Morphologic Variability of Bone and Soft Tissue in Microtia With Hemifacial Microsomia

Analyzing Discrepancies and Correlations in Soft and Hard Tissue Asymmetry: A Focused Study on Hemifacial Microsomia and Isolated Microtia

BACKGROUND

This study aims to thoroughly investigate the distinctions and relationships between facial hard and soft tissue asymmetry, as well as their variations within different conditions and age groups.

METHODS

This cross-sectional study analyzed pre-treatment computed tomography (CT) images from 120 male patients aged 5 to 12 years with unilateral HFM (Pruzansky-Kaban types I and IIA) or isolated microtia. The 120 patients were categorized into four groups by condition (HFM or isolated microtia) and age (5-7, 8-12 years). Segmentation and extraction of anatomical landmarks were performed using Mimics software, followed by generating root-mean-square (RMS) values for facial asymmetry. Statistical analysis, including the Wilcoxon signed-rank test and Spearman correlation coefficient, was conducted to assess differences and correlations in asymmetry.

RESULTS

The study found that soft tissue asymmetry was generally greater than hard tissue asymmetry across all facial regions. The complexity of regional asymmetry correlations increased with age in HFM patients but decreased in isolated microtia patients. Significant correlations between hard and soft tissues were observed within the same anatomical regions, particularly in HFM patients aged 8-12 years.

CONCLUSION

The intricate interplay between hard and soft tissues was observed in HFM and isolated microtia patients. Personalized analysis of the causes of asymmetry in different regions is crucial for the formulation of effective treatment plans.

LEVEL OF EVIDENCE IV

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Prograde transposition for anteriorly low-set earlobe in lobule-type microtia reconstruction

BACKGROUND

Lobule transposition, a common procedure in auricle reconstruction, has been successfully performed over the past few decades. However, the transposition methods for unilateral microtia with evident asymmetry of bilateral earlobe positions still remain a challenge. The objective of this study was to investigate the application of prograde transposition for anteriorly low-set earlobes.

METHOD

A total of 25 patients with lobule-type microtia with anteriorly low-set residual earlobe underwent prograde transposition during auricle reconstruction between 2020 and 2022. The post-operative earlobe aesthetic assessment and patient satisfaction were evaluated, and the data on any complications that occurred when followed-up were collected. This study provides a comprehensive analysis and summary of the techniques used in earlobe transposition for auricular reconstruction.

RESULTS

The patients with evident asymmetry between the residual and healthy earlobes were usually concomitant with hemifacial microsomia and the residual ear was located in the anterior and lower region. No instances of flap necrosis, hematoma, or wound dehiscence were observed following auricular reconstruction. The mean aesthetic score of the auricle was 3.52, with 23 patients attaining good or excellent aesthetic outcomes. The mean Visual Analog Scale satisfaction score was 3.68, with 24 patients reporting relative satisfaction or satisfaction.

CONCLUSION

The prograde transposition of anteriorly low-set earlobe in lobule-type microtia reconstruction can effectively ensure adequate blood supply, enhance aesthetic appearance, and significantly improve patient satisfaction.