Symposium on deformities of the external ear. Foreward.
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All ears are different, and the degree of difference within the bounds of acceptability is remarkable. To that end, the keys to construction, reconstruction, or modification must be observed in order to mold an ear that "looks right." Simply stated, these keys are as follows: The ear is a flap approximately 50 to 60% as wide as it is high, sitting back one earlength (6.5 to 7.5 cm) from the lateral orbital rim, with the top of the ear level with the brow inclined approximately 20 degrees and protruding 1.5 to 2.0 cm from the head. It is composed of five critical elements: concha, helix, antihelix, tragus, and lobule, and parts of lesser importance including antitragus, intertragic notch, and Darwin's tubercle. The subtleties of form and proportion of its features will be revealed by careful observation and study.
Ears amputated as part of scalping injuries have a good chance of survival in favorable circumstances. Survival of subtotally amputated ears is probably enhanced materially by arterial repairs. One experience with a completely avulsed ear that was replaced with two arterial repairs and no vein repairs showed initial perfusion, but eventually failed.
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The effect of uni- and bilateral denervation of muscles of the pinna on the audio-visual targeting reflex reinforced by food was studied. In comparison with the normal group the unilaterally denervated animals showed a decreased capacity to localize sound sources placed behind the animal ipsi- and contralaterally to the operated side. The denervation of the second ear in these animals induced a further decrease of the localization scores, especially of the sources placed behind them. The localization behavior strategies were different depending on the integrity of the innervation of muscles of the pinna. The stimulation of the operated side with tones of a 30 dB higher intensity than in the normal side did not improve the animalsperformance in localizing the sound sources. The shortening of duration from 500 to 50 ms reduced, the capacity to localize the loudspeakers placed ipsilaterally to the denervated side, especially those behind the animal. The role for the targeting reflex of the feedback information from the muscles controlling the pinna movements, and the significance of the postural changes induced by the tone are discussed.
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The concha of the auricle is frequently affected by deep burns, especially when it is due to contact with flame. In similar cases the goal of operative treatment is to arrest as early as possible the development of the inflammatory process in the cartilage. In case of central localization of the lesion the necrotically altered skin and cartilage is removed, and the resulting defect is resurfaced immediately or within a few days using a free skin graft. Treatment in case of marginal localization consists in incision along the edge followed by resection of the changed cartilage alone, and adaptation of the skin edges one to each other using several stitches and fixation to the head by means of a compression bandage. In severe burns with simultaneous central and marginal localization complete excision of necrotic cartilage and skin is performed, and the defect is covered by a free skin autograft immediately or within a few days.
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