New strategies and methods for reconstruction of the outer ear canal (OEC)

Abstract

Background: The incidence of re-stenosis or re-atresia after reconstruction of the Outer Ear Canal (OEC) in patients with Congenital Malformation of the Middle and Outer Ear (CMMOE) is very high (up to 48%), and it has been a difficult problem for otologists not being able to solve.

Aims/Objectives: To explore new strategies and methods to improve re-stenosis or re-atresia after reconstruction of the OEC in patients with CMMOE.

Material and Methods: According to the characteristics of reconstructed OEC (r-OEC) re-stenosis or re-atresia summarized by us, a number of new prevention strategies and methods have been proposed and related patent products have been designed, including the improvement of covering epithelium types and skin grafting methods (7 types), simulated drum ring function to prevent the formation of negative pressure in the cavity, and strengthen postoperative support to reduce skin shrinkage and bone hyperplasia. The postoperative effects of different ages and preoperative OEC malformations are statistically analyzed.

Results: The incidence of re-stenosis/re-atresia is 14.3% (5/35) in the thin sectional skin of the temporal scalp overlap splicing skin grafting, which was significantly better than 45.5% (15/33) in the whole piece mosaic splicing and barrel skin grafting from the inner thin sectional thigh skin and overlay splicing other methods, including the inner thigh thin sectional skin, chest medium thick skin and subcutaneous pedicle + chest medium thick skin (p<0.05). The patent artificial drum ring and the model stent of the OEC have obvious effects. The mean operation age of postoperative atresia, stenosis, and good groups are 9.3, 13.1, and 12.5 years old, respectively. The proportion of preoperative atresia is 91.3%, 85.7%, and 57.7%, respectively. The total incidence of re-atresia and re-stenosis of r-OEC for two groups of atresia and stenosis of OEC before surgery is 40.5% (49/121) and 13.3% (8/60), respectively.

Conclusions and Significance: The best result is found in overlapping the splicing thin sectional skin of the temporal scalp, combined with artificial drum ring implantation, effective support of postoperative model stent of OEC and post-pubertal surgery selection are new and effective strategies and methods to prevent re-stenosis or re-atresia of r-OEC. Atresia or stenosis of the OEC before the operation is the influence factor of the postoperative effect.

Chinese Abstract

背景: 先天性中外耳畸形(CMMOE)患者外耳道重建(OEC)后再狭窄/闭锁的发生率非常高(高达48%)。这一直是一个棘手的问题, 耳科医生无法解决。

目的: 探索改善 CMMOE 患者 OEC 重建后再狭窄/闭锁的新策略和方法。

材料与方法: 根据我们所总结的重建OEC(r-OEC)后再狭窄/闭锁的特点, 提出了多种新的预防策略和方法, 并设计了相关专利产品, 包括覆盖上皮类型的改进及植皮方法(7种), 模拟鼓环功能防止腔内负压形成, 加强术后支撑以减少皮肤皱缩和骨质增生。 对不同年龄和术前OEC畸形的术后效果进行了统计分析。

结果: 颞部头皮薄层重叠拼接植皮术再回缩/狭窄发生率为14.3%(5/35), 明显优于自大腿内侧薄段皮肤植皮和叠加拼接的整片镶嵌拼接植皮术和桶状植皮术以及其他方法的45.5%(15/33), 包括大腿内侧薄段皮肤、胸部中厚皮肤和皮下蒂+胸部中厚皮肤(p < .05)。 专利人工鼓环和OEC模型支架效果明显。 术后闭锁组、狭窄组和良好组的平均手术年龄分别为9.3岁、13.1岁和12.5岁, 术前闭锁的比例分别为91.3%、85.7%和57.7%。 术前OEC闭锁和狭窄两组的r-OEC再闭锁和再狭窄总发生率分别为40.5%(49/121)和13.3%(8/60)。

结论及意义: 颞部头皮薄层皮肤重叠拼接联合人工鼓环植入的效果最佳, 术后OEC模型支架的有效支撑以及青春期后手术选择是预防 r-OEC 再狭窄或再闭锁的新的有效策略和方法。 术前OEC闭锁或狭窄是术后效果的影响因素。

Keywords:

• Congenital atresia/stenosis of the outer ear canal
• Reconstruction of the outer ear canal
• Strategies and Methods
• Thin sectional skin of the temporal scalp

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported by National Clinical Medical Center Special Project: YiHui Zou 202100003 and National Logistics Support Department Special Family Planning Project: YiHui Zou 22JSZ14.