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Ear Reconstruction. Clinical and physiological evaluations.

Author

Summary, in English

Microtia is a congenital malformation where the auricle is not fully developed. In some cases the malformation

is complete and the auricle is absent. In Sweden the incidence of microtia is about 2 per 10,000 births. Reconstruction

of the external ear is possible by using autologous rib cartilage in three surgical steps: rib cartilage transplantation,

ear elevation and final adjustments.

Although the aesthetic result is most essential, there are also functional aspects of a reconstruction of the outer

ear. To keep the ear free from injury, the skin depends on a functioning alert system: sensitivity to touch, heat

and cold. However, the process of ear reconstruction necessarily includes surgical trauma that endangers these

protective systems. The blood supply of the skin cover is also impaired during the different reconstructive stages.

Little is known about the level and time scale of recovery of sensitivity and blood supply to the reconstructed ear

after surgical bisection of nerves and vessels.

Symmetry is important in ear reconstruction and the new ear should match the normal ear at the time of

reconstruction as well as in the adult life. The potential growth of the ear is a subject of debate. We decided to

investigate the precision of today’s tools for size measurements. With this knowledge the issue of growth hopefully

can be elucidated.

A total of 54 patients with unilateral ear reconstruction, and 30 individuals with normal ears, were included in

the studies. We evaluated sensitivity to heat, cold and touch in the reconstructed and normal ear. We also assessed

blood flow before and after body heating to investigate the pathophysiological dynamics in the reconstructed ear.

Digital morphometry for measuring ear size was compared to the manual methods: compass & ruler and callipers.

Measurements were performed on individuals with normal ears. In digital morphometry we also measured

reconstructed ears.

Our findings show that there is a high degree of restoration of thermosensitivity in the reconstructed ear but

the upper parts of the ear still show signs of reduced sensitivity to heat. Tactile sensitivity followed that of thermal

sensitivity, with a high degree of restoration in combination with elevated thresholds in the upper parts. The basal

blood flow in the reconstructed ear is compatible with that of the normal ear and its dynamic response to indirect

heating is also similar. Digital morphometry shows a similar reproducibility as compass & ruler and callipers for

measurement of normal ears. Digital morphometry can show great precision in measurements of reconstructed

ears but there is high inter-individual variation between different assessors.

Publishing year

2012

Language

English

Publication/Series

Lund University Faculty of Medicine Doctoral Dissertation Series

Volume

2012:75

Document type

Dissertation

Publisher

Reconstructive Surgery, University of Lund

Topic

  • Surgery

Keywords

  • Plastic surgery
  • autologous ear reconstruction
  • sensitivity
  • blood flow
  • digital morphometry

Status

Published

Supervisor

ISBN/ISSN/Other

  • ISSN: 1652-8220
  • ISBN: 978-91-86671-04-4

Defence date

30 November 2012

Defence time

09:00

Defence place

Inga Marie Nilssons gata 46, Skåne University Hospital, Malmö

Opponent

  • Jorma Rautio