CHANIDA KANCHANALARP, MD.

Abstract :

During 1990-98, 15 patients underwent pinna reconstruction using costal cartilagenous allografts, 10 males, 5 females aged 13 to 37 years. The costal cartilages were implanted beneath the post auricular skin. Three months later, the composite cartilage-skin graft was elevated and the other free skin graft was used to reconstruct the pinna. Thirteen out of 15 patients had satisfactory Cosmetic and functional result. Only one cartilagenous graft was necrosis and the other one was infected necrosis after accidental trauma 2 weeks postoperatively. In conclusion costal cartilagenous allograft is an alternative pinna reconstruction with a good long term result.

Introduction

Auricular reconstruction for congenital microtia is a complex multi-staged procedure. In 1980 Brent extended Tanzer's work by antogenous rib cartilage as the framework of the new pinna. 1,2 The purpose of our study on pinna reconstruction is to improve the cosmetic appearances as much as possible and the functional wearing glasses. Since 1990 auricular reconstruction using a cartilagenous allograft from Bangkok Biomaterial Center has been successful. After 8 years follow up there are 13 patient had satisfactory cosmetic and functional result.

Patients and Methods

During 1990-1998, 15 cases of pinna reconstruction underwent in Ramathibodi Hospital There were 10 males and 5 females aged 13-37 years. They are 11 unilateral microtia patients, 2 bilateral microtia patients and 2 traumatic ear patients The cartilagenous allograft which we used for pinna reconstruction, these were prepared costal cartilage by aseptic technique removal from cadavers and were subsequently placed in a deep freeze at -80⁰ Celsius by the Bangkok Biomaterial Bank Centre.³

Operative procedure

There are 3 stages-operations

	Implantation : We used the costal cartilage with out perichondrium by modelling the form the auricular shape as we designed and then we implanted under the skin behind the ear canal (Figure 1A,B)
	Elevation : After 3 months we waited for the healing process then we made the incision to lift up the composition of pinna and cartilage anteriorly. We used the free skin from inner arm of the patient to form the postauricular surface of the pinna (Figure 2A, B, C, D)
	Reconstruction : After 3 months we would repair ear lobule and ear canal for cosmetic and functional result as : ear-rings, eye-glasses and hearing aid wearing (Figure 3)

Details of the patients

1. Audiometry

2. Mastoid roentgenography

3. CT scan for ear

4. CBC

	They are 13 cases of congenital microtia which have conductive hearing loss and 2 cases of traumatic pinnas have normal hearing. All together 17 ears
	The report of mastoid film revealed 14 ears normal mastoid air cell', 8 ears loss of air cell, 4 ears sclerosis of mastoid, 5 ears atresia of external ear canal and 1 case mandible hypoplasia
	Only 5 cases have CT scan of middle ear, which are anomalies of middle ear
	CBC revealed normal before surgery

Result

We have follow up period from 1 year to 8 years. There are only 2 cases in 15 cases which are cartilage exposure and necrosis because of infection and trauma after cartilage graft implantation there are no complications in 13 cases, and they accepted the ears for functional wearing glasses & wearing hearing aid and even ear ring in the girl. Pre and postoperative results were demonstrated in figure 4 and 5.

Conclusion

There were 17 cases of Pinna Reconstruction by using costal cartilagenous allograft in Ramathibodi Hospital, Mahidol University Bangkok, Thailand. The surgery were 3 steps : First step implantation, second step elevation by skin graft and third step canal & ear lobule reconstruction. The indication for cosmetic and wearing glasses. Follow up period 1-8 years. We have very successful result the patients like his ear for wearing glasses. Only 2 cases had cartilage exposure and necrosis. There were no other complication.

Reference

	Tanzer RC, Correction of microtia with autogeneous costal cartilage In Tanzer, R.C., Edgerton, M.T., eds. Symposium on reconstruction of the aurical. St. Louis: CV Mosby Ca, 1974: 46-57.
	Brennt B, The correction of microtia with antogenous cartilage grafts: The classical deformity. Plastic and reconstructive surgery 1980; 66: 1-12.
	Kanchanalarp C, Pinna reconstruction by costal cartilagenous allograft: Ramathibodi Medical Journal 1996; 19 No.2, April - June 100-4.
	Berghans A, To plak F; Surgical concepts for reconstruction of the auricle : History and current state of the art. Archives of Otolaryngology- Head and Neck Surgery 1986;112:388-97.
	Brent B, The correction of microtis with autogenous cartilage grafts: The classical deformity. Plastic and Reconstructive Surgery 1980;66: 1-12.

Figure I A) Preoperative congenital microtia

                    B) Stage I operative procedure

Note : The stripped area is the buried costal cartilage under the undermined skin flap

Figure 2 A) demonstrated the ear after stage I reconstruction

        B) free skin graft.

       C) the stripped area demonstrated the elevated pinna into with

the free skin graft being sutured in place postauricularly.

       D) showed ear pinna at the end of stage 111.

 

 

 

 

 

 

 

Figure 3 Diagram showed a functional postoperative pinna,

accommodating an eye-glassed as well as cosmetically

acceptable ear lobule for an earing.

Figure 4 A) Preoperative photograph of microtia in a 17 years old boy.

        B) Twelve months postoperatively.

Figure 5 A) Preoperative photograph of microtia in a 14 years old girl.

        B) Fifteen months postoperatively.

 

 

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