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This study summarizes the common clinical nursing modes for patients undergoing ear reconstruction surgery for microtia, including refined combined family centered nursing mode, homogeneous medical nursing mode, full process nursing mode, information-motivation-behavior skills model (IMB), mind map nursing mode, Peplau's interpersonal relationship theory, etc. And analyze the application prospects, explore the advantages and disadvantages, aiming to provide reference and inspiration for the in-depth research of the nursing mode of ear reconstruction surgery for microtia. [ABSTRACT FROM AUTHOR]

Predictors of outcomes in pediatric microtia surgery are not well understood within the current literature. A multi-institutional database study may reveal insights into these predictors. To explore the predictors of 30-day complications, 30-day readmission, and postoperative length of stay (PLOS) in pediatric microtia patients undergoing autologous rib grafting. The Pediatric National Surgical Quality Improvement Program was queried for details on patients with microtia (ICD-9/10 744.23/Q17.2) who underwent autologous rib grafting (CPT 21230) between 2012–2021. Demographics, comorbidities, inpatient status, 30-day complications, PLOS, and 30-day readmissions were analyzed. Statistical analyses were performed to compare the preoperative characteristics with postoperative outcomes. Overall, 667 patients met the inclusion criteria. Sixty-three (9.4%) had at least one complication, and 19 (2.9%) were readmitted. Univariate analysis showed that inpatient status (p = 0.011) and race (p = 0.023) were associated with higher complication rates. Multivariate analysis revealed that outpatient status was associated with significantly lower odds of complications (OR: 0.49, 95% CI [0.27, 0.87], p = 0.018), and developmental delay was associated with higher odds of 30-day readmission (OR: 2.80, 95% CI [1.05, 7.17], p = 0.036). Longer operative time was associated with older age (13.9% increase per five-year age increase, p < 0.001) and inpatient status (35.3% increase, p < 0.001). PLOS was shorter for outpatients (45.45% shorter, p < 0.001) and cases performed by plastic surgeons (14.2% shorter, p < 0.001). Microtia reconstruction using autologous cartilage is a relatively safe procedure with low complication and readmission rates. Significant predictors of postoperative outcomes include inpatient status, race, developmental delay, and age. These findings highlight the importance of considering these factors in surgical planning and patient counseling. [ABSTRACT FROM AUTHOR]

Background: Chest deformity is a potential complication associated with auricular reconstruction using autologous costal cartilage. The impact of the incision size employed for costal cartilage harvesting on chest deformities remains unclear. This study aimed to investigate the correlation between the incision size used for harvesting costal cartilage and the occurrence of chest deformities. Methods: We retrospectively analyzed patients who underwent ear reconstruction using autologous costal cartilage between June 2021 and September 2022. The patients were categorized into two groups based on the size of the costal cartilage incision: large and small. Chest computed tomography (CT) was performed 18–24 months postoperatively, followed by three-dimensional color map quantification to assess the degree of asymmetry of the chest surface. Subsequently, quantitative data analysis was performed to compare the extent of chest asymmetry between the large- and small-incision groups. The Visual Analog Scale (VAS) was used to assess patient satisfaction with chest morphology. Results: This study included 62 patients, with an equal distribution of 31 in each group. The mean asymmetry value of the small and large incision groups was −3.15 ± 1.88 and −5.27 ± 3.63, respectively. Moreover, the mean VAS score for the small and large incision groups was 7.48 ± 0.72 and 5.09 ± 0.94, respectively. Statistically significant differences were observed between the two groups. Conclusions: Small incision costal cartilage harvesting can effectively alleviate the severity of chest deformities and significantly enhance patient satisfaction. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Although the technologies for auricular reconstruction in microtia have improved, issues such as low hairlines or excessive hair growth can still pose aesthetic problems for the reconstructed ear. Laser depilation has been reported as a solution for hair problems. However, few studies have discussed the appropriate region for hair removal. A retrospective analysis was performed on 276 patients with unilateral microtia who underwent the Nagata two-stage ear reconstruction. The gender ratio of male to female was 2.5 (198 males/78 females). Intense pulsed light depilation was used to remove hair. To determine the proper hair removal area, we measured the extent of hair removal. Before the first stage, the average vertical distance between the upper point (after localization) and hairline was 3.42 ± 4.75 mm (-10–20 mm). After the first stage, the average vertical distance between the upper point of the reconstructed ear and the hairline was 1.27 ± 2.41 mm (-10–15 mm). By using chi-square test to assess differences in hair removal success rates among various regions, we aimed to identify the suitable depilation region. Before the first stage, a depilation vertical distance ≥ 10 mm led to a 92.1% success rate. After the first stage surgery, among the patients needing additional hair removal, a vertical depilation distance ≥ 4 mm resulted in an 81.3% success rate. Based on our observation, we suggested that a depilation region of ≥ 10 mm (before the first surgery) or ≥ 4 mm (after the first surgery) would be the ideal range for laser hair removal. [ABSTRACT FROM AUTHOR]

This is the first description of Negative Pressure Wound Therapy (NPWT) use in rescuing alloplastic ear reconstructions. Previously considered a sign of certain impending failure, severe infections with frank purulence can be salvaged. As a more recently developed technique, porous polyethylene (PPE) ear reconstruction provides benefits when compared to rib techniques. Increasing surgeon awareness of complication management may lead to further adoption of the technique and improve reconstructive results. Described herein are two cases of draining infections following PPE ear reconstruction that were salvaged with satisfactory results. Laryngoscope, 134:4122–4125, 2024 [ABSTRACT FROM AUTHOR]

Background: The issue of hair growth on reconstructed ears has been a matter of concern for both patients and surgeons, despite the notable progress made in microtia reconstruction technology in recent times. Objective: This study aims to present the practical implementation of long-pulsed 800-nm diode laser depilation technology in the field of auricular reconstruction. Furthermore, it seeks to establish a comprehensive and standardized protocol for utilizing lasers in the reconstruction of microtia ears. Methods: A total of 965 patients (comprising 1021 ears) diagnosed with congenital microtia underwent treatment using 800-nm long-pulsed diode laser depilation. The participants received 1–3 treatment sessions with intervals of 25–30 days. To assess the effectiveness of the treatment, two independent observers compared photographs and measured the reduction in terminal hair count before and after the final session. Clinical outcomes were evaluated using VAS questionnaires, and any adverse events were diligently recorded. Results: The findings indicated that the utilization of the long-pulsed 800-nm diode laser was both safe and efficient in achieving hair removal during microtia ear reconstruction. As additional sessions were conducted, pain scores demonstrated a decline, while adverse reactions remained minimal. Limitations: This is a retrospective single-institution study. Conclusion: The application of a long-pulsed 800-nm diode laser has been proved to be a safe and effective method for removing hair during the process of microtia ear reconstruction, involving the use of a tissue expander and autologous costal cartilage. To achieve satisfactory results in hair removal, it was found necessary to repeat the shots procedure two to three times. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background/Aim: Hemifacial microsomia (HFM) is the second most common congenital anomaly of the craniomaxillofacial region after the cleft lip and palate. This malformation is characterized by unilateral mandible and ear hypoplasia. Treatment varies and depends on different phenotypes. Severe deficiencies require multiple reconstructive surgeries to address facial asymmetries. This study aimed to review the surgical approach and evaluate the postoperative results of a case with right hemifacial microsomia and anotia. Case Report: This is the case of a 35-year-old female patient who, after multiple graft operations in the right mandible due to hemifacial microsomia, was operated for auricle reconstruction. Initially, a three-dimensional custom made Medpor (porex) was used, covered by the superficial temporal fascia. Subsequently, due to inflammation and partial exposure of this porous polyethylene implant (PPI), a temporalis muscular flap along with the deep temporal fascia were used as a salvage operation. Ten months later, the patient underwent deep plane face lift combined with open rhinoplasty. Lefort I osteotomies and transoral lip lengthening through a transection of the levator nasi septi muscle were also performed. Ear helix reconstruction was completed with a rotation scalp flap after tissue expansion. The patient had an uncomplicated postoperative course with an aesthetically acceptable result. Conclusion: As a congenital disorder, hemifacial microsomia is present at birth and successful reconstruction is of fundamental importance for the smooth integration of these individuals into society. The multiple asymmetries, the affected topographic area of the face, as well as the onset in neonatal age constitute a challenge for reconstructive surgery. [ABSTRACT FROM AUTHOR]

Objective: To describe factors affecting anxiety, depression, stress, and self-esteem in parents of children with microtia. Design: Cross-sectional correlational study. Participants: Parents (N = 117) of children with microtia were recruited nationally through a Turkish craniofacial non-governmental organization's social media. Main Outcome Measures: Demographics, parental report of microtia experiences and concerns, the Depression Anxiety Stress Scale, and the Rosenberg Self-Esteem Scale. Results: The mean parental age was 35.61 ± 5.96 years and 74.4% were female. The mean age of their children was 6.08 ± 4.22 years, 69.2% were male, 93.8% had unilateral microtia, and 14.5% had ear reconstruction. Some parents had low self-esteem (24.8%) and were in the severe range for depression (30.7%), anxiety (25.6%), and stress (21.4%). Depression (M = 7.43, SD = 5.35) was associated with worry about child's future (β = 0.25, P =.013), microtia information given around birth (β = −0.20, P =.024), and child no ear surgery (β = −0.23, P =.008), while stress (M = 8.21, SD = 5.37) was associated with worry about the child's future (β = 0.28, P =.008). Parental self-esteem (M = 29.59, SD = 5.10) was related to child having ear surgery (β = 0.19, P =.047) and information about microtia provided around birth (β = 0.22, P =.018). There were no significant associations with Anxiety (M = 6.04, SD = 4.82) identified by multiple regression. Conclusions: While most parents were in the average to moderate range for clinical concerns, a fifth to a third of participants were in the severe range for depression, anxiety, and stress and a quarter of participants for low self-esteem. Informing families about the microtia treatment process, having the child have surgery, and interventions for reducing their future concerns may provide psychological relief for them. [ABSTRACT FROM AUTHOR]

Microtia is a relatively common congenital craniofacial malformation, and auricular reconstruction is always the preferred treatment method. At present, auricular reconstruction using the tissue expander has gradually become the main surgical method for the treatment of congenital microtia in China. Satisfactory skin expansion is the prerequisite and basis for subsequent auricular reconstruction. However, postoperative complications of stage Ⅰ auricular reconstruction are not rare. In this review, authors introduced common complications after postauricular expander implantation surgery, as well as the prevention and treatment measures for them. [ABSTRACT FROM AUTHOR]

Purpose: External ear reconstruction has been a challenging subject for plastic surgeons for decades. Popular methods using autologous costal cartilage or polyethylene still have their drawbacks. With the advance of three-dimensional (3D) printing technique, bioscaffold engineering using synthetic polymer draws attention as an alternative. This is a clinical trial of ear reconstruction using 3D printed scaffold, presented with clinical results after 1 year. Materials and Methods: From 2021 to 2022, five adult patients with unilateral microtia underwent two-staged total ear reconstruction using 3D printed implants. For each patient, a patient-specific 3D printed scaffold was designed and produced with polycaprolactone (PCL) based on computed tomography images, using fused deposition modeling. Computed tomography scan was obtained preoperatively, within 2 weeks following the surgery and after 1 year, to compare the volume of the normal side and the reconstructed ear. At 1-year visit, clinical photo was taken for scoring by two surgeons and patients themselves. Results: All five patients had completely healed reconstructed ear at 1-year follow-up. On average, the volume of reconstructed ear was 161.54% of that of the normal side ear. In a range of 0 to 10, objective assessors gave scores 3 to 6, whereas patients gave scores 8 to 10. Conclusion: External ear reconstruction using 3D printed PCL implant showed durable, safe results reflected by excellent volume restoration and patient satisfaction at 1 year postoperatively. Further clinical follow-up with more cases and refinement of scaffold with advancing bioprinting technique is anticipated. The study’s plan and results have been registered with the Clinical Research Information Service (CRIS No. 3-2019-0306) and the Ministry of Food and Drug Safety (MFDS No.1182). [ABSTRACT FROM AUTHOR]

De novo germline variants of the SRY‐related HMG‐box 11 gene (SOX11) have been reported to cause Coffin–Siris syndrome‐9 (CSS‐9), a rare congenital disorder associated with multiple organ malformations, including ear anomalies. Previous clinical and animal studies have found that intragenic pathogenic variant or haploinsufficiency in the SOX11 gene could cause inner ear malformation, but no studies to date have documented the external ear malformation caused by SOX11 deficiency. Here, we reported a Chinese male with unilateral microtia and bilateral sensorineural deafness who showed CSS‐like manifestations, including dysmorphic facial features, impaired neurodevelopment, and fingers/toes malformations. Using trio‐based whole‐exome sequencing, a de novo missense variant in SOX11 (NM_003108.4: c.347A>G, p.Y116C) was identified and classified as pathogenic variant as per American College of Medical Genetics guidelines. Moreover, a systematic search of the literature yielded 12 publications that provided data of 55 SOX11 intragenic variants affecting various protein‐coding regions of SOX11 protein. By quantitatively analyzing phenotypic spectrum information related to these 56 SOX11 variants (including our case), we found variants affecting different regions of SOX11 protein (high‐mobility group [HMG] domain and non‐HMG regions) appear to influence the phenotypic spectrum of organ malformations in CSS‐9; variants altering the HMG domain were more likely to cause the widest range of organ anomalies. In summary, this is the first report of CSS with external ear malformation caused by pathogenic variant in SOX11, indicating that the SOX11 gene may be not only essential for the development of the inner ear but also critical for the morphogenesis of the external ear. In addition, thorough clinical examination is recommended for patients who carry pathogenic SOX11 variants that affect the HMG domain, as these variants may cause the widest range of organ anomalies underlying this condition. [ABSTRACT FROM AUTHOR]

Hypothesis: Unilateral costal cartilage harvesting (UCCH) for auricle reconstruction in children tends to cause thoracic deformities. Therefore, our study aimed to develop a novel bilateral costal cartilage harvesting (BCCH) method to prevent and reduce thoracic deformities. Methods: Patients with unilateral microtia who underwent either UCCH (n = 50) or BCCH (n = 46) were enrolled in this study. The grafts for the BCCH group were harvested from the 6th costal cartilage of the ipsilateral hemithorax and the 7th and 8th cartilage from the other hemithorax. Computed tomography and physical examination were performed to identify any physical deformities in the chest contours post‐surgery. The cosmetic appearance of the thoracic scars post‐surgery was evaluated using the Scar Cosmesis Assessment and Rating Scale (SCAR) and Visual Analogue Scales (VAS cosmetic). The numerical rating scale (NRS) was used to quantify the pain in donor sites. The reconstructed ears were assessed during the follow‐up period. Result: None of the patients in the BCCH group developed thoracic deformities, while 16 patients within the UCCH group developed mild (n = 12) or severe (n = 4) thoracic deformities (p < 0.001). The SCAR (3.09 vs. 2.92, p = 0.580) and VAS scores (0.96 vs. 0.90, p = 0.813) did not differ significantly between the two groups. For both treatment arms, the NRS scores were highest on the first‐day post‐surgery and gradually dropped over the 10 days. No significant differences were found in the NRS scores and the aesthetic outcomes of the reconstructed ears between the two groups. Conclusion: The BCCH method effectively reduced the incidence of thoracic deformity at the donor site without increasing postoperative pain and cosmetic concerns for patients. It could be used clinically to improve patient outcomes of costal cartilage grafts. Level of Evidence: 4 Laryngoscope, 134:3572–3580, 2024 [ABSTRACT FROM AUTHOR]

Purpose: Pain following costal cartilage harvest surgery is the most common complaint of auricular reconstruction (AR). Anesthesiologists are continuously searching for an effective postoperative pain control method. Methods: This study was conducted from 10 April 2022 to 10 June 2022. Sixty children undergoing AR using costal cartilage were randomly assigned to either a serratus anterior plane block performed before costal cartilage harvest (SAPB-pre-cohort; n = 30) or the SAPB-post-cohort (Post-costal cartilage Harvest Cohort: n = 30). The primary endpoint measures were the Numerical Rating Scale (NRS) scores of the chest and ear pain degrees recorded at 1-, 6-, 12-, 24-, and 48-h after surgery. Intraoperative anesthetic and analgesic dosages, sufentanil consumption and rescue analgesia consumption during the first 24 h post-operation, cough score during extubation, extubation agitation score, length of stay, the extubation time, first ambulatory time, analgesia duration, and opioid-related adverse effects and SAPB-related adverse effects were the secondary endpoints. Results: The rest and coughing NRS scores were significantly reduced in the SAPB-pre-cohort 6 and 12 h post-operation in comparison with the SAPB-post-cohort (rest 6 h p = 0.002, others p < 0.001). No significant difference in the NRS ear scores existed between the two cohorts (p > 0.05). The use of propofol and remifentanil for general anesthesia during the SAPB-pre-procedure was significantly reduced compared to the SAPB-post-group, with statistical significance (p < 0.001). Sufentanil consumption and rescue analgesia consumption were significantly reduced in the SAPB-pre-cohort (p = 0.001, p = 0.033). The extubation time and first ambulatory time were markedly shorter in the SAPB-pre-cohort (all p < 0.001). Analgesia duration was markedly longer in the SAPB-pre-cohort (p < 0.001). No significant differences were noted in the cough score during extubation, extubation agitation score, length of stay between the two cohorts (all p > 0.05). Opioid-related adverse effects occurred more in the SAPB-post-cohort, while there was no statistical significance (16.7 vs. 36.7%; p = 0.082). There were no blockade-related complications observed in either cohort. Conclusion: The analgesic effect of the SAPB-pre-cohort was better than the SAPB-post-cohort suggesting both efficacy and feasibility of preemptive analgesia. Level of Evidence II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Autologous costal cartilage has gained widespread acceptance as an important material for ear reconstruction in patients with microtia. Despite its recognition as being "worth the trade-off," attention should be directed toward donor-site deformities. This systematic review focused on existing English literature related to microtia reconstruction and aimed to reveal the incidence of chest wall deformities and assess the effectiveness of the various proposed surgical techniques aimed at reducing donor-site morbidities. A comprehensive search was conducted on Pubmed and OVID using the keywords "microtia," and "chest deformity" or "rib harvest." Articles were screened based on predefined inclusion and exclusion criteria. Data acquisition encompassed patient demographics, employed surgical techniques, methods for evaluating chest deformity, and incidence of associated complications. Among the 362 identified articles, 21 met the inclusion criteria. A total of 2600 cases involving 2433 patients with microtia were analyzed in this review. Perichondrium preservation during cartilage harvesting led to a significant reduction in chest deformities. However, the wide incidence range (0% to 50%) and the lack of specific assessment methods suggested potential underestimation. Computed tomography revealed reduced chest wall growth in the transverse and sagittal directions, resulting in decreased thoracic area. Innovative surgical techniques have shown promising results in reducing chest deformities. Although a quantitative analysis was not feasible, objective evidence of deformities was established through computed tomography scans. This analysis highlighted the need for dedicated studies with larger sample sizes to further advance our understanding of chest wall deformities in microtia reconstruction. [ABSTRACT FROM AUTHOR]

Congenital microtia presents challenges that encompass physical disabilities and psychosocial distress. It is reported that people with low income have a higher possibility of giving birth to babies with congenital malformations. At the end of June 2023, auricular reconstruction was partially incorporated into national health insurance in our hospital. Briefly, 1290 surgeries, including stage-I and stage-II auricular reconstruction with tissue expansion were performed in 2023, involving 779 patients. Patient data, including age, sex, length of stay, residence, and costs, were retrieved from the electronic medical record system. The final cost before and after health insurance coverage, as well as the medical insurance reimbursement ratio in each province and municipality were statistically analyzed. Following insurance coverage, a significant increase in the number of surgeries was observed (514 [39.84%] vs. 776 [60.16%], χ2 = 45.99, p = 0.000), with notable reductions in out-of-pocket costs for unilateral and bilateral stage-I and -II auricular reconstructions ($3915.01 vs. $6645.28, p < 0.05; $11546.80 vs. $5198.08, p < 0.05). Disparities in reimbursement rates across regions were evident, but showed no correlation to the local GDP per capita. There was a positive correlation between the length of stay and inpatient cost. Patient's age was not related to the inpatient cost, but to the length of stay. The health insurance coverage for microtia treatment significantly alleviated financial burdens on the patients' family and increased the number of auricular reconstruction surgeries. These findings underscore the critical role of insurance coverage in enhancing healthcare accessibility and affordability for patients with congenital microtia. [Display omitted] [ABSTRACT FROM AUTHOR]

Objectives: To understand attentional preferences for normal and microtia ears. Methods: Eye‐tracking technology was used to characterize gaze preferences. A total of 71 participants viewed images of 5 patients with unilateral microtia. Profile images of patient faces and isolated ears including normal, microtia, and post‐reconstruction microtia ears were shown. Total time of fixation in predefined areas of interest (AOI) was measured. Inferential statistics were used to assess significance of fixation differences between AOIs within and between facial or auricular features. Results: The ear received most visual attention in lateral view of the face (1.91 s, 1.66–2.16 s) [mean, 95% CI], followed by features of the "central triangle"—the eyes (1.26 s, 1.06–1.46), nose (0.48 s, 0.38–0.58), and mouth (0.15 s, 0.15–0.20). In frontal view, microtia ears received less attention following surgical reconstruction (0.74 s vs. 0.4 s, p < 0.001). The concha was the most attended feature for both normal (2.97 s, 2.7–3.23) and reconstructed microtia ears (1.87 s, 1.61–2.13). Scars on reconstructed ears altered the typical visual scanpath. Conclusion: The ear is an attentional gaze landmark of the face. Attention to microtia ears, both pre‐ and post‐reconstruction, differs from gaze patterns of normal ears. The concha was the most attended to subunit of the ear. Attentional gaze may provide an unbiased method to determine what is important in reconstructive surgery. Level of Evidence: NA Laryngoscope, 134:3136–3142, 2024 [ABSTRACT FROM AUTHOR]

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Objective: We conducted this meta-analysis to compare the efficacy of these two surgical methods by comparing the incidence of major evaluation indicators. Methods: The databases such as PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP information databases were searched. Results: The satisfaction rate of patients with auricle reconstruction using expanded flaps was 86.5%, and the satisfaction rate of patients with auricle reconstruction using non-expanded flaps was 87.9%. The incidence of postoperative hematoma was 3.2% in patients with auricle reconstruction using expanded flaps and 18.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative skin necrosis was 2.2% in patients with auricle reconstruction using expanded flaps and 4.1% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative incision infection was 3.1% in patients with auricle reconstruction using expanded flaps and 0.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of cartilage framework exposure was 2.2% in patients with auricle reconstruction using expanded flaps and 1.9% in patients with auricle reconstruction using non-expanded flaps. The incidence of postoperative scar hyperplasia was 3.8% in patients with auricle reconstruction using expanded flaps and 3% in patients with auricle reconstruction using non-expanded flaps. The publication bias of included literature was evaluated by Egger test. There was no publication bias in this Meta-analysis (P >.05). Conclusion: The auricle reconstruction using non-expanded flaps is dominant in four of the six evaluation indexes. Therefore, we believe that the auricle reconstruction using non-expanded flaps has better therapeutic effect in patients with microtia. Due to the limitations of this meta-analysis, the conclusions of this meta-analysis still need to be further verified. [ABSTRACT FROM AUTHOR]

The absence of ears in children is a global problem. An implant made of costal cartilage is the standard procedure for ear reconstruction; however, side effects such as pneumothorax, loss of thoracic cage shape, and respiratory complications have been documented. Three-dimensional (3D) printing allows the generation of biocompatible scaffolds that mimic the shape, mechanical strength, and architecture of the native extracellular matrix necessary to promote new elastic cartilage formation. We report the potential use of a 3D-bioprinted poly-ε-caprolactone (3D-PCL) auricle-shaped framework seeded with remaining human microtia chondrocytes for the development of elastic cartilage for autologous microtia ear reconstruction. An in vivo assay of the neo-tissue formed revealed the generation of a 3D pinna-shaped neo-tissue, and confirmed the formation of elastic cartilage by the presence of type II collagen and elastin with histological features and a protein composition consistent with normal elastic cartilage. According to our results, a combination of 3D-PCL auricle frameworks and autologous microtia remnant tissue generates a suitable pinna structure for autologous ear reconstruction. [ABSTRACT FROM AUTHOR]

Objective: Given the lack of specific evaluation indices, it is difficult to determine whether to transpose or abandon remnant ears in lobule‐type microtia reconstruction. The authors illuminate referable parameters beneficial for proper treatment of remnant ear in an efficient manner. Methods: A series of 359 lobule‐type microtia patients underwent autogenous costal cartilage auricular reconstruction between 2016 and 2021. Fourteen measuring points and defined distances as well as six ratios of specific distances based on position, plumpness, similarity and the width‐to‐length ratio of the remnant ear have been described, and relevant tactics for appropriate treatments are introduced. Results: Definite morphometric results contribute to attaining satisfactory contours of reconstructed auricles with harmonious earlobes, which exhibit highly similar dimensions and appearances compared to the contralateral normal ears. Conclusion: With the help of the proposed locating points and measuring approaches, the procedure of remnant ear treatment is systematically clarified. This technique ensures operation safety and contributes to the aesthetic contour of the auricle. Level of Evidence: IV Laryngoscope, 134:2741–2747, 2024 [ABSTRACT FROM AUTHOR]

The human auricle has a complex structure, and microtia is a congenital malformation characterized by decreased size and loss of elaborate structure in the affected ear with a high incidence. Our previous studies suggest that inadequate cell migration is the primary cytological basis for the pathogenesis of microtia, however, the underlying mechanism is unclear. Here, we further demonstrate that microtia chondrocytes show a decreased directional persistence during cell migration. Directional persistence can define a leading edge associated with oriented movement, and any mistakes would affect cell function and tissue morphology. By the screening of motility‐related genes and subsequent confirmations, active Rac1 (Rac1‐GTP) is identified to be critical for the impaired directional persistence of microtia chondrocytes migration. Moreover, Rho guanine nucleotide exchange factors (GEFs) and Rho GTPase‐activating proteins (GAPs) are detected, and overexpression of Tiam1 significantly upregulates the level of Rac1‐GTP and improves directional migration in microtia chondrocytes. Consistently, decreased expression patterns of Tiam1 and active Rac1 are found in microtia mouse models, Bmp5se/J and Prkralear‐3J/GrsrJ. Collectively, our results provide new insights into microtia development and therapeutic strategies of tissue engineering for microtia patients. [ABSTRACT FROM AUTHOR]

Background Injecting botulinum toxin (BTX) into the submandibular glands (SMGs) can treat drooling symptoms in neurological diseases and improve the aesthetics of SMG hypertrophy and ptotic SMGs. Objectives This study aimed to define the size and position of the SMGs by high-frequency ultrasound, and to perform statistical analysis to improve the safety and accuracy of BTX injection therapy. Methods Neck ultrasonography with high-frequency ultrasound was performed on 214 volunteers. The length, height, and thickness of the SMGs, and the distance between the SMGs and the midline, the anterior border of the sternocleidomastoid, the mandible, and the surface were measured. Results The SMGs were almond-shaped with a mean [standard deviation] length of 33.7 [4.7] mm, a thickness of 13.3 [2.9] mm, and a height of 27.6 [6.0] mm. The length and height were significantly different between underage and youth groups. The size of the SMGs did not show any notable differences with increasing BMI; however, their depth, and the distance from the mandible, midline, and anterior border of the sternocleidomastoid increased. No significant differences were observed between the affected and healthy sides in patients with microtia, hemifacial microsomia, or cleft lip and palate. Conclusions Ultrasound provides more comprehensive information regarding the size and position of the SMGs, which can serve as a reference in BTX therapy and in the diagnosis of SMG diseases involving size alterations. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

VACTERL association is typically defined as the presence of three components among these birth defects: vertebral anomalies, anal atresia, cardiac anomalies, esophageal atresia/tracheoesophageal fistula (EA/TEF), renal anomalies, and limb defects. There is increasing recognition that VACTERL and other recurrent constellations of embryonic development often overlap clinically and might share pathogenesis. We conducted a comprehensive chart review of a large patient population with VACTERL association from two tertiary care centers in California. We included patients with incomplete VACTERL expression, which we denoted as "partial VACTERL" (pVACTERL). We assessed the occurrence of craniofacial (CF) findings in these two groups and the combined cohort. We collected data on potential risk factors and demographic information such as sex, Hispanic ancestry, pregnancy complications, and maternal age. The study included 409 participants, of whom 263 had VACTERL and 146 pVACTERL. CF abnormalities were found in 17.3% of VACTERL patients and 9.4% of pVACTERL patients. In the VACTERL group, ear anomalies were found in 10.2%, microtia in 5.9%, hearing loss (HL) in 13.90%, and orofacial clefts in 3.1%. In the pVACTERL group, ear anomalies were found in 7.2%, microtia in 5.0%, HL in 9.3%, and orofacial cleft in 2.2%. Maternal diabetes significantly increased the risk for HL in VACTERL (odds ratio [OR]: 3.71, 95% confidence interval [CI]: 1.5-7.3) and pVACTERL patients (OR: 6.7, 95% CI: 1.70-23.4). Poorly controlled maternal diabetes significantly increased the risk for all the outcomes in VACTERL patients including CF anomalies (OR: 4.2, 95% CI: 1.9-9.6), ear anomalies (OR: 4.7, 95% CI: 1.8-11.8), microtia (OR: 5.4, 95% CI: 1.7-16.6), and HL (OR: 8.1, 95% CI: 3.4-19.4). Twin status was significantly associated with the occurrence of microtia (p = 0.038) in VACTERL patients. Occurrence of CF features, particularly ear anomalies, microtia, and HL, might be considered as part of phenotypic diversity of VACTERL association. Diabetes and twinning might appear to play a role in increasing the risk for this phenotype in VACTERL association.

Abstract Background Microtia is reported to be one of the most common congenital craniofacial malformations. Due to the complex etiology and the ethical barrier of embryonic study, the precise mechanisms of microtia remain unclear. Here we report a rare case of microtia with costal chondrodysplasia based on bioinformatics analysis and further verifications on other sporadic microtia patients. Results One hundred fourteen deleterious insert and deletion (InDel) and 646 deleterious SNPs were screened out by WES, candidate genes were ranked in descending order according to their relative impact with microtia. Label-free proteomic analysis showed that proteins significantly different between the groups were related with oxidative stress and energy metabolism. By real-time PCR and immunohistochemistry, we further verified the candidate genes between other sporadic microtia and normal ear chondrocytes, which showed threonine aspartase, cadherin-13, aldolase B and adiponectin were significantly upregulated in mRNA levels but were significantly lower in protein levels. ROS detection and mitochondrial membrane potential (∆ Ψ m) detection proved that oxidative stress exists in microtia chondrocytes. Conclusions Our results not only spot new candidate genes by WES and label-free proteomics, but also speculate for the first time that metabolism and oxidative stress may disturb cartilage development and this might become therapeutic targets and potential biomarkers with clinical usefulness in the future.

Abstract The main objective of this study was to investigate the incidence and characteristics of electrocardiographic abnormalities in patients with microtia, and to explore cardiac maldevelopment associated with microtia. This retrospective study analyzed a large cohort of microtia patients admitted to Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, from September 2017 to August 2022. The routine electrocardiographic reports of these patients were reviewed to assess the incidence and characteristics of abnormalities. The study included a total of 10,151 patients (5598 in the microtia group and 4553 in the control group) who were admitted to the Plastic Surgery Hospital of Peking Union Medical College. The microtia group had a significantly higher incidence of abnormal electrocardiographies compared to the control group (18.3% vs. 13.6%, P

Abstract Background Microtia is a congenital ear malformation that can occur as isolated microtia or as part of a syndrome. The etiology is currently poorly understood, although there is strong evidence that genetics has a role in the occurrence of microtia. This systematic review aimed to determine the genes involved and the abnormalities in microtia patients' head and neck regions. Methods We used seven search engines to search all known literature on the genetic and phenotypic variables associated with the development or outcome of microtia. The identified publications were screened and selected based on inclusion and exclusion criteria and assessed for methodological quality using the Joanna Briggs Institute (JBI) critical appraisal tools. We found 40 papers in this systematic review with phenotypic data in microtia involving 1459 patients and 30 articles containing genetic data involved in microtia. Result The most common accompanying phenotype of all microtia patients was external ear canal atresia, while the most common head and neck abnormalities were the auricular, mental, and oral regions. The most common syndrome found was craniofacial microsomia syndrome. In the syndromic microtia group, the most common genes were TCOF1 (43.75%), SIX2 (4.69%), and HSPA9 (4.69%), while in the non-syndromic microtia group, the most frequently found gene was GSC exon 2 (25%), FANCB (16.67%), HOXA2 (8.33%), GSC exon 3 (8.33%), MARS1 (8.33%), and CDT1 (8.33%). Conclusions Our systematic review shows some genes involved in the microtia development, including TCOF1, SIX2, HSPA9, GSC exon 2, FANCB, HOXA2, GSC exon 3, MARS1, and CDT1 genes. We also reveal a genotype-phenotype association in microtia. In addition, further studies with more complete and comprehensive data are needed, including patients with complete data on syndromes, phenotypes, and genotypes.

Objectives: Every individual possesses the inherent right to appear human. Physical imperfections, especially those affecting the orofacial region, can have a detrimental impact on one’s quality of life in today’s image-conscious society. Auricular abnormalities, ranging from minor malformations to complete microtia/anotia, can occur due to congenital or acquired factors. While significant progress has been made in the surgical treatment of oral and facial abnormalities, achieving complete correction through plastic surgery alone is often a compromise. Consequently, there has been a recent increase in the demand for maxillofacial prosthetics to aid in the recovery of these patients. Case Presentation: A 26 year old male patient with complaints of microtia of the bilateral ear was referred from the Department of Plastic Surgery for prosthetic rehabilitation. After a clinical examination, a bilateral removable auricular prosthesis made of room temperature vulcanizing (RTV) silicone elastomer and retained by extraoral adhesive and hair band was planned for the patient. After the rehabilitation, the patient was satisfied with the prosthetic outcome. By utilizing anatomical landmarks and a whipmix facebow, the bilateral auricular prosthesis was accurately oriented in three-dimensional (3D) alignment with the patient’s face. Discussion: This case report presents a simple and cost-effective technique for the prosthetic rehabilitation of a patient with congenital bilateral microtia. This approach can be considered for patients who are either unwilling or contraindicated for reconstruction or implant-retained prostheses.

Background: Microtia is reported to be one of the most common congenital craniofacial malformations. Due to the complex etiology and the ethical barrier of embryonic study, the precise mechanisms of microtia remain unclear. Here we report a rare case of microtia with costal chondrodysplasia based on bioinformatics analysis and further verifications on other sporadic microtia patients. Results: One hundred fourteen deleterious insert and deletion (InDel) and 646 deleterious SNPs were screened out by WES, candidate genes were ranked in descending order according to their relative impact with microtia. Label-free proteomic analysis showed that proteins significantly different between the groups were related with oxidative stress and energy metabolism. By real-time PCR and immunohistochemistry, we further verified the candidate genes between other sporadic microtia and normal ear chondrocytes, which showed threonine aspartase, cadherin-13, aldolase B and adiponectin were significantly upregulated in mRNA levels but were significantly lower in protein levels. ROS detection and mitochondrial membrane potential (∆ Ψ m) detection proved that oxidative stress exists in microtia chondrocytes. Conclusions: Our results not only spot new candidate genes by WES and label-free proteomics, but also speculate for the first time that metabolism and oxidative stress may disturb cartilage development and this might become therapeutic targets and potential biomarkers with clinical usefulness in the future. [ABSTRACT FROM AUTHOR]

The presence of polyotia in individuals with microtia is a rare deformity. Due to the intricate structure of the auricle, uncertain etiology, and challenging corrective techniques, it has always been a focal point in the field of plastic surgery. The present study presents a technique for correcting the combination of polyotia and microtia by utilizing residual ear tissue as graft material. The retrospective study included 23 patients with polyotia and microtia from 2018 to 2022. The residual ear tissue was used to rectify auricular deformities in all patients. The patients were instructed to evaluate the satisfaction of the auricle shape using a visual analog scale (VAS) both before and 6 months after the surgical procedure. The esthetic outcomes of auricle subunits were simultaneously assessed by a senior physician pre- and postoperatively. The mean duration of follow-up in this study was 8.73 months. The preoperative VAS satisfaction score was recorded as 2.26 ± 0.86, while the post-operative VAS score significantly increased to 7.86 ± 0.86. The preoperative auricle esthetic outcomes score was recorded as 9.95 ± 1.74, while the post-operative score significantly increased to 24.04 ± 2.16. The follow-up period did not present any cases of flap necrosis, hematoma, infection, or wound dehiscence. The study demonstrates that comprehensive utilization of residual auricular tissue can lead to optimal outcomes in correcting polyotia with concha-type microtia. The utilization of residual ear tissue can be maximized to streamline the operation, minimize bodily harm, and enhance patient satisfaction. [Display omitted] [ABSTRACT FROM AUTHOR]

Lobule transposition, a common procedure in auricle reconstruction, has been successfully performed over the past few decades. However, the transposition methods for unilateral microtia with evident asymmetry of bilateral earlobe positions still remain a challenge. The objective of this study was to investigate the application of prograde transposition for anteriorly low-set earlobes. A total of 25 patients with lobule-type microtia with anteriorly low-set residual earlobe underwent prograde transposition during auricle reconstruction between 2020 and 2022. The post-operative earlobe aesthetic assessment and patient satisfaction were evaluated, and the data on any complications that occurred when followed-up were collected. This study provides a comprehensive analysis and summary of the techniques used in earlobe transposition for auricular reconstruction. The patients with evident asymmetry between the residual and healthy earlobes were usually concomitant with hemifacial microsomia and the residual ear was located in the anterior and lower region. No instances of flap necrosis, hematoma, or wound dehiscence were observed following auricular reconstruction. The mean aesthetic score of the auricle was 3.52, with 23 patients attaining good or excellent aesthetic outcomes. The mean Visual Analog Scale satisfaction score was 3.68, with 24 patients reporting relative satisfaction or satisfaction. The prograde transposition of anteriorly low-set earlobe in lobule-type microtia reconstruction can effectively ensure adequate blood supply, enhance aesthetic appearance, and significantly improve patient satisfaction. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: To assess which information about microtia and the possible reconstructive options health care providers (HCPs), patients and parents believe should be included in a patient decision aid (PtDA). Design: A mixed-methods study comprised of an online survey of HCPs and focus group discussions with patients and parents. Participants: Survey respondents were members of the International Society for Auricular Reconstruction (ISAR). Focus group participants were patients with microtia and their parents, recruited through the microtia outpatient clinic at Amsterdam UMC, and through a Dutch patient organization for cleft and craniofacial conditions. Methods: An online, investigator-made survey was sent to ISAR members in December 2021. Semi-structured focus group discussions were held in February 2022. Quantitative results were summarized, and qualitative results were thematically grouped. Results: Thirty-two HCPs responded to the survey (response rate 41%). Most respondents (n = 24) were plastic surgeons, who had a median of 15 years of experience (IQR: 7-23 years). Two focus groups were held with a total of five patients and two parents. HCPs, patients and parents generally agreed on the information needed in a PtDA, emphasizing the importance of realistic expectation management. Patients and parents also considered psychosocial and functional outcomes, patient experiences, as well as patients' involvement in decision-making important. Conclusions: A PtDA for microtia reconstruction should target all patients with microtia, and include information on at least technique-related information, expected esthetic results, possible adverse effects, psychosocial and functional outcomes and patient experiences. Preference eliciting questions should be developed for both pediatric patients and their parents. [ABSTRACT FROM AUTHOR]

Background: Microtia is a congenital ear malformation that can occur as isolated microtia or as part of a syndrome. The etiology is currently poorly understood, although there is strong evidence that genetics has a role in the occurrence of microtia. This systematic review aimed to determine the genes involved and the abnormalities in microtia patients' head and neck regions. Methods: We used seven search engines to search all known literature on the genetic and phenotypic variables associated with the development or outcome of microtia. The identified publications were screened and selected based on inclusion and exclusion criteria and assessed for methodological quality using the Joanna Briggs Institute (JBI) critical appraisal tools. We found 40 papers in this systematic review with phenotypic data in microtia involving 1459 patients and 30 articles containing genetic data involved in microtia. Result: The most common accompanying phenotype of all microtia patients was external ear canal atresia, while the most common head and neck abnormalities were the auricular, mental, and oral regions. The most common syndrome found was craniofacial microsomia syndrome. In the syndromic microtia group, the most common genes were TCOF1 (43.75%), SIX2 (4.69%), and HSPA9 (4.69%), while in the non-syndromic microtia group, the most frequently found gene was GSC exon 2 (25%), FANCB (16.67%), HOXA2 (8.33%), GSC exon 3 (8.33%), MARS1 (8.33%), and CDT1 (8.33%). Conclusions: Our systematic review shows some genes involved in the microtia development, including TCOF1, SIX2, HSPA9, GSC exon 2, FANCB, HOXA2, GSC exon 3, MARS1, and CDT1 genes. We also reveal a genotype-phenotype association in microtia. In addition, further studies with more complete and comprehensive data are needed, including patients with complete data on syndromes, phenotypes, and genotypes. [ABSTRACT FROM AUTHOR]

Objective To summarize the clinical experience of external ear reconstruction with large-capacity dilator in patients with congenital microtia. Methods The surgery was carried out in three stages. In the first stage, the soft tissue expander of post-auricular skin was placed in the residual ear, and the post-auricular skin was fully expanded. In the second stage, the expander was removed and the right side of rib cartilage was taken to sculpture the ear cartilage scaffolding, which was embedded under the expanded flap to obtain a three-dimensional ear shape. Finally, the reconstructed ear was partially trimmed, so that the reconstructed ear was close to the normal ear. Results The 52 patients operated in Wuhan Third Hospital from 2013 to 2022 were followed up for 6 months to 3 years. 46 patients of reconstructed ear were satisfied with clear and three-dimensional ear structure, good symmetry with the healthy ear, and no displacement or deformation of cartilage scaffolding, and 4 patients had shallow cranio-auricular angles, and full-thickness skin grafts were performed to deepen the cranio-auricular angle in stage III. In 2 cases, the scaffolds were absorbed, and the reconstructed ears were poorly shaped. Conclusion For patients with congenital microtia, applying completely expanded retroauricular flap method of external ear reconstruction can provide a clear and three-dimensional structure of the reconstructed ear, with good uniformity of complexion and texture, and fewer complications, solving the drawbacks of the traditional expansion method that requires skin grafting and reducing the possibility of scarring. [ABSTRACT FROM AUTHOR]

Objective To evaluate the auricle radial cartilage incision as for a method for the alternative to treat mild to moderate type of concha-type microtia. Methods As for an example of five patients aged between 6 to 35 and who were diagnosed with mild to moderate type of concha-type microtia, in a period between 2023 May to 2023 Dec. the Department of Plastic Surgery of The First Hospital of China Medical University applied auricle radial cartilage incision with autologous cartilage form auricle concha and skin graft for treatment. The auricle width, perimeter and the scores of detailed structures of the affected ear were recorded and evaluated preoperatively and postoperatively. The satisfaction and the complication of the operation were followed and recorded. Results The average improvement of the width and the perimeter of the affected ear is about 31 percent and 28 percent respectively, measured immediately after surgery. The average score of ear fine structure increased by about 35%. The width and the perimeter of the affected ear have been both improved and the improvements have been proved to have significant differences (P<0.01). The scores of detailed structures of the affected ear has also been improved and the improvement has been proved to have difference (P<0.05). Conclusion The auricle radial cartilage incision assisted with autologous cartilage form auricle concha and skin graft is a promising alternative to the method costal cartilage graft for the purpose of auricle reconstruction in mild to moderate type of concha-type microtia patients. [ABSTRACT FROM AUTHOR]

Background: In microtia, there is a remnant of the malpositioned lobe and deformed auricle. To achieve an aesthetically appealing consistent ear; there must be a balanced 3-dimensional structural support, and there must be an adjustment of the skin to the framework. Aim: To compare extension of the cartilaginous framework downwards to be inserted in a pocket created inside the ear lobe (ear lobe push down) versus ear lobe transposition in cases presented with microtia. Patients and methods: Twenty cases presented with unilateral microtia, underwent ear reconstruction with cartilaginous framework, randomized into two groups; in (group A) the carved 3D cartilaginous framework was introduced based on auricular foot print, with its lower end inserted in a pocket dissected inside ear lobe, while in (group B) the carved 3D framework was introduced as well based on auricular foot print, with no interference with the ear lobe, with assessment of the results objectively and subjectively. Results: The movement of the lobe in the second stage in (group A) ranged from 0 to 45 degree if needed, whereas in (group B) it ranged from 135 to 180 degrees, with higher patient satisfaction in group A. Conclusion: Ear lobe push down technique, by extension of the cartilaginous framework downwards to be adapted in a pocket dissected in ear lobe, is a feasible modification (step) in microtia reconstruction with appealing aesthetic outcomes. [ABSTRACT FROM AUTHOR]

Single-stage microtia auricular reconstruction is becoming more relevant. The determining factor is a temporoparietal fascia flap (TPF) with both branches of the superficial temporal artery (STA). There are not many studies regarding vascular branching in people with microtia. We conducted an anatomical study on the TPF flap harvested during single-stage endoscopic-assisted microtia auricular reconstruction from May 2018 to July 2021. We observed the flaps under endoscopic and surgical microscopes to determine several variables (vascular size, number of frontal/parietal branches, distance from the branching location to the estimated external ear canal, distance from the frontal artery to projected course of facial nerve's frontal branch, etc.). The study included 55 flaps from 54 patients. Of the 55 flaps, 50 (90.9%) had a parietal branch, and all 55 (100%) had a frontal branch with a mean diameter of 0.98 and 0.91 mm, respectively. Regarding the frontal artery, 1.8%, 25.5%, 50.9%, 16.35% and 5.45% had 0–4 traverse frontal branch(es), respectively. The mean distance from the frontal artery to the estimated course of the frontal nerve was 10.56 mm. Parietal artery absence is more likely in patients with severe hemifacial microsomia or STA trunk go under the auricular cartilage remnants (p < 0.05). Either frontal or parietal artery absence or small diameter can cause necrosis. Frontal arteries travelling near the frontal nerve may result in post-operative nerve palsy. Microtia auricular reconstructive surgery is always a big challenge for plastic surgeons. Anatomical variants are common. A detailed anatomical description of the STA, with the help of microsurgery and endoscopy, allows arterial-based flap designing and harvest, which tremendously improves surgical success rate by diminishing flap necrosis and nerve damage. Therapeutic, IV. [ABSTRACT FROM AUTHOR]

The article discusses a novel minimally invasive technique called MOSIA (Minimally Invasive OSIA Bone Conduction Hearing Implant) for the placement of the Cochlear OSIA® 2 System in children under the age of 12. The technique involves a modified incision and biplane dissection to reduce postoperative pain, bleeding, and improve aesthetics. The study included seven children with aural atresia who underwent MOSIA, and the outcomes reported were postoperative pain, complications, and patient satisfaction. The authors found that MOSIA resulted in successful implantation with minimal complications and high patient satisfaction. [Extracted from the article]

This article discusses the clinical experience of performing simultaneous bilateral Osia implantation in children with microtia, a condition characterized by underdeveloped or absent external ears. The Osia implant is a new generation of an active transcutaneous bone-anchored hearing implant that utilizes a piezoelectric transducer fixed to a titanium implant. The article describes the surgical technique, including considerations for anatomical variations, future auricular reconstruction, and symmetry of audio processors. The authors emphasize the importance of preventing pressure necrosis and post-operative infection. The results of the procedure were successful, with no complications reported in the two patients described in the study. The authors conclude that this approach is safe, simple, and effective for addressing hearing impairment in children with microtia and may also be applicable to non-microtia patients with bilateral conductive deafness. [Extracted from the article]

Objectives: Every individual possesses the inherent right to appear human. Physical imperfections, especially those affecting the orofacial region, can have a detrimental impact on one's quality of life in today's image-conscious society. Auricular abnormalities, ranging from minor malformations to complete microtia/anotia, can occur due to congenital or acquired factors. While significant... [ABSTRACT FROM AUTHOR]

Objectives: Microtia and anotia repair require techniques that consider both aesthetics and function. The outcomes of different reconstructive frameworks such as costal cartilage or a porous polyethylene implant have not been evaluated on a national scale. We aim to understand differences in outcomes/complication rates and operative times between different reconstructive frameworks used in microtia/anotia reconstruction. Methods: This was a retrospective review of the National Surgical Quality Improvement Program Pediatric database between 2012–2019. Patients with ICD‐9/10 codes for microtia/anotia were isolated. Reconstruction methods were identified using CPT codes for rib graft, ear cartilage graft, and alloplastic implants (biocompatible implants, porous polyethylene, etc). Outcomes included operative‐time, wound complications, and unplanned re‐operations within 30 days of surgery. Multivariable logistic regression was performed to control for confounders. Results: We included 593 patients for analysis. Reconstruction with rib grafts (N = 506, 85%) was the most common. In 58 patients (9.8%), an implant was used for the auricular framework, whereas in 47 (7.9%) ear cartilage grafts were used. The overall wound complication rate was 3.4%. On univariate analysis, alloplastic implants exhibited a higher rate of wound complications (8.6% vs. 2.8%, p = 0.037) and longer operative times (350 min vs. 235 min, p < 0.001). After controlling for demographics and comorbidities, implants conferred an independently increased risk of wound complications (OR 3.52, 1.10–9.54, p = 0.020). Conclusion: Although the use of alloplastic implants (e.g., porous polyethylene) may confer an increased risk of early complications, the long‐term clinical implications of these findings are unclear relative to aesthetic benefits. Multi‐institutional studies are needed to validate these findings using patient‐specific and surgeon‐specific data. Level of Evidence: 3 Laryngoscope, 134:1214–1219, 2024 [ABSTRACT FROM AUTHOR]

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Congenital microtia is the most common cause of auricular defects, with a prevalence of approximately 5.18 per 10,000 individuals. Autologous rib cartilage grafting is the leading treatment modality at this stage of auricular reconstruction currently. However, harvesting rib cartilage may lead to donor site injuries, such as pneumothorax, postoperative pain, chest wall scarring, and deformity. Therefore, in the pursuit of better graft materials, biomaterial scaffolds with great histocompatibility, precise control of morphology, non-invasiveness properties are gradually becoming a new research hotspot in auricular reconstruction. This review collectively presents the exploit and application of 3D printing biomaterial scaffold in auricular reconstruction. Although the tissue-engineered ear still faces challenges before it can be widely applied to patients in clinical settings, and its long-term effects have yet to be evaluated, we aim to provide guidance for future research directions in 3D printing biomaterial scaffold for auricular reconstruction. This will ultimately benefit the translational and clinical application of cartilage tissue engineering and biomaterials in the treatment of auricular defects.

Background: Recently, three-dimensional (3D) models have been used more frequently than the traditional two-dimensional (2D) models as an intraoperative guide to ease sculpture of costal cartilages in total auricular aesthetic reconstruction in cases of microtia. Usually, 3D imaging techniques are used to create compact ear models, however, there is insufficient clinical knowledge of using them to create segmented 3D auricular models for cartilage framework reconstruction. In this study: assessment of the advantages of segmentation of 3D models over the traditional compact 3D models in total auricular aesthetic reconstruction has been discussed. Patients and methods: In the current study, 16 patients who underwent total auricular aesthetic reconstruction using 3D models were included, patients were divided into two groups (Group I, 8 patients had total auricular aesthetic reconstruction using compact 3D printed mirror image model). Whereas (Group II, 8 patients had total auricular aesthetic reconstruction using segmented 3D printed mirror image model into auricular subunits. Then, each subunit was used for reconstruction of the corresponding part of the auricle. In both groups the patient's unaffected ear was mirrored and used as a reference to reconstruct the affected side. Results: The results were evaluated in both groups. The overall operative and carving times were found to be less in Group II; Also, postoperative aesthetic outcome and patient satisfaction were favorable in this group. Conclusion: Using segmentation of 3D printed models in total auricular aesthetic reconstruction had less intraoperative time, better aesthetic results, and high postoperative patient satisfaction.

Background Microtia is an uncommon congenital malformation ranging from mild anatomic structural abnormalities to partial or complete absence of the ear leading to hearing impairment. Congenital microtia may present as a single malformation (isolated microtia) or sometimes associated with other congenital anomalies involving various organs. Microtia has been classified in three degrees according to the complexity of the auricular malformation and to anotia referred to the total absence of the ear. Genetic role in causing auricular malformation has been widely demonstrated, and genotype–phenotype correlation has been reported in cases of syndromic microtia.

Summary: Background: Commonly used methods to evaluate auricles are subjective and are therefore not specific, comprehensive, and precise nor effective in the assessment of microtia reconstruction outcomes. This scoping review aimed to summarize the objective methods for the accurate evaluation of microtia reconstruction. Methods: We performed a scoping review of publications that used objective measurement methods to evaluate outcomes of microtia reconstruction according to the PRISMA-ScR guidelines. A systematic literature search was conducted in the Embase, PubMed, Cochrane, CNKI, and VIP databases, and literature references were screened for additional records. Studies that evaluated auricles after microtia reconstruction using quantitative anthropometric methods were included, and data on these methods were collected. Results: Twenty-five publications reported on quantitative objective outcome measurements. Thirteen studies evaluated auricular protrusion, three articles assessed the position or symmetry, and twelve studies reported on auricle size. The quantitative measurements of fine structures, such as the tragus and concha, were described in three studies. All described measurements used manual landmarking, where fifteen studies described well-defined landmarks, fifteen studies described poorly defined landmarks, and four studies used a combination of well and poorly defined landmarks. Conclusion: The objective evaluation of microtia reconstruction outcomes is hindered by significant heterogeneity of measurement methods. The measurement methods used for general auricular measurements (auricular protrusion, auriculocephalic angle, and size) used in microtia reconstruction were abundant, while measurements of auricular position and the fine structures of the auricle were limited. Three-dimensional imaging combined with computer analyses poses promising future alternatives.

The creation of multi‐tissue auricular transplants for the treatment of microtia is a challenge due to the complex and layered structure of this anatomical tissue. A novel casting technique for the 3D biofabrication of heterogeneous, multi‐layered, and human‐scale tissue transplants using eluting agarose molds is presented. The molds are generated by casting agarose into custom 3D‐printed containers, termed metamolds, optimized to facilitate the hydrogel casting process based on geometric and topological constraints. Casting yields high resolution (50 µm) and allows for subsequent casting of further hydrogel layers on the transplant. Multi‐layered auricular constructs are fabricated on a cartilage core consisting of a hyaluronic acid‐alginate double network and an adjacent gelatin‐based dermal layer. Bonding between adjacent layers is achieved by orthogonal physical and enzymatic crosslinking of residual functional groups between each layer. Material composition and culture duration are optimized for each layer allowing for maturation into cartilaginous and pre‐vascularized dermal tissues. To demonstrate the scalability of this technique for the biofabrication of human‐sized transplants, bi‐layered human‐sized ears are cast. Overall, this novel casting technique offers a promising approach for the fabrication of complex tissue grafts, overcoming the limitations of other traditional biofabrication methods. [ABSTRACT FROM AUTHOR]

Objective To investigate the safety and efficiency of depilation with intense pulsed light (IPL) in congenital microtia patients during reconstruction treatment sessions. Methods A study was conducted at the Plastic and Reconstructive Surgery Hospital of Peking Union Medical College, Chinese Academy of Medical Sciences. From January 2018 to September 2021, a total of 96 patients were divided into two groups: the expansion group (58 cases) and the non-expansion group (38 cases), based on the treatment method. All patients received 3 to 5 sessions of IPL treatment using filters ranging from 695 nm to 1200 nm, with a pulse width of 15 ms, single-pulse mode, and energy levels set at 14 to 15 J/cm² for the non-expansion group and 13 to 14 J/cm² for the expansion group. The efficacy of hair removal and the occurrence of adverse reactions were evaluated in both groups. Results All patients completed 3 treatments, while 75 patients completed 5 treatments. The reduction of hair density after 3 treatments is higher than the non-expansion group 82.28% (75.41%, 88.54%) versus 76.53% (70.10%, 85.34%), P<0.05. Among the patients who completed 3 treatments, 44 in the expansion group and 21 in the non-expansion group achieved excellent treatment outcomes. After 5 treatments, 44 patients in the expansion group and 31 patients in the non-expansion group had excellent results. During the 6 to 11 months follow-up period, three cases of folliculitis and two cases of blisters were observed, none of which resulted in expander exposure or cartilage resorption. Conclusion Hair removal with IPL is a safe and effective photo-epilation method during all stages of ear reconstruction using tissue expander. [ABSTRACT FROM AUTHOR]

Tissue engineering (TE) techniques offer solutions for tissue regeneration but require large quantities of cells. For microtia patients, TE methods represent a unique opportunity for therapies with low donor-site morbidity and reliance on the surgeon's individual expertise. Microtia-derived chondrocytes and perichondrocytes are considered a valuable cell source for autologous reconstruction of the pinna. The aim of this study was to investigate the suitability of perichondrocytes from microtia patients for autologous reconstruction in comparison to healthy perichondrocytes and microtia chondrocytes. Perichondrocytes were isolated via two different methods: explant culture and enzymatic digestion. The isolated cells were analyzed in vitro for their chondrogenic cell properties. We examined migration activity, colony-forming ability, expression of mesenchymal stem cell markers, and gene expression profile. We found that microtic perichondrocytes exhibit similar chondrogenic properties compared to chondrocytes in vitro. We investigated the behavior in three-dimensional cell cultures (spheroids and scaffold-based 3D cell cultures) and assessed the expression of cartilage-specific proteins via immunohistochemistry, e.g., collagen II, which was detected in all samples. Our results show that perichondrocytes from microtia patients are comparable to healthy perichondrocytes and chondrocytes in terms of chondrogenic cell properties and could therefore be a promising cell source for auricular reconstruction. [ABSTRACT FROM AUTHOR]

Objective: Microtia is a congenital auricular malformation with a hypoplastic external ear that ranges in severity from a slightly smaller auricle to complete the absence of the auricle. The present study was conducted to identify and analyze the characteristics of microtia-related articles published from 2006 to 2020 by using bibliometric analyses. Method: Microtia-related studies published from 2006 to 2020 were retrieved from the Web of Science Core Collection database. Keywords, first author, citations, date of publication, and publication journal were extracted and quantitatively analyzed using Bibliographic Item Co-Occurrence Matrix Builder software and the Bibliometric (https://bibliometric.com/app). VOSviewer was used to visualize research and form a network map on keywords and citations. Results: A total of 1031 articles from 2006 to 2020 were included. The number of articles showed an overall trend of growth over time. The United States and China are the top 2 countries in terms of the number of microtia-related articles. From the analysis of keyword clustering, keywords could be mainly divided into 4 clusters in the field of microtia research: surgery, tissue engineering, epidemiology, and rehabilitation including hearing-related treatments, evaluation of effects, and quality of life after surgery. The top 10 most frequently cited papers from 2006 to 2020 were also extracted and analyzed. Conclusion: A bibliometric research of microtia-related articles from 2006 to 2020 was conducted. This study may be helpful to understand the current research status of microtia and find the research trends in this field, thus proposing future directions for microtia research. [ABSTRACT FROM AUTHOR]