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A new technique is described for increasing the nasal tip by using an en bloc autogenous ear cartilage graft in such a manner as to create, in essence, a replacement of the entire ipsilateral alar cartilage.
To determine whether the lamina tragi, isthmus, and cavum conchae are a donor area for reconstruction of the alar cartilage with all its elements (medial crus, junction of the medial and lateral crura, and lateral crus), with the same dimension and en bloc, 40 alar cartilages and 40 lower parts of ear cartilages of 20 cadavers were dissected. Several measurements were taken in the alar cartilages, such as distance, thickness, and angle. Then they were compared with the measurements performed in the ear cartilages and segments removed from the lamina tragi, isthmus, and cavum conchae. This study, done with cadavers, shows that from the lamina tragi, isthmus, and cavum conchae, en bloc resection is possible with characteristics of form and dimension similar to those of the homolateral alar cartilage. The segment removed en bloc from the intermediate part of the lamina tragi, isthmus, and cavum conchae replaces, respectively, the medial crus, junction of the medial and lateral crura, and lateral crus.
Normal rabbit ear cartilage studied with the light and electron microscope shows chondrocytes in which large lipide spherules, and an abundance of glycogen, a few small mitochondria, and relatively few elements of the endoplasmic reticulum can be identified. The chondrocytes contain, in addition, a material which stains strongly with acid fuchsin and appears in the electron microscope as a relatively dense felt-work. In electron micrographs, the matrix of normal rabbit ear cartilage consists of two components: a uniformly distributed moderately dense substance which appears as a fine meshwork without any particular pattern extending from cartilage cell border to cartilage cell border; and a three-dimensional anastomotic network of more dense material, which is best described as "felt-like" lying between the cells. The similarity between the felt-like material of the matrix and the elastic fibers described in previous electron microscope observations is discussed.
OBJECTIVES/HYPOTHESIS: The ideal material for reconstructing the nasal septum in the deficient nose has not been found. Since 1986, the authors have used autogenous cartilage from the cavum conchae to successfully correct the anterior septum and the associated cartilaginous saddle. The long-term results in 26 patients with a destroyed septum and a saddle nose are reported. STUDY DESIGN: Retrospective study. METHODS: The mean age of the patients at surgery was 40.2 years, and the mean number of previous nasal procedures was 1.6. Because 11 patients had septal perforations and insufficient septal cartilage or bone, ear cartilage grafts from the cavum conchae were harvested through an anterolateral approach. A special incision was used to divide the concave ear cartilage while preserving the posterior perichondrium. This produced a stable, balanced back-to-back graft. The graft was 2.5 to 3 cm long, long enough to allow reconstruction of the anterior septum and to correct part of the saddle nose deformity. The rest of the conchal cartilage was used to fill the remaining cartilaginous saddle. Follow-up investigations included photographs and visual analogue scales of the patients' symptoms and satisfaction. RESULTS: After a mean interval of 36.7 +/- 22.3 months, the back-to-back grafts showed no macroscopic signs of resorption. Graft position and shape remained intact after transplantation. All noses were adequately projected and mobile. All patients but one were satisfied with the functional and esthetic result. With a score of 4 representing the level of satisfaction as "very good," the mean score of the patients was 3.2 +/- 0.79. The saddle of the nose completely disappeared in 65.4% of patients, was minimally visible in 23.1%, and was slightly present in 11.5%. Nasal breathing improved considerably in 21 patients, remained the same in 4 patients, and worsened in 1 patient. The mean score of all patients for nasal breathing was 7.3 +/- 1.87 on a visual analogue scale of 0 to 10, with 10 representing satisfaction as "very good". CONCLUSION: The back-to-back autogenous ear cartilage graft is a viable, stable, and balanced graft for functional and aesthetic reconstruction of the anterior nasal septum and cartilaginous saddle deformity in patients with a severely traumatized and deficient septum.
CONTEXT: Sporadic infections following ear piercing are well documented, but common-source outbreaks are rarely recognized. OBJECTIVE: To investigate reports of auricular chondritis subsequent to commercial ear piercing. DESIGN, SETTING, AND SUBJECTS: Outbreak investigation by Oregon public health agencies, including cohort study of persons pierced at a jewelry kiosk in August-September 2000, environmental sampling, and molecular subtyping of isolates. Confirmed cases had Pseudomonas aeruginosa cultured from ear wounds. Suspected cases had signs and symptoms of external ear infection, including drainage of pus or blood for at least 14 days. MAIN OUTCOME MEASURES: Risk factors for infection and comparison of bacterial isolates by molecular subtyping. RESULTS: From 186 piercings in 118 individuals, we identified 7 confirmed P aeruginosa infections and 18 suspected infections. Confirmed cases were 10 to 19 years old. Most were initially treated with antibiotics ineffective against Pseudomonas. Four were hospitalized, 4 underwent incision and drainage surgeries (1 as an outpatient), and several were cosmetically deformed. Upper ear cartilage piercing was more likely to result in either confirmed or suspected infection than was lobe piercing (confirmed: RR undefined, P<.001; suspected: RR, 3.6; 95% confidence interval, 1.5-8.5). All persons with confirmed infections had their ear cartilage pierced with an open, spring-loaded piercing gun. Patient isolates were indistinguishable by molecular subtyping, and matching isolates were recovered from a disinfectant bottle and nearby sink. At least 1 worker admitted sometimes spraying the disinfectant on the ear studs before piercing. CONCLUSIONS: Ear cartilage piercing is inherently more risky than lobe piercing. Clinicians should respond aggressively to potential auricular chondritis and consider Pseudomonas a possible cause pending culture results.
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Autologous ear cartilage is relatively easy to procure in suitable form and sufficient quantity. At the donor site, there are, as a rule, no complications to be expected. Autologous ear cartilage without conjunctival coverage is of good use for replacing and lengthening the inner layer of an eyelid, not only to reconstruct large eyelid-defects, but also to give additional support and length. The cartilage graft will grow on well, provided the wound is well vascularized. This must not be expected with scarring or poor blood perfusion. The brittleness of the cartilage demands an adapted technique. Precautions to protect the cornea and to prevent adhesions in the fornix are to be taken.
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OBJECTIVE: To study the allograft antigenicity of human ear cartilage and the effect of the cell extraction on antigenicity. METHODS: The human ear cartilage was acellular by cell extraction with Triton X-100. Then the cartilage and the acellular cartilage were analyzed by anti-MHC-I immunohistochemical staining, the reaction of the peripheral blood mononuclear(PBM) cells to the cartilage and the acellular cartilage and the migration of the PBM cells toward the cartilage and the acellular cartilage. RESULTS: The result of human ear cartilage was positive for the anti-MHC-I immunohistochemical staining, whereas that of the acellular cartilage was negative for the staining. The reactive proliferation of the PBM cells was more when they were co-cultured with human ear cartilage than that when they were cultured alone in vitro(P < 0.05), but the acellular cartilage did not show the same phenomena (P > 0.05); when the cartilage and the acellular cartilage were co-cultured with the PBM cells, the PBM cells migrated to the cartilage much more than that to acellular cartilage(P < 0.01). CONCLUSION: Human ear cartilage has allograft antigenicity and its antigenicity can be removed by cell extraction with Triton X-100.
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PURPOSE: To investigate the surgical results of an ear cartilage graft and supplemental procedures for correcting lower lid retraction combined with entropion in anophthalmic patients. METHODS: We reviewed retrospectively the medical records of 7 anophthalmic patients with lower lid retraction and entropion, who received a posterior lamellar ear cartilage graft and one or both of lateral tarsal strip or eyelash-everting procedure between March 1998 and March 2003. Preoperative and postoperative lid and socket statuses were also investigated. RESULTS: Ear cartilage grafts were performed in all 7 patients, lateral tarsal strips in 6, and eyelash-everting procedures in 5. Postoperative follow-up durations ranged from 4 to 28 months (average 12.6 months). Retractions were corrected during follow-up in all patients. There were no cases of entropion immediately after surgery. However, the eyelashes of the lower lid returned to an upright position in 4 patients, but not so severe as to touch the ocular prosthesis, and thus did not require surgical correction during follow up. CONCLUSIONS: Lower lid retraction combined with entropion in anophthalmic patients can be corrected effectively using an ear cartilage graft with selective, supplemental procedures.
The proposed operative technique with maternal auricular cartilage ear-donor) is modification of the method of M. Madzharov et al., for total and partial reconstruction of the auricle. The method includes the use of allogenic auricular cartilage and autogenic perichondrium (rib of auricular), attached to the cartilage with autogenic fibrin glue and/or sutured by nylon. The method is applied to 18 years old female patient with bilateral microtia III gr., for reconstruction of the left year. 2 years later, satisfying cosmetic result was encountered on the operated left ear and ear-donor. Briefly summarizing, auriculoplasty with maternal auricular cartilage is reliable method, especially in cases when cartilage of the ear-donor is strictly subperichondrially dissected and covered with autogenic rib of auricular perichondrium.
Ear cartilage has been studied by histochemistry, histoenzymology, immunofluorescence and electron microscopy in three cases of relapsing polychondritis. The most significant lesions have been observed at the cellular level, both by enzymology and electron microscopy: chondrocytes of peripheral zones seem to be first hypertrophic and then necrotic; at the opposite, their is no correlation between histochemical and electron microscopic studies about the chondroid intercellular substance whom lesions are probably secondary to the cellular ones. A few chondrocytes are positive with antiimmunoglobulins sera (IgM and IgA); this fact could be a proof of the dysimmune nature of this disease.
Ear cartilage has been studied by histochemistry, histoenzymology, immunofluorescence and electron microscopy in three cases of relapsing polychondritis. The most significant lesions have been observed at the cellular level, both by enzymology and electron microscopy : chondrocytes of peripheral zones seem to be first hypertrophic and then necrotic ; at the opposite, there is no correlation between histochemical and electron microscopic studies about the chondroid intercellular substance whose lesions are probably secondary to the cellular ones. A few chondrocytes are positive with antiimmunoglobulins sera (IgM and IgA) ; this fact could be a proof of the dysimmune nature of this disease.
Our study verifies that homografted ear cartilage in baby rabbits does, indeed, grow in size. It showed an average increase of 75 percent in length and 211 percent in area.