Biomedical subjects
Publications and source records attributed to H Tolleth.
A brief outline of the structure of the ear is presented, indicating that there is a hierarchy of importance to the various components of the ear in reconstruction. Consideration of fundamental shape, size, and position of the ear and its parts would be of use in various surgical procedures.
The concepts gleaned from the world of artists and sculptors can be profitably used by the plastic surgeon in both aesthetic and reconstructive surgery. Judgment and taste are learned skills; talent is important but not primary.
The criteria for assessing efficacy and the factors that affect the long-term persistence of collagen injection are discussed. The response obtained will depend on the type of lesion that is treated. It is important to provide full information for the patient before treatment to ensure optimal patient satisfaction whatever the objective response may be.
The applications for an injectable, highly purified form of calfhide collagen (Zyderm Collagen Implant) were first described by Knapp et al in 1977. Since that time, the material has undergone evaluation in a nationwide clinical trial in which 728 physicians participated under a cooperative protocol. In these trials--which culminated in marketing clearance by the Food and Drug Administration--over 5,000 patients were treated for a variety of soft-tissue depressions resulting from surgery, atrophy, acne, viral pox, and aging. We participated in the clinical trial and have used injectable collagen in our practices since 1977 when the material was undergoing evaluation in California. We have treated over 400 patients with injectable collagen for a variety of facial cutaneous defects. The material has proved to be an effective tool for correction of certain soft-tissue defects not previously amenable to correction, and a useful surgical adjunct. Simplicity and safety are its major advantages. The persistence of correction afforded by injectable collagen is variable, but the majority of our patients have maintained improvement twelve or more months since the end of treatment. Hence we believe that there is a definite role for injectable collagen but that its long-term persistence must still be confirmed. This paper represents our state-of-the-art assessment of injectable collagen after six years of personal experience.
All ears are different, and the degree of difference within the bounds of acceptability is remarkable. To that end, the keys to construction, reconstruction, or modification must be observed in order to mold an ear that "looks right." Simply stated, these keys are as follows: The ear is a flap approximately 50 to 60% as wide as it is high, sitting back one earlength (6.5 to 7.5 cm) from the lateral orbital rim, with the top of the ear level with the brow inclined approximately 20 degrees and protruding 1.5 to 2.0 cm from the head. It is composed of five critical elements: concha, helix, antihelix, tragus, and lobule, and parts of lesser importance including antitragus, intertragic notch, and Darwin's tubercle. The subtleties of form and proportion of its features will be revealed by careful observation and study.
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