An Effective Surgical Method for Correcting Different Degrees of Constricted Ears.

Despite the multitude of corrective procedures described, adequate surgical correction of the congenital constricted ear remains a challenge. The maintenance of the shape and elevation of the reconstructed upper neohelix poses a particular problem. In the present series, experiences with lop ear correction utilizing standard techniques and the use of the mastoid hitch as a useful adjunct to these procedures are described. A total of 19 ears were reconstructed. There were three type 1, eight type 2a, seven type 2b, and one type 3 deformities (Tanzer classification). A graded sequence of procedures was adopted. Mild deformities were corrected by cartilage scoring techniques; a V-Y advancement of the helical root was added for moderate deformities. Cartilage expansion by a banner flap was required for more severe deformities. A mastoid hitch, whereby the refashioned upper neohelix is sutured to the mastoid fascia, should be used as an adjunct to these procedures to maintain helical elevation and prevent recurrence. Severe type 3 deformities may require autologous auricular reconstruction. Mean follow-up time was 1 year. There were six excellent, seven good, four fair, and two poor results. Two patients who had not had mastoid hitch procedures developed a recurrence of the lop deformity. Adequate surgical correction of constricted ear deformities requires a variety of surgical techniques. The mastoid hitch being used for constricted ear correction has not been described elsewhere. The mastoid hitch is a useful adjunctive procedure that may be used effectively in combination with other procedures.

An alternative approach for correction of constricted ears of moderate severity

Objective This study aimed to get the data of Neonatal auricle for helping pediatricians and obstetricians to make definite diagnosis and individualized treatment for newborn congenital auricular deformities in China. Methods A total of 1500 newborns’ ears were evaluated in this study. Six surface measurements were performed directly on the auricles of the subjects as follows: physiognomic ear length and breadth, morphological ear length and breadth, cephalo-auricular distance, and cephalo otic angle. Results The incidence of neonatal auricular deformities in the Pearl River Delta area was 57.47% and the self-healing rate was 31.61% by the 30-day follow-up. There were significant differences between different types of auricular deformities (protruding ear, cup ear, lop ear, Stahl’s ear, conchal crus, helical rim deformity, and composite deformity) and normal morphological differences of the auricle. Conclusions Our findings suggested that individual differences in ear morphology are large and there were some differences between measurement data in our study and EarWell. Application of the EarWell system may lead to localized skin excoriations or breakdown as a result of mismatch with the ear. Therefore, early use of personalized ear molds produced by three-dimensional printing to determine if more deformed auricles may be corrected.

Reconstruction of anterior ear defects is poorly described, but using "like" tissue provides the optimal reconstruction. We present a cadaveric dissection and our experience with the pedicled superficial temporal artery perforator (STAP) flap for reconstruction of partial ear defects. Two cadavers were dissected bilaterally (n = 4) following injection of latex and barium sulfate. A retrospective review of 20 consecutive patients undergoing reconstruction with the STAP flap from 2009 to 2012 was performed. Twenty patients underwent reconstruction of anterior ear defects following resection for non-melanoma skin malignancies using a tunneled pedicled STAP flap (scapha: 5, triangular fossa: 2, scapha and triangular fossa: 13). Two perforators were identified in all dissections with one perforator at the level of the tragus, and the second perforator within 1 cm cephalad to the tragus. Thirteen patients underwent reconstruction following basal cell carcinoma excision and seven patients were reconstructed following excision of squamous cell carcinoma. There were no flap losses, but four flaps (20%) developed congestion at the tip of the flap that resolved without need for flap delay, leeching, or vasodilators. No patients developed complications with the donor site, and no patients underwent revisions. With a mean follow-up of 27.3 months (range: 19-38 months), all patients were pleased with their aesthetic outcomes and alive without recurrent disease. The STAP flap is a pedicled perforator flap providing local "like" tissue that can be utilized for resurfacing of defects involving the anterior upper external ear with minimal donor site morbidity.

Nonoperative treatment of congenital deformities of the ear

Introduction. Short frenulum of the penis (frenulum breve) is a condition associated with a decrease in the length of the frenulum of the penis and/or a decrease in its elasticity. A number of different techniques have been proposed for the surgical treatment of a short frenulum of the penis, from a simple incision (frenulotomy) to complex frenuloplasty and frenulum grafting techniques. Purpose of the study. To assess the results of various surgical techniques in the treatment of frenulum brevis by examining the current evidence base in the world literature. Materials and methods. A search was made for publications in the international database MEDLINE on the platform PubMed, in the scientific electronic library eLibrary.ru and in the Google Scholar search engine. Results. A total of 12 publications were selected. Selected publications were represented by retrospective cohort studies and case series. 3 studies evaluated the results of frenulotomy (frenulectomy), 8 – different methods of frenuloplasty and one – circumcision in the treatment of a short frenulum of the penis. Conclusion. The results of the literature review showed that all techniques of surgical correction of the short frenulum of the penis demonstrate excellent early functional and aesthetic results, with a minimum number of postoperative complications. The best results in the treatment of a short frenulum of the penis can be achieved by choosing the optimal surgical technique in each case.

To evaluate the clinical application and outcomes of the inverted T-shape connective tissue graft (IT-CTG) technique for reconstructing deficient interdental papillae in cases of advanced gingival recession, focusing on both quantitative and qualitative results in a consecutive case series. The IT-CTG technique was performed using a remotely mucoperiosteal tunnel approach, with the donor graft harvested in an inverted T configuration from the palate. Patient selection included five individuals with RT2 or RT3 recession and papilla loss in the esthetic zone, following defined inclusion and exclusion criteria. All surgical steps were standardized, including graft shape, the use of thin suture material, and a consistent postoperative care protocol. Quantitative outcomes such as papilla height gain and Jemt's papilla index improvement were assessed at 3, 6, and 12 months. Among five treated sites, complete papilla fill (Jemt index score 2) was achieved in two sites (both RT3 cases; 40%) after restorative procedures had been performed, and partial fill (Jemt index score 1-2, corresponding to 50%-75% improvement) was observed in the remaining three sites (RT2 cases; 60%). The mean Jemt's papilla index improved from a baseline of 0.2 to 1.8 in the final follow-up. Acceptable esthetic outcomes and minimal morbidity were consistently noted across all patients. The addition of restorative procedures is expected to further enhance papilla fill and support creeping attachment over time. The inverted T-shape connective tissue graft technique achieved acceptable papilla reconstruction, satisfactory esthetic outcomes, and minimal complications in this case series. While the results are promising, further controlled studies with larger sample sizes and longer follow-up are necessary to confirm the efficacy and broader applicability of this approach. Loss of interdental papilla in advanced gingival recession presents a significant esthetic and functional challenge, often resulting in compromised smile esthetics and patient dissatisfaction. The IT-CTG technique offers an innovative surgical solution for interdental papilla reconstruction, especially in cases where traditional approaches may be limited by poor vascularity and difficult access. By employing enhanced vascularization and a remotely tunneled approach, IT-CTG may improve esthetic outcomes and restore papillary architecture in the anterior esthetic zone. This technique is particularly beneficial in cases of RT2 and RT3 recession with papilla loss, where achieving optimal fill in a single procedure is challenging. Integration of IT-CTG into clinical practice expands the treatment options for clinicians managing complex mucogingival defects, though careful case selection and adjunctive restorative procedures may be required to support complete papilla regeneration and long-term stability.

Surgical therapy of congenital nevi using power-stretching technique on the forehead.

Modern techniques of osteotomy have evolved to take into account the effects of bony repositioning on functional as well as aesthetic outcomes. Although a variety of methods have been described to appropriately mobilize and reposition the bony nasal vault, there is still no single procedure that can successfully manage nasal bones in its entirety. We present the bone chisel scraping osteoectomy technique for lateral and medial osteotomies with the aim of managing nasal bone deformities that can overcome diverse shortcomings of the conventional methods. The new operative method was performed in 184 nasal bone osteoectomies (92 patients, 22 men and 70 women), ranging in age from 18 to 69 years (mean age, 38 years). The functional results were evaluated postoperatively by the Nasal Obstruction Symptom Evaluation scale, a brief and easy to complete validated questionnaire with a final score grading from 0 to 100 at 3 and 6 months postoperatively. With this new approach, no functional problems were reported. The mean Nasal Obstruction Symptom Evaluation scale score was 5.3 at 3 months and 1.9 at 6 months. Only 1 primary case was reoperated for open roof deformity. Comparing the results with the previous osteotomy series of the senior author osteoectomy and osteotomy revision rates for inadequate bone mobilization were similar but osteoectomy technique did not create functional problems as the osteotomy technique did. Although this technique prolongs the operating time, it could offer considerable advantages in comparison with the classical techniques using osteotomies and hammer. This is because it offers a greater respect to the nasal respiratory function and gives a much better nasal base width control, resulting in more predictable results, less trauma, and therefore a lower risk of postoperative complications.

Treatment of Mediastinitis: Early Modified Robicsek Closure and Pectoralis Major Advancement Flaps

Background:Postbariatric surgery, either by itself or in association with other procedures, tries to correct physical defects and body deformities. Because of the intrinsic complexity of massive weight loss (MWL) patients, more than a single procedure is, most of the time, required. We report a combined surgical method able to improve arms’ and breasts’ contour that aims to obtain a satisfying functional and aesthetic result by reducing surgical times and costs.Methods:A female MWL patient with proper body mass index was clinically evaluated and considered suitable for surgery. While authors performed a modified Pascal-Le Louarn brachioplasty for the upper arm, a standard McKissock mastopexy followed by a Wise pattern skin closure was selected to obtain the breast lift. By sparing the proximal pedicle, the fasciocutaneous flaps were harvested on both posteromedial sides of the arms. The posterior arm flaps (PAF) were tunneled and transposed below the subcutaneous skin bridge across the axilla and finally used to increase the breast mound.Results:In the immediate postoperative follow-up, no complications were reported. After the 6-month and 1-year follow-up, both arms’ silhouette was documented as healthy and symmetric. Breasts were soft, without any signs of ptosis and/or contracture. No skin disorders or scar hypertrophy or lymphedema were reported.Conclusions:PAF in breast contouring procedures is an interesting surgical option, but more patients need to be treated to validate the effectiveness of the procedure. This technique should be considered when there is a need for simultaneously improving arm’s contour and breast’s volume and shape.

IntroductionThe aim of this paper is to present our experience using autologous fat transplantation for facial augmentation and to evaluate the effectiveness of lipofilling in different regions of the face for the reconstruction and aesthetic improvement of the facial contouring. Case presentationData in term to the age, gender distribution, harvest and injection sites, degree of satisfaction with post-surgical facial, and complications were recorded. DiscussionProgressive haemifacial atrophy, also Known as Parry Romberg's disease, is a common craniofacial disease that conventionally affects the subcutaneous tissue on one side of the face. We report here a series of 27cases of hemifacial atrophy (Parry-Romberg syndrome), admitted to our department, and treated with lipofilling in conformity with Coleman's guidelines. The volume of fat grafting was assessed by an attempt to reach symmetry with the controlateral side within a single procedure. ConclusionAll patients claimed that they were satisfied or very satisfied with the aesthetic results and affirmed that it had a positive psychological impact on their daily life.

To evaluate the clinical, radiographic, and esthetic outcomes of immediate implant placement with buccal bone dehiscence in the anterior maxilla. In this case series, implants were inserted immediately after tooth extraction in sockets with buccal bone dehiscence. Guided bone regeneration (GBR) with a papilla preservation flap and simultaneous connective tissue grafting (CTG) was used. The following outcome variables were measured: mid-facial mucosal recession, probing depth, bleeding on probing, Pink Esthetic Score (PES), marginal bone loss, and thickness of buccal bone plate (TBP). 12 patients were recruited. Stable mid-facial mucosal level (-0.03 ± 0.17 mm) and excellent soft-tissue esthetic outcomes (PES, 9.17 ± 0.72) were achieved at 1year. The TBP at platform level was 2.01 ± 0.31 mm at 1-year follow up with a resorption rate of 28.90% ± 15.14%. Immediate implant placement using GBR performed with a papilla preservation approach and simultaneous CTG is a feasible treatment procedure in compromised extraction sockets in the anterior region. Favorable esthetic outcomes and buccal bone thickness were obtained. Further studies were needed to evaluate the long-term tissue alteration.

Congenital auricular deformation is not an uncommon phenomenon, and it may cause substantial annoyance to the growing child. Many parents of affected children will seek surgical correction of the deformed auricles. The variety of techniques that have been described for the correction of this anomaly suggests that none has been considered satisfying. The consequent possible surgical complications should also be considered, when the surgical procedure can be replaced by an effective conservative treatment. The authors describe their experience using early splinting for congenital auricular deformities. Fifty-two newborn infants with lop, prominent, Stahl's, and constricted ears referred to us by the neonatal department staff were enrolled in this study. Putty Soft, a vinyl polysiloxane impression material, has been used for early molding of the auricles. Surgical tapes were used for the fixation of the mold and to fix the auricle to the scalp. The results were evaluated by one of the parents and by a layperson (medical student) 6 months after completion of the procedure. The above-described early splinting procedure was applied onto 92 auricles of 52 newborn infants aged 1 to 10 days, mostly around day 3. The mean treatment time was 6.8 weeks. All treated auricles were improved, 87 percent were rated as excellent improvement, and there were no complications related to the treatment. The authors conclude that early splinting of deformed auricles should be offered to parents of affected children, and the awareness of this procedure by neonatologists, pediatricians, and nursery staff should be increased.

Loss of the maxilla and midfacial bone buttresses after tumor resections can lead to severe functional and esthetic consequences. The loss of palate function may lead to oro-nasal communication, nasal speech, and oral intake difficulties. Several techniques have been proposed for maxillary defects reconstruction including prosthesis, locoregional flaps, or free flaps. The authors propose the use of anterolateral thigh free flap and iliac crest, or calvaria bone graft association for reconstruction of this kind of defects. Between November 2003 and June 2007, eight patients underwent maxillectomies, with preservation of the orbital contents and simultaneous reconstruction using this technique. : All the flaps were harvested and transplanted successfully. No major complication occurred and only one patient developed a palatal dehiscence with partial necrosis of the skin of the flap. There were no complications at the donor sites. Speech was assessed as normal in five patients, intelligible in two patients, and poor in one patient. Six patients returned to normal diets, while two patients were restricted to soft diets. The esthetic results were evaluated by the patients themselves as good (in five cases) and acceptable (in two cases). In the remaining case, the esthetic result was deemed to be poor, due to ectropion and poor color matching of the skin used for the external coverage. The good results obtained using this technique encourage the choice of the association of anterolateral thigh and bone grafts for reconstructing maxillary complex defects.