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Yang Q, Qiang S, Fan X, Guo SZ, Yin Y, Li T, Dang H, Dong LW, Song BQ. Clinical Application of Long-Pulsed 800-Nm Diode Laser Depilation Technology on Microtia Reconstruction in 965 Patients. Aesthetic Plast Surg 2024; 48:2155-2161. [PMID: 38238570 DOI: 10.1007/s00266-023-03780-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/28/2023] [Indexed: 06/06/2024]
Abstract
BACKGROUND The issue of hair growth on reconstructed ears has been a matter of concern for both patients and surgeons, despite the notable progress made in microtia reconstruction technology in recent times. OBJECTIVE This study aims to present the practical implementation of long-pulsed 800-nm diode laser depilation technology in the field of auricular reconstruction. Furthermore, it seeks to establish a comprehensive and standardized protocol for utilizing lasers in the reconstruction of microtia ears. METHODS A total of 965 patients (comprising 1021 ears) diagnosed with congenital microtia underwent treatment using 800-nm long-pulsed diode laser depilation. The participants received 1-3 treatment sessions with intervals of 25-30 days. To assess the effectiveness of the treatment, two independent observers compared photographs and measured the reduction in terminal hair count before and after the final session. Clinical outcomes were evaluated using VAS questionnaires, and any adverse events were diligently recorded. RESULTS The findings indicated that the utilization of the long-pulsed 800-nm diode laser was both safe and efficient in achieving hair removal during microtia ear reconstruction. As additional sessions were conducted, pain scores demonstrated a decline, while adverse reactions remained minimal. LIMITATIONS This is a retrospective single-institution study. CONCLUSION The application of a long-pulsed 800-nm diode laser has been proved to be a safe and effective method for removing hair during the process of microtia ear reconstruction, involving the use of a tissue expander and autologous costal cartilage. To achieve satisfactory results in hair removal, it was found necessary to repeat the shots procedure two to three times. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Qing Yang
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Forth Military Medical University, No.127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Shuai Qiang
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Forth Military Medical University, No.127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Xing Fan
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Forth Military Medical University, No.127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Shu Zhong Guo
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Forth Military Medical University, No.127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Yue Yin
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Forth Military Medical University, No.127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Tong Li
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Forth Military Medical University, No.127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Hui Dang
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Forth Military Medical University, No.127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Li Wei Dong
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Forth Military Medical University, No.127 Changle West Road, Xi'an, 710032, Shaanxi, China.
| | - Bao Qiang Song
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Forth Military Medical University, No.127 Changle West Road, Xi'an, 710032, Shaanxi, China.
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Su XH, Ye J, Lei C, Wei SJ, Zheng HB, Shan XY, Wang B, Wang MS. Secondary ear reconstruction based on the Nagata method after unsatisfactory microtia surgery outcomes. J Plast Reconstr Aesthet Surg 2023; 87:251-258. [PMID: 37924716 DOI: 10.1016/j.bjps.2023.10.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/29/2023] [Accepted: 10/07/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Follow-up studies on auricular reconstruction procedures have reported postoperative complications; some of which can only be reversed with revision surgery. This study aims to provide a feasible surgical strategy based on the Nagata method for patients requiring secondary revision and verify mid-term aesthetic outcomes. METHODS Secondary auricular reconstructions based on the Nagata method were performed on seven patients seeking secondary revision between 2017 and 2021. Scores of a five-point Likert scale and artificial intelligence ratings based on convolutional nerve networks were used as outcome measures. RESULTS Five patients underwent complete two-stage ear reconstruction, and the other two patients underwent the first-stage microtia procedure only. Few complications were observed, except in Case 4; this patient required an additional minor surgery after frame exposure 6 weeks after the first-stage procedure. All revised ears showed clear anatomical structures, and all patients were satisfied with the aesthetic results. Statistical analysis showed a significant increase in postoperative versus preoperative scores by convolutional neural network models (p < 0.05). Cases 5 and 6, which involved projection surgeries only, had decreased artificial intelligence appearance scores postoperatively. CONCLUSION After adequate preoperative evaluation, secondary auricle reconstruction based on the Nagata method can achieve reliable aesthetic outcomes with few complications. CLINICAL TRIAL REGISTRATION INFORMATION ClinicalTrials.gov ID: NCT05604456.
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Affiliation(s)
- X H Su
- Department of Plastic and Cosmetic Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Plastic and Cosmetic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - J Ye
- Department of Plastic and Cosmetic Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Plastic and Cosmetic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - C Lei
- Department of Plastic and Cosmetic Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Plastic and Cosmetic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - S J Wei
- Department of Plastic and Cosmetic Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Plastic and Cosmetic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - H B Zheng
- Department of Plastic and Cosmetic Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Plastic and Cosmetic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - X Y Shan
- Department of Plastic and Cosmetic Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Plastic and Cosmetic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - B Wang
- Department of Plastic and Cosmetic Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Plastic and Cosmetic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - M S Wang
- Department of Plastic and Cosmetic Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Plastic and Cosmetic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China.
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Liu Y, Huang L, Feng Y, Huo M, Lin L, Zhang L. Utilization of intense pulsed light for hair removal in pediatric auricular reconstruction using tissue expander: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e33736. [PMID: 37335650 PMCID: PMC10256402 DOI: 10.1097/md.0000000000033736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 04/20/2023] [Indexed: 06/21/2023] Open
Abstract
This study aimed to investigate the safety and efficacy of depilation with intense pulsed light (IPL) in congenital microtia patients during their reconstruction treatment. The hairy skin was treated with the M22TM system (Lumenis, German) using a filter of 695 to 1200 mm. A contact prob with a window of 15 cm × 35 mm or 8 cm × 15 mm was used at a radiant setting of 14 to 15 J/cm2 in the non-expander group and 13 to 14 J/cm2 in the expander group, both in a single pulse mode. The efficiency index of hair removal was classified based on the percentage of hair density reduction as excellent (>75%), good (50-75%), fair (25-50%), poor (<25%). The depilation effect was compared between the 2 groups, and any adverse effects were evaluated. A total of 159 patients were included, with 93 patients in the expander group and 66 in the non-expander group. The reduction of the hair density in the expander group after 3 treatments was higher than that in the non-expander group [82.98 (73.47-89.09)% vs 77.84 (71.50-85.34)%; P < .05, Wilcoxon rank-sum test], as well as the efficiency [excellent cases 68 (73.12%) vs 37 (56.06%); P < .05, Chi-square test]. Four cases of folliculitis, 3 cases of blisters, and no instance of expander exposure and cartilage absorption were observed in this study. Hair removal with IPL is a safe and effective photo-epilation method during all stages of ear reconstruction using tissue expander. Depilation in the skin expansion period resulted in better outcomes after 3 treatments, although after 5 treatments no difference between the 2 groups was observed.
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Affiliation(s)
- Ying Liu
- Plastic Surgery Department, Beijing Hospital of Integrated Traditional Chinese and Western Medicine, Beijing, China
| | - LvPing Huang
- Laser Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yongqiang Feng
- Laser Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Menghua Huo
- Laser Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Lin Lin
- Laser Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ling Zhang
- Plastic Surgery Department, Beijing Hospital of Integrated Traditional Chinese and Western Medicine, Beijing, China
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Braun M, Pomerantz JH, Hoffman WY, Mathes EF. Long-pulsed neodymium-doped yttrium aluminum garnet for hair reduction in pediatric microtia repair. Pediatr Dermatol 2023. [PMID: 36807931 DOI: 10.1111/pde.15281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 01/30/2023] [Indexed: 02/22/2023]
Abstract
Microtia is the term for congenital malformation of the ear in which the external and internal ear are absent or malformed. Surgical reconstruction is a common management approach and occasionally requires hair reduction of the newly constructed auricle. Few studies have investigated lasers for this purpose. We conducted a retrospective chart review of patients seen at a single institution between 2012 and 2021 who underwent laser hair reduction with long-pulsed neodymium-doped yttrium aluminum garnet laser (Nd:YAG). Efficacy ratings were done through review of clinical photographs. Twelve patients were identified with 14 total ears treated. The number of laser treatments varied from 1 to 9 sessions with an average of 5.1 treatments. The majority (8/12) had an "excellent" or "very good" response, one patient had a "good" response, and three were lost to follow-up. Other than pain, there were no side effects documented. Nd:YAG laser was both effective and safe in our pediatric cohort, without any cutaneous side effects in patients with darker skin.
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Affiliation(s)
- Mitchell Braun
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jason H Pomerantz
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Francisco, San Francisco, California, USA.,Craniofacial Center, University of California San Francisco, San Francisco, California, USA
| | - William Y Hoffman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Francisco, San Francisco, California, USA.,Craniofacial Center, University of California San Francisco, San Francisco, California, USA
| | - Erin F Mathes
- Craniofacial Center, University of California San Francisco, San Francisco, California, USA.,Department of Dermatology, University of California San Francisco, San Francisco, California, USA
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Expanded scalp flap combined with laser hair removal to reconstruct facial defects around the hairline. J Plast Reconstr Aesthet Surg 2022; 75:3365-3372. [PMID: 35729044 DOI: 10.1016/j.bjps.2022.04.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 03/12/2022] [Accepted: 04/12/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Congenital and acquired facial lesions around the hairline can bring huge physical and psychological trauma to patients. At present, reconstruction of this area remains a challenge. In this study, we present an alternative technique to reconstruct the aesthetic units using an expanded scalp flap combined with laser hair removal. METHODS We retrospectively reviewed 25 cases of facial lesions around the hairline reconstructed with this surgical technique between May 2014 and May 2020. Expander was implanted under the scalp as designed before the operation. After the expander was fully expanded, the lesion was removed and the scalp flap was transferred. Laser hair removal was performed on the transplanted skin flap 2 weeks after flap transfer. RESULTS There were ten cases of postburn scar, nine cases of congenital nevus, four cases of traumatic scar, one case of haemangioma, and one case of nevus sebaceous. The median times of laser treatment was 3 (range, 1-8). The median follow-up time was 11 months, ranging from 1 to 27 months. The colour and texture of expanded flaps were similar to adjacent tissue in all cases. The direction of reserved hair in transferred flaps was consistent with the direction of hair in the recipient area or contralateral hair. There were no complications, such as infection, blistering, discolouration, and ulceration. All patients were satisfied with the appearance of the reconstructed hairline and the surgical outcomes. CONCLUSIONS The expanded scalp flap combined with laser hair removal is a feasible and effective technique to reconstruct both sides of the hairline simultaneously from a single donor site with a good colour match and a similar texture and thickness.
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You P, Rosenberg TL, Liu YCC. Utilization of Alexandrite Laser for Hair Removal in Pediatric Auricular Reconstruction. Otolaryngol Head Neck Surg 2021; 167:203-205. [PMID: 34464219 DOI: 10.1177/01945998211041948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Auricular reconstruction with autologous rib cartilage involves using a soft tissue envelope to cover the cartilage framework. In patients with a low hairline, hair-bearing skin may be incorporated on the reconstructed ear, creating a difficult and conspicuous aesthetic problem. A retrospective chart review was conducted to summarize and share the experience of using the Candela GentleMax Pro 755-nm alexandrite laser system (Candela Corp) in children following auricular reconstruction. Nine patients received laser hair removal via the alexandrite laser system with good results. The number of completed sessions ranged from 1 to 5. The procedures were completed without the need for premedication or procedural sedation. Laser hair removal with an alexandrite laser system was safe, fast, and effective. With multistage auricular reconstruction, it was feasible to incorporate laser hair removal between the stages.
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Affiliation(s)
- Peng You
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | - Tara L Rosenberg
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | - Yi-Chun Carol Liu
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
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Wang M, Wei Z, Zheng H, Lei C, Shan X, Ye J, Wang B. Comparison of Two Surgical Epilation Procedures Based on the Nagata Method in All Degrees of Low Hairline Microtia. Facial Plast Surg Aesthet Med 2020; 23:294-301. [PMID: 33259731 DOI: 10.1089/fpsam.2020.0324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Various methods exist to manage unwanted hair in low hairline microtia. We present our 10-year experience that compares the two procedures toward all degrees of low hairline microtia. Methods: The tongue-shaped split-thickness skin graft procedure (modified Chen's procedure) and the modified Nagata procedure were used for ear reconstruction in 42 microtia patients with three degrees of low hairlines from 2010 to 2020. Hair follicles in the low hairline area were removed free-hand, and the removed area was replaced with extended temporoparietal fascia (TPF) flap during the ear elevation. The satisfaction score and the clearance percentages of the hair were used as outcome measures. Results: There was no significant difference in satisfaction scores and the hair clearance percentages of hair between two procedures (p > 0.05) and among three degrees of low hairline (p > 0.05), respectively. Although the complication rate showed no significant difference, the major types of complication in modified Chen's procedure was fluid accumulation (9.52%), whereas in modified Nagata procedure was hypertrophic scar (4.76%). Conclusion: Patients with low hairlines can be treated using two different microtia reconstruction techniques to limit hair growth on the new ear. The rib graft construct is covered by a TPF flap, which is then grafted with an ultrathin skin graft and shows benefit in this review of our 10-year experience. Clinical Trial Registration Information Provided: Registration no. and date registered: ChiCTR2000030214.
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Affiliation(s)
- Meishui Wang
- Department of Plastic Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, P.R. China
| | - Zhenni Wei
- Department of Plastic Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, P.R. China
| | - Houbing Zheng
- Department of Plastic Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, P.R. China
| | - Chen Lei
- Department of Plastic Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, P.R. China
| | - Xiuying Shan
- Department of Plastic Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, P.R. China
| | - Jiong Ye
- Department of Plastic Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, P.R. China
| | - Biao Wang
- Department of Plastic Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, P.R. China
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Yen CI, Chang CJ, Chang CS, Chen HC, Chien MH, Hsiao YC. Laser hair removal following forehead flap for nasal reconstruction. Lasers Med Sci 2020; 35:1549-1554. [PMID: 32006263 DOI: 10.1007/s10103-020-02965-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 01/12/2020] [Indexed: 11/26/2022]
Abstract
The forehead flap is a dependable option for nasal reconstruction owing to its reliability and anatomic likeness to nasal skin. For patients with low hairlines, the vertical design of the paramedian forehead flap can intrude into the scalp, thus incorporating hair into the nasal reconstruction. The inadequate length of the forehead flap or shift to an oblique design may result in eyebrow elevation and asymmetry. Therefore, laser hair removal (epilation) on the forehead flap has been proposed to improve esthetic results. An alexandrite laser (755 nm, 10 to 20 ms, 18-mm spot size) with a Dynamic Cooling Device™ (DCD™) cooling system was used for hair removal in 22 patients (16 male and 6 female patients) after nasal reconstructions using forehead flaps from December 2011 to September 2016. All patients received cryogen spray cooling laser treatment (CSC-LT). The mean follow-up period was 24 months, with a range between 18 and 50 months. The average duration of treatment was 1.8 months (range, 1-5 months). The energy density ranged from 14 to 18 J/cm2 with an average of 17.2 J/cm2. The number of treatments ranged from 2 to 4 (mean 2.8). Patients had satisfactory esthetic results over 11.1 months (range, 8-18 months). Residual white hairs were observed in 3 patients, and 4 patients had tiny black residual hairs without deteriorating cosmesis. Using an alexandrite laser to remove hair on the forehead is safe and reliable in nasal reconstruction with superior recipient site cosmesis.
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Affiliation(s)
- Cheng-I Yen
- Department of Plastic and Reconstructive Surgery, Chang Gung Aesthetic Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Cheng-Jen Chang
- Department of Surgery, School of Medicine, College of Medicine, and Graduate Institute of Biomedical Optomechatronics, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Chun-Shin Chang
- Department of Plastic and Reconstructive Surgery, Chang Gung Aesthetic Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Hung-Chang Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Aesthetic Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Mei-Hua Chien
- Burn Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yen-Chang Hsiao
- Department of Plastic and Reconstructive Surgery, Chang Gung Aesthetic Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan.
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Abstract
Restoration of a missing external ear is important for the child/adult with craniofacial deformities to achieve balance and harmony of the face and head. Ear reconstruction is not an isolated requirement, however. For 2 reasons, we believe that external ear reconstruction is an integral part of craniofacial reconstruction: (1) the auricle is located, not in the face mask, but just outside the face mask, and projects onto the posterior part of the temporal bone; and (2) isolated microtia may be an early clinical marker of hemifacial microsomia. This is the first English-language article describing the specific requirement for external ear reconstruction in hemifacial microsomia. It may also be the first article to describe the long-term follow-up of 2-stage ear reconstruction in hemifacial microsomia. After reviewing the long-term results, we offer recommendations on the management of microtia in hemifacial microsomia.
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