Deformation of auricles
Deformation of auricles - various defects of a structure of an external ear of the congenital or acquired character. Some types of deformations of auricles come down only to purely cosmetic defect and do not influence hearing of the person in any way, and others can lead to the expressed loss of acoustical and speech functions. Deformation of an auricle can be unilateral or affect two ears. Correction of deformations of auricles (otoplastik) is carried out by plastic surgeons. Before performing surgery consultation of the otolaryngologist with a research of acoustical function is obligatory.
Deformation of auricles
Auricles are located kzad from a temporal and mandibular joint and in front of a mastoidal shoot. The basis of auricles is made by the elastic cartilages on both sides covered with skin. They by means of muscles and ligaments it is attached to skull bones. Auricles are external department of an organ of hearing. Besides, they carry out an important esthetic role in formation of harmonious shape of the person.
Deformation or the wrong arrangement of auricles concerning other parts of the face break complete perception of an external image of the person by people around, and at him give rise to feeling of physical inferiority. Existence of similar defects is taken by children especially painfully. Therefore the main task of plastic correction of deformations of auricles is change of a shape of ears and giving to it esthetic and proportional in relation to other parts of the face and the appearance heads.
Usually anomalies, surplus or the wrong arrangement of an ear cartilage, and also deformation of soft tissues of auricle are the reasons of defects of a structure of an external ear.
Classification of deformations of auricles
All types of deformations of auricles depending on time of their emergence are divided on congenital and acquired.
Congenital deformations of auricles are caused by impact of adverse factors on an embryo in the first 2-3 months of pregnancy when the external ear is formed. The following types of deformations belong to congenital defects of auricles:
- Makrotiya — disproportionate increase in auricles as a result of excess development of cartilaginous tissue;
- Lopoukhost — increase in a corner of diligence of an auricle to skull bones;
- The "turned-off" auricles — an excess of the top part of a cartilage forward and down;
- Deformations of a lobe of an ear (bifurcation, increase, absence, increment);
- Deformations of a curl – Darwin hillock (a ledge on a curl), "an ear satire" (an auricle with the pointed top pole and a smoothed curl), "an ear of a macaque" (a smoothness of curls), etc.;
- Mikrotiya – an underdevelopment of auricles (small, flat, grown etc.). Mikrotiya is quite often accompanied by an atresia of acoustical pass and an underdevelopment of a middle ear; sometimes it is combined with an underdevelopment of the relevant side of a face in connection with anomaly of development of the ascending branch of the lower jaw. At a bilateral mikrotiya loss of speech and acoustical functions is noted that leads to the patient's invalidization. On degree of an underdevelopment of an auricle allocate 3 degrees of a mikrotiya:
- The I degree — separate parts of a normal anatomic structure of an auricle of the reduced size are distinguishable;
- The II degree — instead of an auricle is present the roller in the form of a curl;
- The III degree — an anotiya – total absence of an auricle, instead of an auricle is present a shapeless hillock.
The acquired deformations of auricles on the frequency of emergence do not concede to congenital. They can be a consequence of injuries of ear (wounds, at non-compliance with safety measures on production), inflammatory processes of an ear, operations, thermal or chemical damages.
The most often found acquired deformation is the keloidny hem - post-inflammatory or post-traumatic growth of skin in the field of a lobe of an ear or all auricle. The keloid can develop as a result of a burn of an external ear or even owing to a trauma harmless at first sight – an ear lobe puncture.
After inflammatory diseases of an ear there can be a deformation and a thickening of a cartilage - so-called, "the boxer's ear". Defects of an auricle can be caused by tumoral processes of parotid area. Its total absence owing to traumatic damage can be the heaviest deformation of an auricle.
Both the congenital, and acquired deformations can be partial (the top, average or lower department of an auricle), subtotal (with sokhraneiy or without preservation of a cartilage of an ear pole) and total.
Features of surgical correction of deformations of auricles
Correction of deformations of auricles – an otoplastik - is one of the difficult directions of plastic surgery. It is explained by anatomic features of an external ear: thin and elastic cartilages with multiple topographical bends and smooth curvature of the outer edge of an auricle cannot almost be recreated anew. The skin which is densely covering an auricle extremely thin, blood supply less plentiful, than in other face zones (lips, area of a nose). Auricles, in fact, are the volume three-dimensional structure acting on the side surface of the head.
The main objective of plasticity of the deformed auricles is anatomic exact reproduction of parts of an external ear and preservation of its properties: structures, size, situation and orientation. The greatest difficulty is presented by a reconstruction of loss of a considerable part of an ear.
Carrying out correction of deformation of auricles demands understanding that intervention is made on very delicate zone and fabrics. The best esthetic results manage to achieve at a right choice of a technique, the most suitable to each case.
At children correction of deformations of auricles is made at the age of 7-9 years in view of features of growth and development of an ear, and at all patients – not earlier than one and a half years after the postponed injuries.
Otoplastika at deformations of auricles is carried out step by step, in 2, and sometimes 3-4 stages with intervals in 2-4 months, in view of complexity of a relief of an external ear, deficiency of parotid fabrics, excessive scarring of the operated zone. As the main material for creation of a basis of a new auricle serves the costal cartilage.
The most important moment of preparation for an otoplastika is full informing the patient on the expected results of operation, possible risks and features of a current of the postoperative period.
Before operation photos in different projections are carried out. Definition of missing elements of an ear is carried out by a technique of Gonzalles-Vola: ears press to the head fingers therefore on the external surface of auricles missing folds which will need to be recreated in the course of operation appear.
The operation on elimination of heavy deformations of auricles (expressed to a mikrotiya) carry out under the general anesthesia, in more mild cases local anesthesia with a sedation or without it can be used.
The first stage of operation usually includes formation in the deformed or absent auricle of a hypodermic pocket and the room in it a cartilaginous framework. After the framework will get accustomed (from 2 to 6 months), carry out the second stage of operation - a detachment of the replanted framework together with skin and formation of an auricle. The shelter of the defect of skin formed in zaushny area is made by means of a free skin transplant. On average the stage-by-stage course of operations and interlandmark treatment makes about one year.
Correction, so-called, "ears of the fighters" having the cartilages broken during the sports meets consists in a reconstruction of their normal anatomic form. The section of a cartilaginous plate is made from the ear back, then anatomic integrity of cartilages is restored and fixed in the correct situation with the help of special rollers. Rollers keep the correct position and shape of an ear within a week, then are removed; seams are removed in 10-12 days. For two weeks it is recommended to carry the fixing bandage protecting auricles from traumatizing.
At the majority of operations the section is made behind an auricle and over time becomes imperceptible. Fixing of auricles by means of special protectors, carrying the supporting elastichesky rings or the bandages protecting the created auricle from casual injuries can be required.
Complications of plastic correction of the deformed auricles
Complications after carrying out an otoplastika are observed seldom – less than in 0,5% of cases. Among them – eruption of seams, suppuration, formation of rough hems. Because of cicatricial reductions of a skin transplant there can be a pressing of the reconstructed auricles to a mastoidal shoot and loss of esthetic results. Asymmetry of auricles can spoil esthetic impression of an otoplastika.
One of the most serious complications is the ischemic necrosis of a cartilage of an auricle. The prevention of complications requires observation of the doctor during the first hours or 2-3 days after operation.
At careful observance of the equipment and technique of an otoplastika efficiency of correction of deformations of auricles makes about 90%. Cases of repeated intervention can be connected with complications, asymmetry or inadequate correction of auricles.