OTOPLASTY

From Big Medical Encyclopedia

OTOPLASTY (grech, us, ot[os] an ear + plastike — sculpture, plastics) — the operational reconstruction method of an acoustic organ consisting in a partial or complete recovery of an outside and middle ear. The lake is subdivided into an aurikuloplastika — plastics of an auricle, a meatoplastika — plastics of outside acoustical pass, an aurikulomeatoplastika — a combination of two previous operative measures. In cases of defeat not only an outside, but also middle ear (inborn malformations of an outside and middle ear, extensive injuries) surgical correction of an outside ear is supplemented with a tympanoplasty (see. Tympanoplasty ), and then operation is called aurikulomeatotimpanoplastiky.

Indications

Indications to an otoplasty: posttraumatic defects of an auricle (partial, subtotal, total), posttraumatic atresias of outside acoustical pass; anomalies of development of an auricle (the bulged ear, a flat ear, an ear satire, a macrotia, a poliotiya etc.) and ear appendages; local malformations of an outside and middle ear; inborn aplasia of outside acoustical pass, tympanic membrane, drum cavity, auricle.

The technique

As a rule, O. is a multi-stage operative measure with use both soft tissues, and various transplants, adjacent to defect. O.'s receptions are defined by degree and the nature of defects of an outside and middle ear. Depending on it reconstruction methods can be divided into the following basic groups: plastics of partial defects of an auricle, plastic of subtotal defects of an auricle, plastic of total defects of an auricle, plastic of outside acoustical pass.

Fig. 1. The diagrammatic representation of operation of skin plastics of outside acoustical pass at a full-fledged auricle: and — a wound before plastics (the black line designated borders of the skin rag created for the subsequent plastics of acoustical pass); — formation and an arrangement of a skin rag in bone department of outside acoustical pass; in — the final stage of skin plastics and a type of an auricle after operation; 1 — a section behind an ear; 2 — the outside acoustical way cleared from hems; 3 — a skin rag behind an auricle on the feeding leg; 4 — plastics of outside acoustical pass by the skin rag laid on a spiral; 5 — a leg of a skin rag after sewing up of a wound.

For O. use skin and skin and cartilaginous rags on a leg from the departments, next to defect, of the reconstructed auricle or from the fabrics surrounding it. The skin rags on a leg found from skin, zaushny, free from hair, most often use for plastics of outside acoustical pass (fig. 1). At reconstruction of the subtotal or total defects of an auricle demanding considerably bigger amount of plastic material use also round (filatovsky) stalk (see. Skin plastics ), to-ry, as a rule, create of skin of a neck, a shoulder or front and side departments of a stomach and most often through a hand transfer to the parotid area. Less often for this purpose take a spiral stalk across Proskuryakov. However these techniques seldom yield satisfactory cosmetic result.

At partial or total absence of a cartilaginous skeleton of an auricle for formation it is used by explants, kseno-, hallo - and autografts (see. Transplantation ). As materials for explantation at different times offered gold, silver, different types of plastic. Try to apply the combined transplants from modern plastic to this purpose (low-pressure polyethylene, polyamide, teflon, a Dacron, etc.).

As material for xenotransplantation served the elephant and bull bone, a cartilaginous and bone tissue of large domestic animals, however also allotransplants are most acceptable cartilaginous auto-: the cadaveric costal cartilage (whole or crushed) preserved by various techniques (formalinizirovanny, frozen, Lyophilized, put in plastic or other environments); the autogenic costal cartilage, necessary quantity to-rogo exsect from a costal cartilage of the patient.

For surgical reconstruction of an outside and middle ear use also tinned integral cadaveric cartilage of an auricle.

Fig. 2. The diagrammatic representation of the initial stage of an otoplasty (movement of a skin rag, free from hair, for substitution of a pilar part of skin): and — two skin rags for the subsequent mutual movement are planned (1 — the skin rag covered with hair; 2 — a skin rag before an auricle, free from hair); — the final stage of operation — fixing of the mutually-moved rags (1, 2) in required position.

At some sick O. it is considerably complicated due to the lack of around zone of reconstruction of an auricle of skin, free from hair. Pilar parts of skin replace with a free skin transplant of the necessary sizes or mutually move skin rags, free from hair, on a leg and ovolo-hay skin (fig. 2).

Partial defects, as a rule, eliminate by means of the piece of leather from zaushny area reinforced (strengthened) on a relief of the absent part of an auricle by a basic transplant. At the first stage the edge of defect of an auricle is sewed internal and outside skin surfaces in skin of zaushny area, free from hair.

Further by means of autografts or explants supplement missing skin and cartilaginous departments of an auricle.

Fig. 3. Diagrammatic representation of operation of skin plastics partial defect of an auricle: and — imposing of inside and outside welds on wound edges of defect of an auricle and a skin section behind it; — outside skin stitches are put; in — the cartilaginous transplant replacing defect of a cartilage of an auricle, and the final stage of operation — formation of an auricle after its separation from the fabrics located behind it and skin plastics of defects is placed; 1 — skin and cartilaginous defect of the left auricle; 2 — an operational wound behind an auricle; 3 — the skin rag taken behind an auricle; 4 — contours of a cartilaginous transplant.
Fig. 4. The diagrammatic representation of plastic surgery at partial defect of the lower third of an auricle: and — imposing of outside and inside welds on wound edges of defect of an auricle and a skin section; — the skin rag (it is designated by a dotted line) for the subsequent plastics of a lobe and lower parts of an auricle is created; in — the lobe and a lower part of an auricle by means of the skin rag taken an ear and laid in a duplikatura is created; 1 — skin and cartilaginous defect of the lower third of an auricle; 2 — a section of skin; 3 — the line of sewing together of skin of an auricle with skin of a neck; 4 — contours of skin rags of a neck; 5 — an auricle after plastics.

After engraftment of all these fabrics the auricle created on a zaushny surface is separated from tissues of a skull. The formed defect of skin is closed by means of local fabrics or a free skin rag (fig. 3). The plastics of the lower third of an auricle is carried out by other technique, in a cut special difficulty is presented by reconstruction of a lobe of an ear. In this case it is rational to use a duplikatura of a skin rag from a neck (fig. 4).

The lake of subtotal and total defects of an auricle consists of two main stages: replanting to the zaushny area of a basic transplant and formation of an auricle from earlier created skin and cartilaginous transplant and a free skin rag, with the help to-rogo replaces defect of skin fabrics on a back surface of an auricle and in zaushny area.

Subtotal and total O. at inborn malformations of an outside and middle ear has the features since in the course of primary operation it is in one step necessary to use as much as possible fabrics of a rudiment of an auricle and skin, surrounding it free from hair, for primary reconstruction of the lower third or the lower half of an auricle and preparation of fabrics for the subsequent final stages of its reconstruction; to create the bone part of outside acoustical pass which is absent at these forms of pathology and to carry out a full-fledged vystilka its skin rag; to carry out reconstruction of absent or it is rudimentary the changed elements of an outside and middle ear (a tympanic membrane and acoustical stones).

At inborn malformations like hypogenesis when on site an auricle only the rudiment consisting of a lobe and vertically located skin and cartilaginous roller is, the skin plastics of newly created outside acoustical pass and the first stage of plastics of an auricle can be carried out in various ways.

After formation of skin department of outside acoustical pass the rudiment of an auricle is cut on 2 or 3 fragments, to-rye then moved and hemmed on a contour of future auricle; the plastics of outside acoustical pass is carried out for account 2 or 3 of the skin rags on a leg found from adjacent fabrics.

Fig. 5. The diagrammatic representation of plastics of an outside ear at inborn malformations of an outside and middle ear: and — formation of two mutually moved rags; — mutual movement of a rudiment of an auricle of the wound surface formed after movement because of an ear of a skin rag of wound defect and formation of outside acoustical pass; in — fixing of the mutually moved rudiment of an auricle and a skin rag taken behind an ear, creating main contours of the lower half of an auricle and outside acoustical pass; — replanting of a cartilaginous basic transplant for formation of a cartilaginous skeleton of an upper half of an auricle; d — the final skin plastics providing a corner of an otstoyaniye of again created auricle and substitution of skin defects on its back surface; 1 — a rudiment of an auricle; 2 — a skin rag behind an ear; 3 — again created outside acoustical pass; 4 — a cartilaginous basic transplant; 5 — the combined skin and cartilaginous rag on a back surface of an auricle; 6 — a free skin transplant on a back surface of an auricle and behind it.

Optimal variant of O. at this form of pathology of an auricle is mutual movement of the trapezoid skin rag on the feeding leg found from skin of zaushny area, free from hair, and a skin and cartilaginous rudiment of an auricle. The mobilized and deployed skin and cartilaginous roller is moved by kzad and hem to skin on edge of growth of hair (fig. 5, and, b), and close the formed wound defect and again created outside acoustical pass the zaushny skin rag laid on a spiral (fig. 5, c). The subsequent stages of reconstruction of an auricle carry out in 4 — 6 months. Under skin of zaushny area in a projection of upper parts of future auricle place explant (fig. 5, d), after engraftment to-rogo (also in 4 — 6 months) separate an auricle from fabrics of zaushny area, and replace the formed defect of cover fabrics by means of free skin transplantation (fig. 5, e).

When skin of parotid area is considerably changed (owing to burns, frostbites, rough hems), the plastics of outside acoustical pass is carried out a free skin rag. The corresponding sizes the split skin rag is sewed in the form of the truncated cone, stacked on the wound surfaces of outside acoustical pass formed later excisions of hems and sewed on perimeter of an outside wound with edge of skin. Ear appendages delete with simple cutting off with an alloying of a vascular bundle and suture on skin.

Correction of inborn defects of an auricle (the bulged auricles, the flattened auricles, an ear satire, etc.) is carried out by a figured section and movement of a cartilaginous skeleton of an auricle for the purpose of formation of its necessary relief and situation.



Bibliography: Kruchinsky G. V. Plastics of an auricle, M., 1975; Lapchenko G. H. Inborn malformations of an outside and middle ear and their surgical treatment, M., 1972; Experience of the Soviet medicine in the Great Patriotic War of 1941 — 1945, t. 8, page 259, M., 1951; Pathology of an acoustic organ, under the editorship of D. I. Tarasov, etc., page 114, 117, M., 1980; I r h at to N. I. Recovery of an auricle at an inborn microtia, Zhurn, ushn., Nov. and throats, Bol., No. 1, page 46, 1973; L u with e n t e F. E. a. Boyers I. E. Reconstruction of the external ear using multiple Burow’s triangles, Ann. Otol. (St Louis), v. 87, p. 432, 1978; Reconstructive plastic surgery, ed. by J. M. Converse, Philadelphia a. o., 1977.


C.H. Lapchenko.

Яндекс.Метрика