CHAPTER 11 Analysis and Principles of Management
Partial defects of the ear can occur in many different circumstances but mostly after trauma or tumor excision. Missing parts of the ear may also be congenital, and these specific cases were discussed in Part III: Management of Unfavorable Conditions.
Acquired defects mostly occur around the periphery of the ear after trauma. Exceptions to this are after tumor excision or complications of otoplasty where defects may be located in the central part of the ear.
To reconstruct a partial auricular defect it is essential to have in mind the normal three-dimensional architecture of the ear and the different anatomic subunits. In most cases, to correctly reproduce the missing contours of the ear, a cartilaginous support will be needed.
The aim of managing acquired partial defects is to reconstruct the missing contours to replicate the appearance of the normal side. This is achieved by performing the following sequence:
Analyzing the defect
Choosing the best type of support
Deciding whether the reconstruction should be performed in one or two stages
ANALYZING THE DEFECT
First, the contralateral ear is drawn on a transparent template. Then, it is inverted and placed on the auricular region in its precise location to determine which anatomic subunits are involved in the defect.
Having in mind the three-dimensional architecture of the ear will help to differentiate cases, which at first seem similar.
The following two examples show two small defects of the helix that may seem similar but require different approaches.
Harvesting costal cartilage for a relatively minor defect may seem excessive to some, because this implies a scar on the thorax. But the scar itself is very short, because it is placed directly over the sixthseventh synchondrosis, limiting the dissection and respecting the adjacent ribs.
The following two examples show larger defects requiring different approaches.