Surgery of the auricle: tumors, trauma, defects, abnormalities PDF
Preview Surgery of the auricle: tumors, trauma, defects, abnormalities
I II Dedicated in gratitude to my wife Barbara III Surgery of the Auricle Tumors · Trauma · Defects · Abnormalities Hilko Weerda, MD, DMD Professor and Former Head Department of Otorhinolaryngology University Hospital Schleswig-Holstein Campus Lübeck Lübeck, Germany With contributions by F.X. Brunner, G. Burg, S. Gottschalk, I. Greiner, A. Haisch, A.A. Hartmann, A. Hasse, D. Hoehmann, R.A. Jahrsdoerfer, R. Katzbach, J.H.N. Kim, S. Klaiber, M. Landthaler, D. Petersen, R. Schoenweiler, R. Siegert, H. Sommer, H. Weerda, M.B. Wimmershoff 1340 illustrations 33 tables Thieme Stuttgart · New York IV LibraryofCongressCataloging-in-PublicationDataisavailable Importantnote:Medicineisanever-changingscienceunder- fromthepublisher. going continual development. Research and clinical ex- periencearecontinuallyexpandingourknowledge,inpartic- ularourknowledgeofpropertreatmentanddrugtherapy.In- sofarasthisbookmentionsanydosageorapplication,readers may rest assured that the authors, editors, and publishers havemadeeveryefforttoensurethatsuchreferencesarein accordancewiththestateofknowledgeatthetimeofpro- ductionofthebook. 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If errors in this work are found Translator:GrahameLarkin,MD,Wimborne,UK after publication, errata will be posted at www.thieme.com Illustrator:KatharinaSchumacher,Munich,Germany ontheproductdescriptionpage. ©2007GeorgThiemeVerlag, Some of the product names, patents, and registered designs Rüdigerstrasse14,70469Stuttgart,Germany referred to in this book are in fact registered trademarks or http://www.thieme.de proprietarynameseventhoughspecificreferencetothisfact ThiemeNewYork,333SeventhAvenue, isnotalwaysmadeinthetext.Therefore,theappearanceofa NewYork,NY10001,USA name without designation as proprietary is not to be con- http://www.thieme.com strued as a representation by the publisher that it is in the publicdomain. TypesettingbyPrimustypeHurler,Notzingen Thisbook,includingallpartsthereof,islegallyprotectedby PrintedinGermanybyDruckhausGötz,Ludwigsburg copyright.Anyuse,exploitation,orcommercializationoutside the narrow limits set by copyright legislation, without the publisher’s consent, is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, ISBN978−3-13−139411-8(TPS,RestofWorld) mimeographing, preparation of microfilms, and electronic ISBN978−1-58890-359−4(TPN,TheAmericas) 123456 dataprocessingandstorage. V Forewords Surgicalcreationoftheouterearwithautogenoustissuesis hisartisticflairandthelovelypaintingsthathehadcreated a unique blend of art and science. The result will be in- bothforhishomeandoffice. fluencedbythesurgeon’sadherencetothebasicprinciples Boththeartandthesurgicalworldareprivilegedtohave ofplasticsurgery,buthisorhersculptureanddesignskills DrWeerda’spresence,fortheimpacthehasmadeonbothis willultimatelydeterminethefinaloutcome. outstanding. Overtheyearsnumeroussurgeonshavevisitedmeinthe Hisbookonearreconstructionwillcertainlybeanother operating room, but only a handful have blossomed into wonderfulcontributionofartisticandscientificendeavor. auricularartists.DrHilkoWeerdaisoneofthesegiftedfew. I have been honored not only to watch Dr Weerda per- formearsurgery,butalsotobetherecipientofanumberof ProfessorBurtonBrent,MD hiswonderfulself-madeChristmascardpaintingsoverthe ElCaminoHospital, years.DuringmyvisittoLübeck,Iwasmostimpressedwith Woodside,CA,USA MyacquaintancewithProfessorHilkoWeerdaoftheLübeck sufficient skin surface area to cover the fabricated three- University School of Medicine in Germany began in May dimensionalcostalcartilageframework(3-Dframe),andits 1995 at the 11th International Congress of Plastic, Recon- associated complications like low hairline and craniofacial structive,andAestheticSurgery(IPRAS)inYokohama,Japan. skeletaldefects.TheNagatamethoddescribedinthistext- Professor Weerda’s concern for the treatment of auricular book by Professor Weerda is a two-stage method for total andmiddleeardefectsledtotheorganizationofthe3rdIn- auricular reconstruction, where anatomical and morpho- ternationalSymposiumonAuricularandMiddleEarMalfor- logical problems have been solved; and with Professor mation, Ear Defects and Their Reconstructions in Lübeck, Weerda’sexpertise,theproblemofmiddleearmalformation Germany, September 1997. At this meeting, Professor (auditoryfunction)isinthemidstofbeingsolvedfortheat- Weerda was able to invite prominent surgeons from tainment of the ultimate goal, the reconstruction of a throughout the world to present lectures and perform de- functionalauricleofnormalappearance. monstrationsurgeries:thiswasindeedoneofthemostedu- It is an honor for me to write a foreword for Professor cational and scientific meetings concerned with problems Weerda’stextbook.Iwouldliketorecommendthistextbook relatedtotheauricletotakeplaceinthetwentiethcentury. to all surgeons involved in, and/or considering a clinical Auricular reconstruction is still considered to be one of practicein,reconstructivesurgeryforauricularandmiddle the most difficult reconstructive surgeries for a plastic re- eardefects. constructivesurgeontoperform.Thisisduetothefactthat anatomicalandmorphologicalknowledgeisrequiredprior to being able to reconstruct an auricle in the proper ana- ProfessorSatoruNagata,MD,PhD tomical location with all the detailed morphological fea- DepartmentofReconstructivePlasticSurgery turesoftheauricle.Inaddition,thereistheproblemofin- AKIBA-Hospital,Saitama,Japan VI Preface WhenIbeganmyworkasaphysicianattheHospitalforOral I extend special thanks to our photographer, Mrs Ellen and Maxillofacial Surgery in Erlangen in 1965, the thali- Liegmann,whowasresponsibleforyearsofdifficultimage domidedisasterwasjustemergingandwehadtomakeexter- documentationandeffectivelyillustratedessentialdiseases nalprosthesesforagreatmanychildrenwithauricularmal- and operations. I also thank Mrs Bettina Villmann, who formations.BecauseIhadstudiedsculptureatanartacademy workedtirelesslytoputmypartiallyhandwrittennotesinto beforeattendingmedicalschool,Iwascalledupontofabricate anintelligibleform. theprostheses.Therelativelypoorpsychologicalrehabilita- IamgratefultoThiemePublishinganditsdedicatedstaff, tionofthesechildrenmovedmedeeplyandpromptedmeto particularly Ms. Elisabeth Kurz, Ms. Stefanie Langner, and seekmoresatisfactorymethodsofreconstruction. Mr. Stephan Konnry. I appreciate the high quality of the Ihavemaintainedakeeninterestinthisareaduringmore illustrations prepared from my sketches by Mrs K. Schu- than 30 years’ practice as a plastic and reconstructive sur- macher and her patience in implementing my suggested geon,workingfirstattheDepartmentofOtolaryngologyat changes. FreiburgUniversityHospitalunderFritzZöllnerandChlod- Fordidacticreasons,themajorityofconditionsandpro- wigBeckandlaterattheDepartmentofOtolaryngologyof cedureshavebeenillustratedfortherightear. LübeckMedicalUniversity. Ihopethatthisbookwillencouragemycolleaguestoex- Particularly in Lübeck, I was able to pursue my work in plore auricular reconstruction and to advance both the this field along with a number of colleagues and doctoral theoryandpracticeofthischallengingfield. candidates,someofwhomhavekindlycontributedtheirre- sultstothisvolume. I also wish to acknowledge all the specialists who en- richedthisbookwiththeircontributions. HilkoWeerda VII Contributors FranzXaverBrunner,MD RobertA.Jahrsdoerfer,MD ProfessorandDirector ProfessorofClinicalOtolaryngology—HeadandNeck DepartmentofOtorhinolaryngology Surgery AugsburgCentralHospital UniversityofVirginiaMedicalCenter Augsburg,Germany DepartmentofOtolaryngology—HeadandNeckSurgery DivisionofOtolgy,Neurotology GuenterBurg,MD Charlottesville,VA,USA Professor DepartmentofDermatology R.Katzbach,MD UniversityHospitalofZürich DepartmentofOtorhinolaryngology Zürich,Switzerland UniversityHospitalSchleswig-Holstein CampusLübeck StefanGottschalk,MD Lübeck,Germany InstituteofNeuroradiology UniversityHospitalSchleswig-Holstein JeffreyHungN.Kim,MD CampusLübeck AssistantProfessor Lübeck,Germany GeorgetownUniversityMedicalCenter DepartmentofOtolaryngology—HeadandNeckSurgery IngoGreiner Washington,DC,USA GreinerEpithesenGmbH Kiel,Germany SusanneKlaiber,MD DepartmentofOtorhinolaryngology AndreasHaisch,MD UniversityHospitalSchleswig-Holstein DepartmentofOtorhinolaryngology CampusLübeck Charité—UniversityMedicineBerlin Lübeck,Germany CampusBenjaminFranklin Berlin,Germany MichaelLandthaler,MD Professor AlbertA.Hartmann,MD ClinicandPolyclinicforDermatology Professor UniversityofRegensburg Dermatology,Allergology Regensburg,Germany Aachen,Germany DirkPetersen,MD AndreasHasse,MD Professor Schlosspark-Klinik InstituteofNeuroradiology DepartmentofOral-MaxillofacialSurgery UniversityHospitalSchleswig-Holstein Berlin,Germany CampusLübeck Lübeck,Germany DirkHoehmann,MD AssociateProfessor RainerSchoenweiler,MD PrivatePracticeClinic Professor Otorhinolaryngology,PlasticSurgery,Allergology DepartmentofOtorhinolaryngology Nuremberg,Germany DivisionofPhoniatrics UniversityHospitalSchleswig-Holstein CampusLübeck Lübeck,Germany VIII Contributors RalfSiegert,MD HilkoWeerda,MD,DMD Professor ProfessorandFormerHead DepartmentofOtorhinolaryngology DepartmentofOtorhinolaryngology ProsperHospital UniversityHospitalSchleswig-Holstein Recklinghausen,Germany CampusLübeck Lübeck,Germany HilkeSommer,MD DepartmentofOtorhinolaryngology MonikaWimmershoff,MD KlinikumOldenburg DermatologistandVenereologist Oldenburg,Germany PrivatePractice Ulm,Germany IX Table of Contents 1 BasicPrinciples .............................. 1 3.3.3 TearsandAvulsionsoftheAuricle............ 28 Classification................................ 28 1.1 AnatomyoftheExternalEar (H.Weerda) ... 1 First-degreeAuricularInjuries ............. 29 1.2 AnthropometryoftheAuricle (R.Siegert) ... 4 Second-degreeAuricularInjuries .......... 29 1.2.1 Introduction ................................ 4 Third-degreeAuricularInjuries ............ 29 1.2.2 VariablesRelativetoAgeandHeight ......... 5 HistoricalReview ........................... 29 1.2.3 Summary ................................... 6 EpidemiologyofAuricularTrauma ........... 31 1.3 AestheticPrinciplesofAuricular TheoreticalPrinciples........................ 31 Reconstruction (H.Weerda)................. 6 CartilageSurvivalTime ................... 32 1.4 BasicPrinciplesofPlasticSurgery EmergencyCareofAuricularAvulsions ....... 34 (H.Weerda) .................................. 8 3.3.4 ReplantationoftheAuricle .................. 34 1.4.1 InstrumentsandAuxiliaryEquipment ........ 8 PreoperativeCareoftheAmputatedPart... 34 1.4.2 WoundManagement,CareofSmallDefects, SutureTechnique ......................... 35 andScarRevision ........................... 9 PerioperativeMeasures ................... 35 1.4.3 CompositeGrafts ............................ 10 ReplantationTechniques..................... 35 1.4.4 GraftandImplantTerminology .............. 10 ClassicReplantation ...................... 35 PocketTechniques ........................ 35 2 TumorsoftheExternalEar DistantBanking .......................... 36 H.Weerda,A.A.Hartmann,F.X.Brunner,G.Burg,and BankingBeneathRetroauricularMastoid D.Hoehmann ................................. 11 Skin ..................................... 36 2.1 Introduction ............................... 11 Mladick’sTechnique ...................... 36 2.2 BasalCellCarcinomaandSquamousCell FlapCoverage ............................ 38 Carcinoma ................................. 11 OtherTechniquesofReplantingAuricular 2.2.1 BasalCellCarcinoma ........................ 11 Parts ....................................... 38 2.2.2 Keratoacanthoma ........................... 15 Baudet’sTechnique ....................... 38 2.2.3 SpinalCellCarcinoma ....................... 15 Arfai’sTechnique ......................... 39 2.3 MalignantMelanoma ....................... 17 MicrovascularEarReplantation .............. 40 Histomorphology ......................... 18 ConcludingSummaryandAssessmentof Therapy .................................. 19 ReplantationTechniques..................... 41 2.4 Keloid ...................................... 20 2.5 Neurofibroma .............................. 21 4 ClassificationandSurgeryofAuricularDefects 2.6 GoutTophi ................................. 23 H.Weerda.................................... 43 2.7 ChondrodermatitisNodularisChronica 4.1 History ..................................... 43 Helicis...................................... 23 4.2 Classification ............................... 44 4.2.1 CentralDefects:RecommendedDefect 3 TraumaandNon-inflammatoryProcesses Coverage ................................... 45 H.Weerda.................................... 24 ConchalDefects ............................. 46 3.1 AcuteTraumaoftheAuricle ................ 24 DefectsoftheAntihelixandCombined 3.1.1 ChemicalBurns ............................. 24 CentralDefects.............................. 47 3.1.2 ThermalInjuries ............................ 24 4.2.2 PeripheralDefects ........................... 52 First-degreeBurns........................... 24 HelixReconstructionwithAuricular Second-degree(Partial-thickness)Burns ...... 24 Reduction................................... 52 Third-degree(Full-thickness)Burns .......... 25 WedgeExcision .......................... 52 Frostbite .................................... 25 Gersuny’sTechnique...................... 54 3.1.3 AcuteOtoseromaandOtohematoma ......... 25 NonrecommendedMethodsofDefect 3.2 ChronicOtohematoma ..................... 27 Reconstruction ........................... 57 3.3 AuricularInjuries .......................... 27 HelixReconstructionwithoutAuricular 3.3.1 BiteInjuries................................. 27 Reduction................................... 58 3.3.2 Piercing..................................... 28 4.2.3 PartialReconstructionoftheAuricle ......... 62
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