Are growth alterations a consequence of surgery for prominent ears?

This study was undertaken to detect growth alterations after surgery for prominent ears. The cartilage excision technique was used in all 76 patients seen for follow-up. Two hundred students served as controls. Auricular measurements were done according to standardized guidelines of anthropometry. There was no significant difference in the retroauricular angle between the surgical group and controls. The morphologic ear length in the surgical group was significantly smaller than in controls. Maximum ear length was significantly greater in men. Our measurements in the control group were significant below the reference values reported in the literature. Comparing the ear index of both groups with published data, we found a harmony between the width and the length of the ear. We could demonstrate that prominent ears were significantly larger in all other dimensions and that auricular growth does not stop following surgery for prominent ears with the cartilage excision method. We also evaluated subjective criteria such as tolerance to cold, scar formation, and patient satisfaction.     

Are growth alterations a consequence of surgery for prominent ears?

This study was undertaken to detect growth alterations after surgery for prominent ears. The cartilage excision technique was used in all 77 patients seen for follow-up. Two hundred students served as controls. Auricular measurements were done according to standardized guidelines of anthropometry. There was no significant difference between the retroauricular angle in the surgical group and in controls. The morphologic ear length in the surgical group was significantly smaller than in controls. Maximum ear length was significantly greater in men. Our measurements in the control group were significant below the reference values reported in the literature. Comparing the ear index of both groups with published data, we found a harmony between the width and the length of the ear. We could demonstrate that prominent ears were significantly larger in all other dimensions and that auricular growth does not stop following surgery for prominent ears with the cartilage excision method. We also evaluated subjective criteria such as tolerance to cold, scar formation, and patient satisfaction.     

Combined otoplasty technique: chondrocutaneous conchal resection as the cornerstone to correction of the prominent ear

The failure to correctly analyze the complex deformity that comprises the prominent ear is the most common cause of the undesired surgical result. Recognizing conchal hypertrophy as one of the leading causes of the prominent ear deformity has led to a versatile and reproducible otoplasty technique that is easily modified to the common side-to-side variation in deformity. From January of 1993 to August of 2000, chondrocutaneous conchal resection has been used as the cornerstone to a combined sequence of maneuvers in otoplasty. The operation was performed on 47 patients (40 bilateral cases and 7 unilateral), and the total number of ears operated on was 87. There were three complications requiring revision surgery, and follow-up periods ranged from 6 months to 7 years, with all patients achieving a satisfactory result. Detailed methods of chondrocutaneous conchal resection along with the sequence of the authors' combined otoplasty techniques are presented.     

钙调素mRNA在受精前后分离的烟草胚囊中的定位

建立了一种新的ｍＲＮＡ原位杂交方法,适用于微量材料的整体观察。应用这一方法定位烟草（ＮｉｃｏｔｉａｎａｔａｂａｃｕｍＬ．ｃｖ．Ｗ３８）受精前后胚囊成员细胞中的钙调素ｍＲＮＡ（ＣａＭｍＲＮＡ）。结果显示成熟胚囊中的ＣａＭｍＲＮＡ主要分布于珠孔极的卵器和合点极的反足细胞;中央细胞中较少。受精前后胚囊中ＣａＭｍＲＮＡ的分布发生显著变化,特别是授粉后到受精前极核与卵器之间出现一条暂时的钙调素ｍＲＮＡ条带。受精前不久该带消失,ＣａＭｍＲＮＡ扩展为占据胚囊珠孔端的扇形区域。受精后胚囊中钙调素ｍＲＮＡ主要集中于伸长的合子和原胚的合点端。讨论了钙调素ｍＲＮＡ表达与受精的关系。     

The crumpled-ear deformity.

The common characteristics of the crumpled-ear deformity, the steps for surgical correction, and the authors' experience are described in this article. Commonly, the ear has a folded-over appearance; a normal length and width when unfurled; and wrinkling of the skin and cartilage of the helical rim, scapha, antihelix, and concha. Principles of correction of this deformity include (1) superficial scoring of the concave segments of the cartilage to open the wrinkled segments, (2) creating the antihelical fold by a mattress-suture technique, (3) repositioning of the helical rim, and (4) repositioning of the prominent ear lobe, if present. A total of 12 crumpled ears were evaluated in six patients, three of whom underwent surgery during their teenage years. No complications have been observed. A new classification of an ear deformity has been proposed based on morphology that to the authors' knowledge has not been described in the literature. Identification of the common features of the deformity allows for precise correction using already well-defined techniques.     

Otoplasty: sequencing the operation for improved results

LEARNING OBJECTIVES:: After studying this article, the participant should be able to: 1. Understand the anatomy and embryology of the external ear. 2. Understand the anatomic causes of the prominent ear. 3. Understand the operative maneuvers used to shape the external ear. 4. Be able to sequence the otoplasty for consistent results. 5. Understand the possible complications of the otoplasty procedure. Correction of prominent ears is a common plastic surgical procedure. Proper execution of the surgical techniques is dependent on the surgeon's understanding of the surgical procedure. This understanding is best founded on an understanding of the historical bases for the operative steps and the execution of these operative steps in a logical fashion. This article describes the concept of sequencing the operation of otoplasty to produce predictable results combining the technical contributions from many authors. The historical, embryological, and anatomic bases for the operation are also discussed. Finally, the authors' preferred techniques are presented. Sequencing the steps in the preoperative assessment, preoperative planning, patient management, operative technique, and postoperative care will produce reproducible results for the attentive surgeon. Careful attention to the details of the operation of otoplasty will avoid many postoperative problems.     

New modification in otoplasty: anterior approach

After harvesting the conchal cartilage in a large series of secondary rhinoplasties using the anterior approach, there was a marked improvement in the shape of the auricle, with unnoticeable scarring hidden under the convolution of the antihelix. In this series of 250 cases, there were no hypertrophic scars or keloid formations. Based on these favorable results, a new modification of otoplasty was developed using only the anterior approach. Between 1992 and 2000, 108 otoplasties were performed on 55 patients to correct the prominent ear using only the anterior approach. All maneuvers used in modern otoplasty, such as conchal reduction, scaphal cartilage scoring and folding, placement of horizontal mattress buried sutures, conchal setback, and the positioning of the tail and upper pole, can be easily and effectively performed using only the anterior approach as described in this article. The use of an anterior approach does not disturb the neurovascular system of the ear because it is located on the ear's posterior side. Overall, patient and physician satisfaction has continued to be very high during the 8 years that this technique has been used. Some patients experienced a few minor complications, such as postoperative pain (16.3 percent), late suture reaction (1.8 percent), hidden helix (3.6 percent), and partial relapse (3.6 percent), that were easily corrected by the application of a Kaye-type buried suture and that were not directly related to the technique.     

Photosynthesis and transpiration of the flag leaf in four spring-wheat cultivars

Co₂ exchange and transpiration rates of the flag leaves of four spring wheat (Triticum aestivum L.) cultivars, namely Glenlea, Neepawa, Opal and Kolibri, were compared using infra-red gas-analysis technique. The plants were grown in a controlled environment under an 18-h photoperiod, with day and night temperatures of 20 and 15° C, respectively. The time course of the CO₂-exchange rate (CER) of the flag leaf differed among cultivars. CER began to decrease rapidly some 2 weeks after ear emergence in Glenlea, Neepawa and Kolibri, but only after 4 weeks in Opal. The decline in CER of Glenlea, Neepawa and Opal was continuous throughout the period of grain development whereas in Kolibri CER was maintained at a constant level between the 4th and 6th weeks after ear emergence. The transpiration rates of the flag leaves of the 4 cultivars did not change markedly until 6–7 weeks after ear emergence, indicating that the reduction in CER was not primarily a response to increased stomatal resistance to the diffusion of CO₂. Removing the ear of the main shoot of intact plants failed to depress CER of the subtending flag leaf until 5 weeks after ear removal. Removing the ears of all the tillers of plants in which all but 3 tillers had been removed at ear emergence did not depress CER until 4 weeks after ear emergence, but removal of the ear of the main shoot of plants where all the tillers had been removed at ear emergence reduced the CER of the flag leaf 2 weeks after ear removal. Removal of tillers at ear emergence had a marked effect on the time course of CER and transpiration rates of the flag leaf. Both CER and transpiration rates of a 4-tiller plant were maintained at a higher level throughout ear development as compared to those of a one-tiller plant. The transpiration rate of the flag leaf of Glenlea increased during the later part of the life of the leaf even for one-tiller plants with no ear, indicating that such a stomatal response may be part of the normal course of leaf aging and not a response to a feedback stimulus from the ear.     

Development of the vascular bed in the rabbit ear: scanning electron microscopy of vascular corrosion casts

The development of the vascular bed in the rabbit ear was investigated using vascular corrosion casts from animals of various ages. Examination of the casts revealed that the arrangement of the major auricular arteries and veins was determined before birth and was maintained during postnatal growth of the ear. Furthermore, the number of arteries branching off the central ear artery and the lateral arteries did not increase with increasing ear length. Scanning electron microscopic examination of lateral segments of adult ear casts revealed many anastomoses between marginal arteries and veins. These arteriovenous anastomoses (AVAs) occurred singly, in pairs, or in clusters of three to six. Their size and shape were variable, even in the same cast. The central segment of many AVA casts showed surface impressions of endothelial cell nuclei which were different from the impressions on adjacent arteries and veins. Arteriovenous anastomoses were also detected in ear casts from animals as young as 8 days. The density of AVAs in lateral ear segments ranged from 95-165 cm-2 in 8- to 11-day-old rabbits to 80-115 cm-2 in adults. However, estimates of the total number of AVAs in the lateral ear margin indicated that AVAs continued to be formed at a steady rate during growth of the ear. During the early neonatal period the cutaneous capillary plexuses developed prominent tufts projecting toward the skin surface, which were apparently associated with developing hair follicles. These capillary tufts were not seen in casts from fetal or adult rabbits.     

Development of hearing in vertebrates with special reference to anuran acoustic communication

Amphibians, specially anurans, are excellent model systems for studying acoustic communication. After hatching, anurans exist in two forms; these have two distinct mode of sound perception. Aquatic larvae are perceptive to waterborne sound stimuli; then, following metamorphosis, as terrestrial adults, perceptive to airborne sound stimuli. Added to this, the metamorphosing tadpole presents an equally interesting study as it could recapitulate the events which occurred during the evolution of hearing in vertebrates at the lime of the transition from aquatic to terrestrial life. Metamorphosis entails the loss of a prominent aquatic sensory system—the lateral line system—and the simultaneous gain of another, the inner ear, along with the coevolution of the tympanic middle ear, a basilar papilla and a periotic labyrinth in the inner ear. Another interesting feature is that anurans are believed to be the first terrestrial vertebrates to use vocalization as a part of their reproductive behaviour. Vocal communication plays an important role in behaviour, ranging from territorial defense to reproduction, and calls are classified according to the particular behaviors that they subserve. Adult male anurans produce a species-specific mating call which is used to attract conspecific females dung their mating season, and this call serves as a mechanism in maintaining reproductive isolation from other sympatric species.     

A simplified technique for producing an ischemic wound model

One major obstacle in current diabetic wound research is a lack of an ischemic wound model that can be safely used in diabetic animals. Drugs that work well in non-ischemic wounds may not work in human diabetic wounds because vasculopathy is one major factor that hinders healing of these wounds. We published an article in 2007 describing a rabbit ear ischemic wound model created by a minimally invasive surgical technique. Since then, we have further simplified the procedure for easier operation. On one ear, three small skin incisions were made on the vascular pedicles, 1-2 cm from the ear base. The central artery was ligated and cut along with the nerve. The whole cranial bundle was cut and ligated, leaving only the caudal branch intact. A circumferential subcutaneous tunnel was made through the incisions, to cut subcutaneous tissues, muscles, nerves, and small vessels. The other ear was used as a non-ischemic control. Four wounds were made on the ventral side of each ear. This technique produces 4 ischemic wounds and 4 non-ischemic wounds in one animal for paired comparisons. After surgery, the ischemic ear was cool and cyanotic, and showed reduced movement and a lack of pulse in the ear artery. Skin temperature of the ischemic ear was 1-10 °C lower than that on the normal ear and this difference was maintained for more than one month. Ear tissue high-energy phosphate contents were lower in the ischemic ear than the control ear. Wound healing times were longer in the ischemic ear than in the non-ischemic ear when the same treatment was used. The technique has now been used on more than 80 rabbits in which 23 were diabetic (diabetes time ranging from 2 weeks to 2 years). No single rabbit has developed any surgical complications such as bleeding, infection, or rupture in the skin incisions. The model has many advantages, such as little skin disruption, longer ischemic time, and higher success rate, when compared to many other models. It can be safely used in animals with reduced resistance, and can also be modified to meet different testing requirements.     

From tendon to nerve: an MSC for all seasons

The potential of mesenchymal stem cells (MSCs) to regenerate damaged tissue is well documented, as this specialized progenitor cell type exhibits superior cellular properties, and would allow medical as well as ethical limitations to be overcome. By now, MSCs have been successfully introduced in manifold experimental approaches within the newly defined realm of Regenerative Medicine. Advanced methods for in vitro cell expansion, defined induction of distinct differentiation processes, 3-dimensional culture on specific scaffold material, and tissue engineering approaches have been designed, and many clinical trials not only have been launched, but recently could be completed. To date, most of the MSC-based therapeutic approaches have been executed to address bone, cartilage, or heart regeneration; further, prominent studies have shown the efficacy of ex vivo expanded and infused MSCs to countervail graft-versus-host disease. Yet more fields of application emerge in which MSCs unfold beneficial effects, and presently, therapies that effectively ameliorate nonhealing conditions after tendon or spinal cord injury are, courtesy of scientific research, forging ahead to the clinical trial stage.     

Correction of low-set ear: superoposterior mobilization of the ear as a transposition flap pivoted on the ear canal with burring of the superoposterior canal wall

In a number of congenital, developmental, and postoperative conditions, many patients have a difference in the vertical and anteroposterior position of the ears. On correction of this deformity, the most difficult problem is the low and anterior location of the external auditory canal. To overcome this unyielding limitation, the authors perform superoposterior transposition of the low-set ear pivoted on the ear canal after making a new path for the canal by burring of the thick superoposterior canal wall. A mastoid hairline incision is followed by three-quarters circumferential subpericranial dissection around the bony ear canal posteriorly. A preauricular incision is followed by subcutaneous dissection anteriorly. By using the natural deformability of the cartilaginous ear canal, the S-shaped canal can be straightened through a new path made by burring of the thick superoposterior wall. Then the low-set ear can be mobilized superoposteriorly as a transposition flap pivoted on the ear canal with minimal tension by straightening of the canal. The corrected auricular position can be maintained by (1) several permanent sutures between the cavum conchae and the mastoid and deep temporal fascia, (2) a suspensory temporoparietal fascial loop, and (3) a skin support provided by the repair in an elevated position and V-Y-plasty or Z-plasty on the lower pole of the ear. From December of 1997 to October of 1998, three cases with a maximum follow-up of 15 months were examined. Symmetric ear position was achieved and maintained on both frontal and lateral views after the operation in all cases. This new technique for correction of low-set ear produces symmetric ear position in both vertical and anteroposterior dimensions for a long time. In addition, it can be performed with various other surgical procedures safely and simultaneously in a variety of pathologic conditions.     

Induction of inner ear fate by FGF3

Loss-of-function experiments in avians and mammals have provided conflicting results on the capacity of fibroblast growth factor 3 (FGF3) to act as a secreted growth factor responsible for induction and morphogenesis of the vertebrate inner ear. Using a novel technique for gene transfer into chicken embryos, we have readdressed the role of FGF3 during inner ear development in avians. We find that ectopic expression of FGF3 results in the formation of ectopic placodes which express otic marker genes. The ectopically induced placodes form vesicles which show the characteristic gene expression pattern of a developing inner ear. Ectopic expression of FGF3 also influences the formation of the normal orthotopic inner ear, whereas another member of the FGF family, FGF2, shows no effects on inner ear induction. These results demonstrate that a single gene can induce inner ear fate and reveal an unexpectedly widespread competence of the surface ectoderm to form sensory placodes in higher vertebrates.     

Total ear reconstruction in the devascularized temporoparietal region: II. Use of the omental free flap

Total ear reconstruction using the omental free flap technique was performed on five patients who presented with a devascularized temporoparietal region. The main indication for this technique was unavailability of the contralateral temporoparietal fascia in those requesting autogenous auricular reconstruction. There were no microvascular failures in the procedures conducted. In one case there was a partial loss of the transferred omentum, which resulted from an inadequate omental tailoring. A normal convoluted auricle was obtained after multistage debulking operations and meticulous postoperative molding. The average follow-up period was 3.4 years. Final aesthetic results were graded as satisfactory in four patients and poor in one patient.     

Replantation of severed ear parts.

We have used a technique whereby a severed ear part is sutured back into place on "shaved" areas on the medical surface of the remaining ear and on the corresponding retroauricular area. After 4 to 6 weeks, the ears are freed and the raw surfaces are skin grafted. We think that replantation of severed ear parts is justifiable, and we recommend this method whereby the supply of blood vessels is increased.     

Hypergravity decreases carbonic anhydrase-reactivity in inner ear maculae of fish

Previous investigations revealed that fish inner ear otolith growth depends on the amplitude and the direction of gravity. Both otolith total size, otolith bilateral size-asymmetry and the total and bilateral calcium-incorporation are also affected by gravity. Hypergravity, e.g., slows down otolith growth and diminishes bilateral otolith asymmetry as compared to 1 g control specimens raised in parallel. Since the enzyme carbonic anhydrase (CA) plays a prominent role in otolithic calcification, the reactivity of inner ear CA during otolith growth under hypergravity was investigated. CA-reactivity was demonstrated histochemically and densitometrically on sections of inner ear maculae of larval cichlid fish (Oreochromis mossambicus), that were kept for 6 hrs in a 3 g hypergravity centrifuge. The total unilateral macular CA-reactivity and the bilateral difference in CA between the left and the right maculae were significantly lower in 3 g animals than in 1g controls. The result is in complete agreement with previous studies indicating that a regulatory mechanism, which adjusts otolith size and asymmetry towards the gravity vector, acts via activation/deactivation of macular CA.     

Computer-integrated finite element modeling of human middle ear

 The objective of this study was to produce an improved finite element (FE) model of the human middle ear and to compare the model with human data. We began with a systematic and accurate geometric modeling technique for reconstructing the middle ear from serial sections of a freshly frozen temporal bone. A geometric model of a human middle ear was constructed in a computer-aided design (CAD) environment with particular attention to geometry and microanatomy. Using the geometric model, a working FE model of the human middle ear was created using previously published material properties of middle ear components. This working FE model was finalized by a cross-calibration technique, comparing its predicted stapes footplate displacements with laser Doppler interferometry measurements from fresh temporal bones. The final FE model was shown to be reasonable in predicting the ossicular mechanics of the human middle ear. Received: 18 February 2002 / Accepted: 6 June 2002 The preparation of temporal bone histological sections of Robert K. Dyer, Jr., MD is gratefully recognized. The Whitaker Foundation supported this work (Research Grant RG-98-0305).