Otopexy

from Wikipedia, the free encyclopedia

With Otopexie also otoplasty , otoplasty or ear applying operation called ( OPS 5-184.2 ) a surgical procedure for correcting is prominent ears , respectively.

history

The first otoplasty was described and performed in 1881 by the American surgeon Edward Talbot Ely . He only resected skin on the back of the auricle. The priority of the first operation of this type was for many years ascribed in the Anglo-American literature to the German surgeon Johann Friedrich Dieffenbach , who described such an operation in 1885. As it turns out, there was a translation error in his book.

General remarks

Traditional otoplasty operations are characterized by the fact that a long skin incision is made on the back of the auricle (so-called rear access). The skin incision is also made on the front of the auricle (so-called anterior access) much less frequently. In adults, otopexy is performed under local anesthesia. General anesthesia is chosen for children under 10–12 years of age. With traditional methods, a head bandage is usually applied for the next 1-2 weeks after the operation. In Germany, correction is recognized as a medical indication for children up to the age of 14. Accordingly, the treatment costs for children are usually covered by the statutory health insurance companies. An operation performed lege artis has no effect on hearing.

Need for surgery

Protruding ears are in themselves an anatomical variant and not a disease. When teased by the social environment, however, they can under certain circumstances acquire disease value. In plastic surgery, protruding ears are classified as a (minor) auricle malformation, which is the result of an embryological "malformation". Those affected can perceive this as stigmatization. There are no functional disadvantages associated with protruding ears; in particular, hearing is not impaired. However, they can dominate the face in a way that can lead to ridicule and teasing in children. Adults too often suffer from the consequences of this dysplasia and perceive the otherness associated with it as undesirable. Women in particular often hide their ears under long hair for their entire life. Some children or adults turn to plastic surgery because they want to get rid of feelings of inferiority, complexes and feelings of shame in connection with protruding ears.

Surgical methods

Incorrect antihelical fold
Reconstructed antihelical fold

The most common cause of protruding ears is an inadequately or insufficiently applied antihelical fold (hypoplastic malformation). The reconstruction of this fold is called an antihelical plastic (see photos).

The second most common cause of protruding ears is an excess of cartilage in the auricle in the parts near the ear canal (hyperplastic malformation of the so-called cavum conchae ). This problem is corrected through cartilage resections and / or suturing techniques. It is not unusual for the two causes mentioned to occur in combination. Then both malformations can be operated on in one session.

The surgical methods used today for ear correction, suture technique , incision-suture technique and scoring technique were developed independently of one another in the early 1960s and since then have undergone a large number of modifications and further developments (the names refer to the processing of cartilage). The three basic techniques are often used in combination.

One representative of the suturing technique is the Mustardé ear replacement surgery . After exposing the cartilage back surface of the auricle, the auricular cartilage is brought into a new position that is closer to the head by pulling threads.

The cut-suture technique is used in the Converse otoplasty operation. With this method, too, a large area of ​​the cartilage on the back of the auricle is exposed and then completely severed with defined incisions. The shaping is also done with threads.

The scratching technique is used in the Stenström's ear replacement surgery . It uses the property of cartilage to bend convex to the opposite side after one-sided superficial scoring, without the need for a suture. The incisions are made on the anterior surface of the anterior cartilage of the anthelix.

The ear-filling operations according to Mustardé, Converse and Stenström are standard methods, from which numerous variants have been developed. They are called conventional or traditional methods.

Various technical additions have been described in recent years. For example, surgeons use a fascial flap prepared behind the ear to secure the sutures or use the endoscope to help work on the cartilage. or insert metal implants ( Earfold ) into the ears.

Following the trend of modern surgery to operate as minimally invasive as possible and to reduce complications, special types of otoplasty have been developed, e.g. B. the ear surgery according to Fritsch . The desired position of the ears can only be achieved by making small incisions in the skin with the help of recessed, non-absorbable plastic threads. Most of these procedures are combinations with conventional methods, in which the cartilage is either scratched, sometimes deeply incised or excised, or the auricle cartilage is sewn to the periosteum of the skull after the skin has been opened (so-called cavity rotation ). The so-called thread method according to Merck, with which the largest number of ears has so far been operated on and evaluated, manages completely without combinations with conventional methods .

Risks and possible complications

With traditional methods : pain; Rebleeding; Bruise ; Inflammation of the wound; Inflammation of the cartilage ( perichondritis ); Abscess ; ears that are too tight or too weak; greater asymmetry in the position of the ears; Deformation of the ears in the form of a telephone earpiece up to the so-called “catastrophe ear” according to Staindl; Hypersensitivity to touch, pressure and cold; Thread fistula ; Thread rejection; Granuloma ; Atheroma ; hypertrophic scar or keloid on skin incision; cosmetically disturbing formation of edges on the front of the auricle; Skin retractions; Relapse (ears sticking out again); difficult post-correction; allergic reactions to the materials used in the operation; Pressure damage with loss of tissue ( necrosis ) due to strong pressure bandages; Narrowing of the ear canal opening; extremely rare thrombosis / embolism when elderly people are in bed for a long time. In rare cases, cervical subluxations have also been reported as a result of surgery under anesthesia with strong lateral rotation of the head.

With the special forms : pain, inflammation, thread rejection, thread granuloma, atheroma, minimal postoperative bleeding, relapse , problem-free correction.

Conservative treatment

There is also plenty of information in the literature about conservative treatment options for protruding ears.

1. By modeling with adhesive strips or by splinting. Good results can be achieved here if treatment is started within three days of birth. The need for early treatment is justified by the fact that the malleability of the very soft cartilage is determined by the hyaluronic acid content , which is controlled by the estrogen level . The estrogen level of the fetus increases 100-fold, and then drops rapidly in the first few days after birth. The basal value is reached after about six weeks (this process takes longer in breastfed children).

2. With the so-called auri method. The infant's ears are fixed with a special clamp and, during the day, with a special adhesive strip.

alternative

Some adults also choose the option of gluing their ears to the skull. However, it only has a temporary effect on them during the gluing process, the position of the ears is mostly unnatural, and skin lesions can be caused by repeated application and removal of the skin glue.

Individual evidence

  1. ^ ET Ely: An Operation for Prominence of the Auricle. Arch. Otolaryngology, 10, 97, 1881
  2. ↑ JF Dieffenbach: The ear formation, otoplastic. In: Dieffenbach JF The operative surgery. Leipzig: Brockhaus; a: 395-397, 1845
  3. ↑ a b c d e f H. Weerda: Surgery of the auricle . Thieme, Stuttgart - New York 2004, ISBN 3-13-130181-3 .
  4. ^ A b Michael Reiss: Specialist knowledge of ENT medicine: Differentiated diagnostics and therapy. Springer, 2009, ISBN 3540894403 , p. 195.
  5. ^ RC Tanzer, RJ Belluci, JM Converse, B. Brent: Deformities of the auricle, 1671-1719 , In: JM Converse (Editor): Reconstructive Plastic Surgery. Saunders, 1977, ISBN 0721626912 .
  6. ↑ J. Sten, Stenström: Deformities of the ear. In: Grabb, W., C., Smith, JS (Eds.): Plastic Surgery , Little, Brown and Company, Boston, 1979, ISBN 0-316-32269-5 (C), ISBN 0-316-32268- 7 (P)
  7. ^ JE Janis, RJ Rohrich, KA Gutowski: Otoplasty, Plastic and Reconstructive Surgery , 115, 4, 2005
  8. ^ JC Mustardé: The correction of prominent ears by buried mattress sutures: a ten-year survey. Plastic Reconstr. Surg. , 39, 382-386, 1967
  9. ↑ JM Converse, A. Nigro, F. Wilson, N. Johnson: A technique for surgical correction of lop ears. Plastic Reconstr. Surg, 15, 411-418, 1955
  10. ↑ Ö. O. Erol: New Modification in Otoplasty: Anterior Approach. Plastic and Reconstructive Surgery, 107, 1, 2001.
  11. ^ SJ Stenström: A natural technique for correction of congenitally prominent ears. Plastic Reconstr. Surg, 32, 509-518, 1963
  12. ^ N. Horlock, A. Misra, D. Gault: The Postauricural Fascial Flap as an Adjunct to Mustardé and Furnas Type Otoplasty. Plastic and Reconstructive Surgery, 108, 6, 2001.
  13. ↑ K. Graham, D. Gault: Clinical Experience of Endoscopic Otoplasty. Plastic and Reconstructive Surgery, 102, 6, 1998
  14. ↑ BL Kaye: A simplified method for correcting the prominent ear. Plastic and Reconstr. Surg., 40, 44-48, 1967
  15. ^ R. Mouly, Correction sans cicatrice des oreilles décollées. Ann. Chir. Plast., 16, 55-59, 1971
  16. ↑ IJPeled: Knifeless otoplasty: how simple can it be? Aesth. Plastic Surg., 19, 253-255, 1995
  17. ^ MH Fritsch: Incisionless Otoplasty. Otolaryngol. Clin. N. Am. 42, 1199-1208, 2009
  18. ↑ MH Fritsch: Ear application without incision. J. Aesth. Chir., 6, 203-208, 2013
  19. ^ H. Tramier: Personal approach to treatment of prominent ears. Plastic Reconstr. Surg., 99, 562-565, 1997
  20. ^ MH Fritsch: Incisionless Otoplasty. Facial Plast. Surg., 20, 267-270, 2004
  21. ↑ Y. Ullmann, L. Fodor: Simple method for the treatment of protruding ears. J.Aesth. Chir., 1, 17-20, 2008
  22. ^ MH Fritsch: Incisionless Otoplasty. Laryngoscope, 105, 1-11, 1995
  23. ↑ WH Merck: The thread method according to Dr. Merck. J. Aesth. Chir., 6, 209-220, 2013.
  24. ↑ WHMerck: Auricle correction without skin incision - the Merck thread method. In: K.Bumm (editor): Correction and reconstruction of the auricle. Springer, 153-169, 2017
  25. ↑ O. Staindl: On failures and complications after auricular plastic surgery . Laryngo-Rhino-Otol., 65, 646-657, 1986
  26. ^ E. Kelly, K. Herbert: Atlantoaxial Subluxation after Otoplasty. Plastic and Reconstructive Surgery, 102, 2, 1998
  27. ↑ H.Raunig: The correction of deformed auricles in newborns. In: Journal for Aesthetic Surgery , 6, No. 4, 186–188, 2013
  28. ^ ST Tan, DL Abramson, MD MacDonald and JB Mulliken: Molding therapy for infants with deformational auricular anomalies. Ann. Plastic Surg., 38: 263, 1997
  29. ↑ K. Matsuo, T. Hirose et al .: Nonsurgical correction of congenital auricular deformities in the early neonate. A preliminary report. Plastic and Reconstructive Surgery, 73, 38-51, 1984
  30. ^ A b H. Byrd, LA Langevin et al .: Ear molding in newborn infants with auricular deformities. Plastic and Reconstructive Surgery, 126, 1191-1200, 2010.
  31. ↑ MM Sorribes, M. Tos: Nonsurgical treatment of prominent ears with the Auri method. In: Arch. Otolaryngology Head Neck Surgery , 128, 12, 1369-1376, 2002
  32. ↑ P. Perez-Barrero, J. Rodrigo et al .: Auto-Otoplasty using cyanoacrylate. In: Plastic and Reconstructive Surgery , 108, 7, 2157-2158, 2001.

Web links