Research progress of clinical therapy for concha-type microtia_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GUO Fengfeng , LIN Lin ,  JIANG Haiyue

The Seventh Plastic Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100144, P.R.China;

Corresponding?author：

JIANG Haiyue, Email: jianghaiyue_psh@163.com

Keywords：

Microtia; concha-type; operation procedure; operative timing; complication

DOI：

10.7507/1002-1892.201909132

Video：

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Objective To summarize the current progress of clinical therapy for concha-type microtia.Methods The domestic and overseas literature about the treatment of concha-type microtia was reviewed and the contents of operative timing, operation selection, and complications were analyzed.Results The unified therapeutic schedule of the concha-type microtia has not yet been determined due to its complicated various therapeutic methods and unknown etiology. The operation methods commonly used in clinic are partial ear reconstruction with autologous costal cartilage framework and free composite tissue transplantation. The timing of the partial ear reconstruction depends on the development of costal cartilage and children’s psychological healthy. The timing of free composite tissue transplantation depends on the severity. It is recommended to perform the operation at about 10 years old for mild patients. For moderate patients, ear cartilage stretching should be performed at 1-2 years old and free composite tissue transplantation would be performed at about 10 years old. The complications of partial ear reconstruction with autologous costal cartilage framework for concha-type microtia mainly include framework exposure, deformation, infection, cartilage absorption, and skin necrosis. The complications of free composite tissue transplantation have not been reported.Conclusion Etiology and elaborated classifications with individualized treatment are the future research directions.

Citation： GUO Fengfeng, LIN Lin, JIANG Haiyue. Research progress of clinical therapy for concha-type microtia. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(5): 656-659. doi: 10.7507/1002-1892.201909132 Copy

1.	Nagata S. A new method of total reconstruction of the auricle for microtia. Plast Reconstr Sur, 1993, 92(2): 187-201.
2.	Nagata S. Modification of the stages in total reconstruction of the auricle: Part Ⅱ. Grafting the three-dimensional costal cartilage framework for concha-type microtia. Plast Reconstr Surg, 1994, 93(2): 231-242.
3.	林琳, 蔣海越, 潘博, 等. 耳軟骨舒展聯合矯正復合組織移植耳甲腔型小耳畸形. 中華耳科學雜志, 2013, 11(4): 515-517.
4.	Schneider AL, Sidle DM. Cosmetic otoplasty. Facial Plast Surg Clin North Am, 2018, 26(1): 19-29.
5.	Owsley TG. Otoplasty: Surgical correction of the prominent ear//Cosmesis of the Mouth, Face and Jaws. West Sussex: Wiley-Blackwell, 2012: 236-249.
6.	Brent B. Technical advances in ear reconstruction with autogenous rib cartilage grafts: personal experience with 1200 cases. Plast Reconstr Surg, 1999, 104(2): 319-338.
7.	Brent B. Microtia repair with rib cartilage grafts: a review of personal experience with 1000 cases. Clin Plast Surg, 2002, 29(2): 257-271.
8.	Nagata S. Modification of the stages in total reconstruction of the auricle: Part Ⅰ. Grafting the three-dimensional costal cartilage framework for lobule-type microtia. Plast Reconstr Surg, 1994, 93(2): 221-230.
9.	Sun Z, Yu X, Chen W, et al. Costal cartilage assessment in surgical timing of microtia reconstruction. J Craniofac Surg, 2017, 28(6): 1521-1525.
10.	Guo F, Yu X, Chen W, et al. Preliminary analysis on characteristics of rib cartilage calcification in patients with congenital microtia. J Craniofac Surg, 2019, 30(1): e28-e32.
11.	蔣海越, 潘博, 林琳. 先天性小耳畸形的分型及治療策略. 中華耳科學雜志, 2013, 11(4): 476-480.
12.	Guo F, Lin L, Yu X, et al. Classification of the concha-type microtia and their new suitable treatment strategies without autogenous costal cartilage grafting. Int J Pediatr Otorhinolaryngol, 2019, 130: 109801.
13.	Brent B. The correction of microtia with autogenous cartilage grafts: Ⅱ. Atypical and complex deformities. Plast Reconstr Surg, 1980, 66(1): 13-21.
14.	Kasrai L, Snyder-Warwick AK, Fisher DM. Single-stage autologous ear reconstruction for microtia. Plast Reconstr Surg, 2014, 133(3): 652-662.
15.	Fermin F. Auricular reconstruction in cases of microtia. Principles, methods and discussion. Ann Chir Plast Esthet, 2001, 46(5): 447-466.
16.	Park C. Modification of two-flap method and framework construction for reconstruction of atypical congenital auricular deformities. Plast Reconstr Surg, 1997, 99(7): 1846-1857.
17.	Park C. An algorithm and aesthetic outcome for a coverage method for large-to medium-remnant microtia: Ⅰ. Coverage in the one-stage erect position. Plast Reconstr Surg, 2012, 129(5): 803e-813e.
18.	Park C, Park JY. Reconstruction of microtias with constricted ear features: A 22 year experience. Plast Reconstr Surg, 2018, 141(3): 713-724.
19.	Madura T, Kubo T, Tanag M, et al. A simple method for auricular reconstruction in mild cases of conchal type microtia. J Craniofac Surg, 2005, 16(6): 1115-1120.
20.	Nataliya B, Martin MC. A true single-stage reconstruction of a projected auricle for concha-type microtia incorporating endoscopically harvested temporoparietal fascia. J Craniofac Surg, 2015, 26(6): 1930-1932.
21.	王江允, 陳春麗, 楊琳琳, 等. 改良二期法耳廓再造術在耳甲腔型小耳畸形中的應用. 中國美容醫學, 2017, 26(9): 6-8.
22.	莊洪興, 蔣海越, 潘博, 等. 先天性小耳畸形的皮膚軟組織擴張器法外耳再造術. 中華整形外科雜志, 2006, 22(4): 286-289.
23.	于曉波, 蔣海越, 潘博, 等. 擴張耳后皮瓣聯合自體肋軟骨移植矯正耳甲腔型小耳畸形. 中華整形外科雜志, 2014, 30(1): 4-7.
24.	Argamaso RV. An ideal donor site for the auricular composite graft. Br J Plast Surg, 1975, 28(3): 219-221.
25.	Avelar JM, Psillakis JM, Viterbo F. Use of large composite grafts in the reconstruction of deformities of the nose and ear. Br J Plast Surg, 1984, 37(1): 55-60.
26.	Pan B, Zhao Y, Zhuang H, et al. Tumbling cartilage flap and free auricular composite tissue transplantation for correcting mild and moderate forms of constricted ear. Arch Facial Plast Surg, 2010, 12(4): 241-244.
27.	Fu YY, Li CL, Zhang JL. Autologous cartilage microtia reconstruction: Complications and risk factors. Int J Pediatr Otorhinolaryngol, 2019, 116: 1-6.
28.	何樂人, 楊慶華, 蔣海越, 等. 小耳畸形八大處法耳廓再造術—團隊 10 年經驗. 中華整形外科雜志, 2017, 33(Z1): 28-33.

1. Nagata S. A new method of total reconstruction of the auricle for microtia. Plast Reconstr Sur, 1993, 92(2): 187-201.
2. Nagata S. Modification of the stages in total reconstruction of the auricle: Part Ⅱ. Grafting the three-dimensional costal cartilage framework for concha-type microtia. Plast Reconstr Surg, 1994, 93(2): 231-242.
3. 林琳, 蔣海越, 潘博, 等. 耳軟骨舒展聯合矯正復合組織移植耳甲腔型小耳畸形. 中華耳科學雜志, 2013, 11(4): 515-517.
4. Schneider AL, Sidle DM. Cosmetic otoplasty. Facial Plast Surg Clin North Am, 2018, 26(1): 19-29.
5. Owsley TG. Otoplasty: Surgical correction of the prominent ear//Cosmesis of the Mouth, Face and Jaws. West Sussex: Wiley-Blackwell, 2012: 236-249.
6. Brent B. Technical advances in ear reconstruction with autogenous rib cartilage grafts: personal experience with 1200 cases. Plast Reconstr Surg, 1999, 104(2): 319-338.
7. Brent B. Microtia repair with rib cartilage grafts: a review of personal experience with 1000 cases. Clin Plast Surg, 2002, 29(2): 257-271.
8. Nagata S. Modification of the stages in total reconstruction of the auricle: Part Ⅰ. Grafting the three-dimensional costal cartilage framework for lobule-type microtia. Plast Reconstr Surg, 1994, 93(2): 221-230.
9. Sun Z, Yu X, Chen W, et al. Costal cartilage assessment in surgical timing of microtia reconstruction. J Craniofac Surg, 2017, 28(6): 1521-1525.
10. Guo F, Yu X, Chen W, et al. Preliminary analysis on characteristics of rib cartilage calcification in patients with congenital microtia. J Craniofac Surg, 2019, 30(1): e28-e32.
11. 蔣海越, 潘博, 林琳. 先天性小耳畸形的分型及治療策略. 中華耳科學雜志, 2013, 11(4): 476-480.
12. Guo F, Lin L, Yu X, et al. Classification of the concha-type microtia and their new suitable treatment strategies without autogenous costal cartilage grafting. Int J Pediatr Otorhinolaryngol, 2019, 130: 109801.
13. Brent B. The correction of microtia with autogenous cartilage grafts: Ⅱ. Atypical and complex deformities. Plast Reconstr Surg, 1980, 66(1): 13-21.
14. Kasrai L, Snyder-Warwick AK, Fisher DM. Single-stage autologous ear reconstruction for microtia. Plast Reconstr Surg, 2014, 133(3): 652-662.
15. Fermin F. Auricular reconstruction in cases of microtia. Principles, methods and discussion. Ann Chir Plast Esthet, 2001, 46(5): 447-466.
16. Park C. Modification of two-flap method and framework construction for reconstruction of atypical congenital auricular deformities. Plast Reconstr Surg, 1997, 99(7): 1846-1857.
17. Park C. An algorithm and aesthetic outcome for a coverage method for large-to medium-remnant microtia: Ⅰ. Coverage in the one-stage erect position. Plast Reconstr Surg, 2012, 129(5): 803e-813e.
18. Park C, Park JY. Reconstruction of microtias with constricted ear features: A 22 year experience. Plast Reconstr Surg, 2018, 141(3): 713-724.
19. Madura T, Kubo T, Tanag M, et al. A simple method for auricular reconstruction in mild cases of conchal type microtia. J Craniofac Surg, 2005, 16(6): 1115-1120.
20. Nataliya B, Martin MC. A true single-stage reconstruction of a projected auricle for concha-type microtia incorporating endoscopically harvested temporoparietal fascia. J Craniofac Surg, 2015, 26(6): 1930-1932.
21. 王江允, 陳春麗, 楊琳琳, 等. 改良二期法耳廓再造術在耳甲腔型小耳畸形中的應用. 中國美容醫學, 2017, 26(9): 6-8.
22. 莊洪興, 蔣海越, 潘博, 等. 先天性小耳畸形的皮膚軟組織擴張器法外耳再造術. 中華整形外科雜志, 2006, 22(4): 286-289.
23. 于曉波, 蔣海越, 潘博, 等. 擴張耳后皮瓣聯合自體肋軟骨移植矯正耳甲腔型小耳畸形. 中華整形外科雜志, 2014, 30(1): 4-7.
24. Argamaso RV. An ideal donor site for the auricular composite graft. Br J Plast Surg, 1975, 28(3): 219-221.
25. Avelar JM, Psillakis JM, Viterbo F. Use of large composite grafts in the reconstruction of deformities of the nose and ear. Br J Plast Surg, 1984, 37(1): 55-60.
26. Pan B, Zhao Y, Zhuang H, et al. Tumbling cartilage flap and free auricular composite tissue transplantation for correcting mild and moderate forms of constricted ear. Arch Facial Plast Surg, 2010, 12(4): 241-244.
27. Fu YY, Li CL, Zhang JL. Autologous cartilage microtia reconstruction: Complications and risk factors. Int J Pediatr Otorhinolaryngol, 2019, 116: 1-6.
28. 何樂人, 楊慶華, 蔣海越, 等. 小耳畸形八大處法耳廓再造術—團隊 10 年經驗. 中華整形外科雜志, 2017, 33(Z1): 28-33.

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