External ear- development

1. External ear- development

4. Week 5 -> Week 8

12. Congenital ear deformities
Classification

13. • Malformations of ENT - 50% is Ear.
• Malformations of the outer and middle ear -
70-90%
• Right side - 58-61%
• Incidence of ear malformations is - 1:3800
• Incidence of outer ear malformations - 1:6000
to 1:6830 newborns
• Prevalence of microtia - 3:10,000

14. Ear pits and ear cysts
• lined by squamous or respiratory epithelium
• in preauricular location
• often bilateral or multiple

15. • Type I
– “duplication” of EAC normally lined by skin
– postauricular > preauricular
– run parallel to EAC and usually end blindly lateral
or superior to facial nerve.
• Type II
– true EAC doublings, lined by skin + cartilage
– Open in EAC and in front of SCM muscle.
– can cross over or under the facial nerve.
– can also open behind the ear

17. Pinna malformation

18. Weerda classification

25. Cup ear deformities

26. • Type I: only the helix. longitudinal axis of
pinna is slightly shortened
• Type IIa: hood-like overhang of helix
accompanied by flattening or absence of
superior crus and pronounced inferior crus of
antihelix
• Type IIb: antihelix flattened
• Type III: underdevelopment of upper pinna
with extreme overhanging

27. Surgeries:
1. Cartilage incised in zig-zag fashion to expand
it once the skin has been peeled off the rim.
2. Series of radial incisions and to splint them
open with a cartilage graft.
3. V-Y plasty at root of helix combined with
undermining of adjacent skin.
4. Formal reconstruction (carved costal cartilage
framework)

28. Tags
• lesion involves only skin
• long tail of cartilage
• Preauricular
• excision of the skin tag and cartilage spindle
• apply a Liga clip

30. Mirror ear or polyotia
skin is peeled off the extra-auricular tissue and protruding cartilage
remnants are trimmed. The trimmed cartilage fragments are
packed into the anterior conchal hollow and then the skin of the
extra ear is redraped

31. Abnormal folds (Stahl's bar)

32. 1. direct wedge excision
of the Stahl‘s bar (skin
and cartilage)
2. splint

34. Prominent ('bat') ears
• Due to
– an absent antihelical fold
– conchal bowl is excessively deep
– Prominent lobe or antitragus

36. • Surgical techniques to remould cartilage:
– anterior scoring
– reshaping of curves by use of posterior sutures (to
emphasize the antihelical fold or to setback
concha)
– Excision techniques to set back the concha
• Age of five years

41. thin indented rim cartilage is re inforced with a
cartilage graft and rim is splinted

42. Cryptotia (the hidden ear)
• Only lower two-thirds of an ear is
visible
• Upper auricular sulcus seems lost
• a small Ear Buddies (to create the
upper sulcus)
• revision procedure

43. Positional problems

44. Secondary procedures
1. Over-correction
2. Visible cartilage irregularities or unnatural
contours
3. Unpleasing shape of the ear (e.g., telephone
ear, protruding lobules)
4. Under-correction, usually of the upper pole of
the ear.

45. References
• Plastic surgery. Neligen. Vol II
• Scott Brown’s otorhinology, head & neck
surgery. Vol I
• Development of the Human External Ear. C.
Gary Wright. J Am Acad Audiol (1997)
• Classification and diagnosis of ear
malformations. Friedrich, Wolke. GMS Curr
Top Otorhinolaryngol Head Neck Surg. 2007