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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4425_Библиотеки_им_академика_М_И_Перельмана
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Aesthetic Otoplasty
Thomas Procedures in Facial Plastic Surgery
Peter A. Adamson MD, FRCSC, FACS
Professor and Head
Division of Facial Plastic and Reconstructive Surgery
Department of Otolaryngology - Head and Neck Surgery
University of Toronto
Toronto, Ontario, Canada
Jason A. Litner MD, FRCSC
Facial Plastic Surgeon
Profi les Beverly Hills
Los Angeles, California, USA
2011
PEOPLE’S MEDICAL PUBLISHING HOUSE—USA
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All rights reserved. Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording, or otherwise), without the prior written permission of the publisher.
11 12 13 14/PMPH/9 8 7 6 5 4 3 2 1
ISBN-13: 978-1-60795-129-2
ISBN-10: 1-60795-129-0
Printed in China by People’s Medical Publishing House
Copyeditor/Typesetter: Spearhead Global, Inc.
Cover designer: Mary McKeon
LibraryofCongressCataloging‐in‐PublicationData
Adamson, Peter, 1946Aesthetic otoplasty : Thomas procedures in facial plastic surgery / Peter
A. Adamson, Jason A. Litner.
p. ; cm. — (Thomas procedures in facial plastic surgery)
Includes bibliographical references and index.
ISBN-13: 978-1-60795-129-2
ISBN-10: 1-60795-129-0
1. Otoplasty. 2. Surgery, Plastic. I. Litner, Jason A. II. Title. III. Series: Thomas procedures in facial plastic
surgery.
[DNLM: 1. Ear, External—surgery. 2. Reconstructive Surgical Procedures—methods. 3. Surgery, Plastic—
methods. WV 220]
RF127.A33 2011
617.9'5—dc23 2011013729
Notice: The authors and publisher have made every effort to ensure that the patient care recommended herein, including choice of drugs and drug dosages, is in accord with the accepted standard and practice at the time of publication.
However, since research and regulation constantly change clinical standards, the reader is urged to check the product
information sheet included in the package of each drug, which includes recommended doses, warnings, and contraindications. This is particularly important with new or infrequently used drugs. Any treatment regimen, particularly
one involving medication, involves inherent risk that must be weighed on a case-by-case basis against the benefi ts
anticipated. The reader is cautioned that the purpose of this book is to inform and enlighten; the information contained herein is not intended as, and should not be employed as, a substitute for individual diagnosis and treatment.
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Preface
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Otoplasty is often casually approached as a quick
and relatively painless procedure, but the surgeon
who is most knowledgeable understands the complexity of this ‘simple’ operation. Overcoming the
intrinsic cartilaginous spring of the native auricle
to reproduce a naturally symmetrical and stable
contour, remains a very challenging proposition.
Every good operation begins with a meticulous
assessment and assiduous operative planning.
Assurance of a satisfactory otoplasty result rests also
on fastidious execution of that plan with a view towards reinforcing the stability of the cartilaginous
auricular framework. Our graduated technique,
starting with conservative postauricular skin excision and conchal setback, and followed by antihelical shaping via precise suture placement, has
yielded exceedingly reproducible outcomes and a
high degree of patient satifaction in our hands. Supplementary adjustments can then be individualized
based on the persistent deformity noted. We reserve
cartilage-cutting techniques for the rare instance of
a densely thickened or infl exible cartilage that is refractory to cartilage-sparing manipulations.
A formula for enduring success with this
fascinating aesthetic procedure combines an appreciation for anatomic nuance with painstaking attention to detail and untiring intraoperative
reevaluation. The vast number of known otoplasty
methods is a tribute to the level of diffi culty involved in this procedure. The objective of this volume is to provide a critical and comprehensive
review of the state-of-the-art of our specialty as it
relates to cosmetic auricular surgery. It is our hope
that this information has been distilled to the extent that surgeons of every experience level may
fi nd some surgical pearls within these pages that
are of some use to their current and future practice
of otoplasty. Whatever the preferred maneuvers,
adherence to the goals and principles outlined in
this volume will help to circumvent the manifold
pitfalls associated with this challenging but rewarding operation.
Peter A. Adamson, MD, FRCSC, FACS
Jason A. Litner, MD, FRCSC
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Table of Contents
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Chapter 1 History and Philosophy .....................................................................1
Introduction ..................................................................................................................................................1
References ......................................................................................................................................................4
Chapter 2 Anatomy and Embryology................................................................. 7
Introduction ..................................................................................................................................................7
Auricular Histology .......................................................................................................................................7
Auricular Embryology ...................................................................................................................................8
Auricular Anatomy ........................................................................................................................................9
References ....................................................................................................................................................13
Chapter 3 Aesthetic Parameters and Specifi c Deformities ........................ 15
Introduction ................................................................................................................................................15
Auricular Deformities ..................................................................................................................................16
Specifi c Auricular Syndromes......................................................................................................................17
References ....................................................................................................................................................19
Chapter 4 Clinical Evaluation, Surgical Goals and
Psychological Implications ................................................................................ 21
Introduction ................................................................................................................................................21
Physical Examination ..................................................................................................................................21
Photographic Assessment ............................................................................................................................22
Surgical Goals ..............................................................................................................................................22
Psychological Implications and Timing of Surgery ....................................................................................25
References ....................................................................................................................................................27
Chapter 5 Marking, Infi ltration, and Soft Tissue Management .............. 29
Introduction ................................................................................................................................................29
Surgical Technique .......................................................................................................................................30
References ....................................................................................................................................................34
viii / Table of Contents
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Chapter 6 Cartilage Management ................................................................... 35
Introduction ................................................................................................................................................35
Surgical Technique .......................................................................................................................................36
References ....................................................................................................................................................43
Chapter 7 Adjunctive Procedures: Management of the Helix,
Scapha, and Lobule ................................................................................................45
Introduction ................................................................................................................................................45
Surgical Technique .......................................................................................................................................45
References ....................................................................................................................................................53
Chapter 8 Closure, Dressings, and Postoperative Care ..............................55
Introduction ................................................................................................................................................55
Surgical Technique .......................................................................................................................................55
References ....................................................................................................................................................62
Chapter 9 Selected Cartilage-Cutting Otoplasty Techniques ................63
Peter A. Adamson and Jason A. Litner
Introduction ................................................................................................................................................63
Surgical Technique .......................................................................................................................................63
References ....................................................................................................................................................71
Chapter 10 Selected Cartilage-Scoring Otoplasty Techniques ...............73
Introdution ..................................................................................................................................................73
Surgical Technique .......................................................................................................................................74
References ....................................................................................................................................................85
Chapter 11 Selected Small Incision and Incisionless
Otoplasty Techniques ..........................................................................................87
Introduction ................................................................................................................................................87
Surgical Technique .......................................................................................................................................87
References ....................................................................................................................................................94
Chapter 12 Selected Cartilage-Suturing Otoplasty Techniques .............95
Introduction ................................................................................................................................................95
Surgical Technique .......................................................................................................................................95
References ..................................................................................................................................................100
Chapter 13 Selected Combination Otoplasty Techniques ......................... 101
Introduction ..............................................................................................................................................101
Surgical Technique .....................................................................................................................................101
References ..................................................................................................................................................114
Chapter 14 Comparison of Otoplasty Techniques .......................................117
Introduction ..............................................................................................................................................117
Surgical Technique .....................................................................................................................................117
References ..................................................................................................................................................121
Table of Contents / ix
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Chapter 15 Complications of Otoplasty ....................................................... 123
Introduction ..............................................................................................................................................123
Early Complications ..................................................................................................................................124
Late Complications ....................................................................................................................................129
References ..................................................................................................................................................132
Chapter 16 Aesthetic Pitfalls in Otoplasty .................................................135
Introduction ..............................................................................................................................................135
General Aesthetic Pitfalls ...........................................................................................................................135
Specifi c Technical Aesthetic Pitfalls ...........................................................................................................141
Reverse Telephone Ear Deformity .............................................................................................................141
References ..................................................................................................................................................144
Index ...................................................................................................................... 147
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