidence of tissue necrosis. Limited contraction occurred in vivo, however, no significant change in size was observed beyond 1 month. Constructs at 6 months showed distinct auricular cartilage microstructure, featuring a self-assembled perichondrial layer, a proteoglycan-rich bulk, and rounded cellular lacunae. Verhoeff's staining also revealed a developing elastin network comparable to native tissue. Biochemical measurements for DNA, glycosaminoglycan, and hydroxyproline content and mechanical properties of aggregate modulus and hydraulic permeability showed engineered tissue to be similar to native cartilage at 6 months. Patient-specific auricular constructs demonstrated long-term stability and increased cartilage tissue development during extended implantation, and offer a potential tissue-engineered solution for the future of auricular reconstructions.

The reconstruction of the secondary lower eyelid to a resection of skin cancer is a challenging surgical procedure that must be carefully planned with regards to issues related to lamella and extension of the resection. We present the case of a 69-year-old male patient who, after oncologic resection, presented a total thickness defect greater than 60% in the lower eyelid. For reconstruction, it was indicated that the use of Tripier's unipedic myocutaneous flap with scapha cartilage graft produced favorable results, which confirms that it is worthwhile using these techniques when planning lower eyelid reconstruction.

Background/objectivesSimilar to conventional cryogen spray cooling, carbon dioxide (CO2) spray may be used in combination with laser cartilage reshaping (LCR) to produce cartilage shape change while minimizing cutaneous thermal injury. Recent ex vivo evaluation of LCR with CO2 cooling in a rabbit model has identified a promising initial parameter space for in vivo safety and efficacy evaluation. This pilot study aimed to evaluate shape change and cutaneous injury following LCR with CO2 cooling in 5 live rabbits.Study design/materials and methodsThe midportion of live rabbit ears were irradiated with a 1.45 µm wavelength diode laser (12 J/cm(2)) with simultaneous CO2 spray cooling (85 millisecond duration, 4 alternating heating/cooling cycles per site, 5 to 6 irradiation sites per row for 3 rows per ear). Experimental and control ears (no LCR) were splinted in the flexed position for 30 days following exposure. A total of 5 ears each were allocated to the experimental and control groups.ResultsShape change was observed in all irradiated ears (mean 70 ± 3°), which was statistically different from control (mean 37 ± 11°, P = 0.009). No significant thermal cutaneous injury was observed, with preservation of the full thickness of skin, microvasculature, and adnexal structures. Confocal microscopy and histology demonstrated an intact and viable chondrocyte population surrounding irradiated sites.ConclusionsLCR with CO2 spray cooling can produce clinically significant shape change in the rabbit auricle while minimizing thermal cutaneous and cartilaginous injury and frostbite. This pilot study lends support for the potential use of CO2 spray as an adjunct to existing thermal-based cartilage reshaping modalities. An in vivo systematic evaluation of optimal laser dosimetry and cooling parameters is required.

Electrospinning is a common and versatile process to produce nanofibers and deposit them on a collector as a two-dimensional nanofiber mat or a three-dimensional (3D) macroscopic arrangement. However, 3D electroconductive collectors with complex geometries, including protruded, curved, and recessed regions, generally caused hampering of a conformal deposition and incomplete covering of electrospun nanofibers. In this study, we suggested a conformal fabrication of an electrospun nanofiber mat on a 3D ear cartilage-shaped hydrogel collector based on hydrogel-assisted electrospinning. To relieve the influence of the complex geometries, we flattened the protruded parts of the 3D ear cartilage-shaped hydrogel collector by exploiting the flexibility of the hydrogel. We found that the suggested fabrication technique could significantly decrease an unevenly focused electric field, caused by the complex geometries of the 3D collector, by alleviating the standard deviation by more than 70% through numerical simulation. Furthermore, it was experimentally confirmed that an electrospun nanofiber mat conformally covered the flattened hydrogel collector with a uniform thickness, which was not achieved with the original hydrogel collector. Given that this study established the conformal electrospinning technique on 3D electroconductive collectors, it will contribute to various studies related to electrospinning, including tissue engineering, drug/cell delivery, environmental filter, and clothing. [ABSTRACT FROM AUTHOR]

The columellar strut graft based on the use of back-to-back autogenous conchal cartilage is one of the most commonly employed invisible grafts used for nasal tip projection. This graft provides an effective means of achieving nasal tip projection but is limited by its flexibility, especially with respect to cephalic rotation. We designed an effective technique that addresses these limitations. A total of 38 patients received augmentation rhinoplasty with non-incisionally bent double-layered conchal cartilage columellar strut graft with nasal tip onlay graft. Projection and location of the nasal tip, nasal length, and nasolabial angle were measured using lateral view photographs. Pre- and postoperative results were compared. Pre- and postoperative nasal tip projection ratios and nasal tip location ratios were significantly different. Revision surgery was not required in any case and no direct graft-associated complication occurred. We performed tip plasty with a modified columellar strut graft, that is, a non-incisionally bent double-layered conchal cartilage columellar strut graft. In most cases, this method resulted in a significant tip projection increase. [ABSTRACT FROM AUTHOR]

ObjectiveTo investigate the differences in hip movement patterns during different daily and athletic activities in persons with cam-type femoroacetabular impingement (FAI) with and without cartilage lesions compared with control subjects in a preliminary study.DesignControlled laboratory study using a cross-sectional design.SettingResearch institution with a tertiary care medical center.ParticipantsFifteen subjects [M:F, 13:2; age, 31.6 ± 9.7 years (range, 22-52 years); body mass index, 24.9 ± 4.6 (range, 18.8-38.4); FAI:control, 7:8].MethodsAll subjects had 3-Tesla magnetic resonance imaging of the hip and also underwent 3-dimensional motion capture during walking, deep-squat, and drop-landing tasks. Experienced radiologists graded cartilage lesions on clinical magnetic resonance images.OutcomesPeak kinematic and kinetic variables were compared between subjects who did and did not have FAI, and subjects who had FAI and cartilage lesions were compared with subjects who did not have cartilage lesions.ResultsSubjects who had FAI demonstrated no significant differences for walking or drop landing compared with control subjects. However, during the deep-squat task, subjects with FAI adducted more and had a greater internal rotation moment. Subjects who had cartilage lesions in the presence of a cam lesion demonstrated (1) no difference for walking; (2) greater adduction, greater internal rotation moment, and lower transverse plane range of motion during the deep-squat task; and (3) greater adduction and lower internal rotation during the drop-landing task compared with subjects who did not have cartilage lesions.ConclusionsWe observed differences in movement patterns between subjects who had FAI compared with control subjects. However, the differences were more pronounced between subjects with FAI who had cartilage lesions compared with subjects who did not have cartilage lesions. These findings highlight the importance of understanding the complex interplay between bony morphologic features, cartilage lesions, and movement patterns in persons with cam-type FAI.

Previous studies have demonstrated the feasibility of laser irradiation (λ = 1.45 μm) in tandem with cryogen spray cooling (CSC) to reshape rabbit auricular cartilage using a total energy density of 14 J/cm(2). The aim of this study was to further explore and identify the dosimetry parameter space for laser output energy, CSC duration, and treatment cycles required to achieve shape change while limiting skin and cartilage injury. Ten New Zealand white rabbits were treated with the 1.45 μm diode laser combined with cryogen spray cooling (Candela Smoothbeam™, Candela Co., Wayland, MA, USA). The ear's central portion was bent around a cylindrical jig and irradiated in consecutive spots of 6 mm diameter (13 or 14 J/cm(2) per spot) along three rows encompassing the bend. CSC was delivered during irradiation in cycles consisting of 25-35 ms. At thin and thick portions of the ear, 4-7 and 6-10 treatment cycles were delivered, respectively. After surgery, ears were examined and splinted for 6 weeks. Treatment parameters resulting in acceptable (grades 1 and 2) and unacceptable (grade 3) skin injuries for thick and thin regions were identified, and shape change was observed. Confocal and histological analysis of cartilage tissue revealed several outcomes correlating to laser dosimetry, CSC duration, and treatment cycles. These outcomes included expansion of cartilage layers (thickening), partial cartilage injuries, and full-thickness cartilage injuries. We determined therapy thresholds for laser output energy, cryogen spray cooling duration, and treatment cycles in the rabbit auricular model. These parameters are a starting point for future clinical procedures aimed at correcting external ear deformities.

Introduction: Cryptotia is a congenital ear deformity common in Easterners and rare in Westerners, with most studies addressing Eastern surgical techniques applied to children. In this pathology, the cartilage of the upper pole of the ear is lodged subcutaneously in the temporal region, which prevents individuals from using glasses due to lack of support and prevents esthetic definition of the upper pole. Objective: The present study aimed to report the case of an adult patient with cryptotia undergoing surgical treatment using a mastoid subcutaneous pedicle flap and review the main techniques described for the treatment of this involvement. Conclusion: The subcutaneous pedicle flap described by Yoshimura proved to be adequate for correcting cryptotia in a Western adult patient.

This study was designed to evaluate the healing process of tracheal cartilage defect after implantation of two different biomaterials in dogs. Eighteen adult dogs from both sexes were used. They were divided into 2 equal groups. A window shape defect of about 3cm x 2cm was induced in the cervical part of three adjacent tracheal rings with their annular ligaments. In group one, the defect was closed with a small strip of ear cartilage (auto graft) from the same animal, while in the second group, calf's pericardium scaffold (xeno graft) was used to close the defect. All the animals were clinically monitored postoperatively, while gross pathological changes and biopsy collections for all animals was performed at 15, 30, 60 postoperative days. No postoperative clinical complications were recorded and all were looking healthy and resuming food and water intake normally. The gross pathological results revealed rapid occlusion to the trachea especially in first group and animals survived without any respiratory complications. The histological features in both groups were represented by newly granulation tissue formation and hyaline cartilage regeneration. The new hyaline cartilage cells formation was showed faster in group 1 rather than group 2. In conclusion, both grafts can be used for closing a tracheal defect in dogs with the priority of ear cartilage implantation.

Laser cartilage reshaping (LCR) with cryogen spray cooling is a promising modality for producing cartilage shape change while reducing cutaneous thermal injury. However, LCR in thicker tissues, such as auricular cartilage, requires higher laser power, thus increasing cooling requirements. To eliminate the risks of freeze injury characteristic of high cryogen spray pulse rates, a carbon dioxide (CO2) spray, which evaporates rapidly from the skin, has been proposed as the cooling medium. This study aims to identify parameter sets which produce clinically significant reshaping while producing minimal skin thermal injury in LCR with CO2 spray cooling in ex vivo rabbit auricular cartilage. Excised whole rabbit ears were mechanically deformed around a cylindrical jig and irradiated with a 1.45-μm wavelength diode laser (fluence 12-14 J/cm(2) per pulse, four to six pulse cycles per irradiation site, five to six irradiation sites per row for four rows on each sample) with concomitant application of CO2 spray (pulse duration 33-85 ms) to the skin surface. Bend angle measurements were performed before and after irradiation, and the change quantified. Surface temperature distributions were measured during irradiation/cooling. Maximum skin surface temperature ranged between 49.0 to 97.6 °C following four heating/cooling cycles. Significant reshaping was achieved with all laser dosimetry values with a 50-70 °C difference noted between controls (no cooling) and irradiated ears. Increasing cooling pulse duration yielded progressively improved gross skin protection during irradiation. CO2 spray cooling may potentially serve as an alternative to traditional cryogen spray cooling in LCR and may be the preferred cooling medium for thicker tissues. Future studies evaluating preclinical efficacy in an in vivo rabbit model are in progress.

The development of three-dimensional (3D) bioprinting technology has provided a new solution to address the shortage of donors, multiple surgeries, and aesthetic concerns in microtia reconstruction surgery. The production of bioinks is the most critical aspect of 3D bioprinting. Acellular cartilage matrix (ACM) and sodium alginate (SA) are commonly used 3D bioprinting materials, and there have been reports of their combined use. However, there is a lack of comprehensive evaluations on ACM-SA scaffolds with different proportions. In this study, bioinks were prepared by mixing different proportions of decellularized rabbit ear cartilage powder and SA and then printed using 3D bioprinting technology and crosslinked with calcium ions to fabricate scaffolds. The physical properties, biocompatibility, and toxicity of ACM-SA scaffolds with different proportions were compared. The adhesion and proliferation of rabbit adipose-derived stem cells on ACM-SA scaffolds of different proportions, as well as the secretion of Collagen Type II, were evaluated under an adipose-derived stem cell chondrogenic induction medium. The following conclusions were drawn: when the proportion of SA in the ACM-SA scaffolds was <30%, the printed structure failed to form. The ACM-SA scaffolds in proportions from 1:9 to 6:4 showed no significant cytotoxicity, among which the 5:5 proportion of ACM-SA scaffold was superior in terms of adhesiveness and promoting cell proliferation and differentiation. Although a higher proportion of SA can provide greater mechanical strength, it also significantly increases the swelling ratio and reduces cell proliferation capabilities. Overall, the 5:5 proportion of ACM-SA scaffold demonstrated a more desirable biological and physical performance.

Objective: Analyze age-related changes in histologic features and biochemical properties of human auricular cartilage and two subsites of nasal cartilages (quadrangular cartilage and dorsal septal articulation with upper lateral cartilages)., Study Design: Prospective cross-sectional study of nasal and auricular cartilages from seventy-three (73) live donors., Methods: Auricular cartilage (AC), quadrangular cartilage (QC), and dorsal septal cartilage articulation (DSA) with the upper lateral cartilage (ULCs) were collected intraoperatively. Histochemical staining was used: Safranin O for glycosaminoglycans (GAGs), Verhoeff's for elastin, and Masson's trichrome for collagen. ImageJ2 software was used to calculate cell count and percent stained for each cartilage type. R studio "ggplot" package was used to visualize age versus cell count or percent stained., Results: Participant ages ranged from 20 to 77 years, average 46.5 years. There was a significant decline in GAGs with age for the DSA subsite, (n = 64, p < 0.001). Significant increase in collagen content with age was observed for DSA subsite (n = 66, p < 0.001) and the QC subsite (n = 64, p < 0.05). There was a statistically insignificant decline in elastin with age (n = 41, p = 0.309) for AC. Cell count declined with age at all cartilage subsites., Conclusion: Our findings confirm that there were age-related decreases in cartilage glycosaminoglycan content, and chondrocyte cell count in both auricular and nasal cartilages. We have also confirmed that collagen content increases with age for both auricular and nasal cartilage. The histologic findings while not statistically significant in all comparisons, provides additional evidence that there is some loss of structural integrity and flexibility in nasal and auricular cartilage with aging., Level of Evidence: NA Laryngoscope, 134:1220-1226, 2024., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

The aim of this study was the development of collagen and collagen/auricular cartilage scaffolds for application in dermal regeneration. Collagen was obtained from bovine tendon by a 72 h-long treatment, while bovine auricular cartilage was treated for 24 h and divided into two parts, external (perichondrium, E) and internal (elastic cartilage, I). The scaffolds were prepared by mixing collagen (C) with the internal part (CI) or the external part (CE) in a 3:1 ratio. Differential scanning calorimetry, scanning electron microscopy (SEM) analysis, microcomputed tomography imaging (micro-CT) and swelling degree were used to characterize the scaffolds. Cytotoxicity, cell adhesion, and cell proliferation assays were performed using the cell line NIH/3T3. All samples presented a similar denaturation temperature (Td) around 48 °C, while CE presented a second Td at 51.2 °C. SEM micrographs showed superficial pores in all scaffolds and micro-CT exhibited interconnected pore spaces with porosity above 60% (sizes between 47 and 149 µm). The order of swelling was CE < CI < C and the scaffolds did not present cytotoxicity, showing attachment rates above 75%-all samples showed a similar pattern of proliferation until 168 h, whereas CI tended to decrease after this time. The scaffolds were easily obtained, biocompatible and had adequate morphology for cell growth. All samples showed high adhesion, whereas collagen-only and collagen/external part scaffolds presented a better cell proliferation rate and would be indicated for possible use in dermal regeneration., (© 2020. Springer Nature B.V.)

Introduction: There remains controversy about the optimal kind of graft to repair tympanic membrane. The purpose of this study was to evaluate the anatomical and auditory outcomes of type I tympanoplasty using fascia with or without cartilage reinforcement. Materials and Methods: This retrospective cohort study was conducted from 2005 to 2015. All cases were surgically treated by a single surgeon. We excluded cases in which the etiology of chronic otitis media was cholesteatoma. According to the use of cartilage reinforcement in the posterosuperior part of the graft, patients were divided into two groups, and the results of anatomical and auditory evaluation were compared between the two groups. The anatomical outcome was grafting success and the auditory outcome was improvement of air bone gap (ABG). Results: A total of 320 patients were classified in Group A (tympanoplasty with fascia temporalis only) and 346 were in Group B (tympanoplasty with cartilage reinforcement). All patients were followed for at least 2 years. The overall success rate in the two groups was 91.6% and 93.4%, respectively (P=0.3). The most common cause of failure in the two groups was re-perforation (5.6% and 3.8%, respectively). The improvement of ABG in two groups was 18.5 dB and 3.2 dB, respectively. The difference between two groups was statistically significant (P

Surgery for early-stage squamous cell carcinoma of the nasal vestibule (SCCNV) may lead to facial disfigurement. We wanted to investigate if skin-preserving excision of SCCNV with reconstruction is oncologically, aesthetically, and functionally justifiable in cases with proximity to the skin. From 2010 to 2016, 16 patients underwent skin-preserving excision of T1–2 N0 SCCNV by a lateral rhinotomy approach at a tertiary referral center. The inner nose was reconstructed using a mucoperichondrial septal flap for the inner lining and a septal pivot flap and/or auricular cartilage grafting for the framework. Nasal appearance was measured on pre- and postoperative photographs. Median follow-up was 5.4 years. Three (19%) patients received adjuvant radiotherapy. Two (12.5%) recurrences occurred locally, but not at the site of preserved skin. The Kaplan–Meier estimate of local control rate after 5 years was 83%. All patients could be salvaged, giving an ultimate control rate of 100%. Nasal tip projection decreased by 6.7% (p < 0.001), and it was retained normal or near normal in 87.5% of patients. Nasal axis changed by 1.7° (p = 0.5). Nasal deviation occurred in 6.25% (1/16) of patients, and minor alar retraction in 6.25% of patients (1/16). Nasal breathing was normal or close to normal in 75% (12/16) of patients. Skin-preserving excision of SCCNV is oncologically justifiable in selected cases even in proximity to nasal skin. Early inner nasal reconstruction preserves nasal form and function to a high degree. This technique is a suitable alternative to rhinectomy and to avoid the sequelae of radiotherapy in selected cases. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to evaluate the surgical and functional results of endoscopic butterfly-inlay cartilage myringoplasty and endoscopic push-through myringoplasty in the treatment of anterior perforation of the tympanic membrane. Method: This open-label randomised clinical study was conducted on 71 patients with small- and medium-sized anterior perforations of the tympanic membrane. Graft success rate, hearing results, operative time and complications were analysed. Results: Graft success rates for endoscopic butterfly-inlay cartilage myringoplasty and endoscopic push-through myringoplasty were 94.1 and 91.8 per cent, respectively (p > 0.05). Post-operative air–bone gap values significantly improved in both the endoscopic butterfly-inlay cartilage myringoplasty and endoscopic push-through myringoplasty groups. The average operative time was significantly shorter in the endoscopic butterfly-inlay cartilage myringoplasty group (31.5 minutes) compared to the endoscopic push-through myringoplasty group (41.7 minutes; p < 0.05). Conclusion: When compared with the endoscopic push-through myringoplasty, the endoscopic butterfly-inlay cartilage myringoplasty technique, which is technically easier to perform, does not require packing and has a shorter operating time. It is a reasonable approach for repair of anterior perforations of the tympanic membrane. [ABSTRACT FROM AUTHOR]