INDEX
AAbnormal shape, 301 Absent lobule, 309
Acid splash, in acquired posttraumatic defects, 172
Acquired posttraumatic defect(s); see also Traumatic amputation acid splash in, 172 antitragus in, 158-159 auricular region fascial flap in, 167-168 burn in, 172, 175 in carcinoma excision, 158 case examples, 169-171 deformed contours in, 160 in electrocution, 172 extending beyond auricular region, 172176 in human bite, 158 indirect expansion in, 166-167 limited to ear, with good retroauricular skin, 157-167 limited to ear, with poor retroauricular skin, 167-171
missing contour analysis in, 158-159 in motor vehicle accident, 158, 172, 174 posterior wall of concha in, 161 prosthesis for, 240-241 random-pattern fascial flap in, 168, 171 skin approach in, 161-165 skin-only incision in, 163-165 superficial temporal artery fascial flap in, 168 tragus in, 158-159 transfixion incision in, 161-163
Adhesion correction of, 298 transfixion incision with, 6
Age minimum, for reconstruction, 83 prominent ear correction and, 321 Airway management, in Treacher Collins–Franceschetti syndrome, 93
Amputation surgical, 182
traumatic; see also Acquired posttraumatic defect(s) adaptation of skin to underlying framework in, 51 photography in, 23-24 projection piece for, 10 prosthesis for, 240-241 in secondary correction, 210-213
Analysis in acquired posttraumatic defects, 158-159 of auricular remnants in microtia, 98-101 modeling in, 99 of partial defects, 259-261 of prominent ears, 322-326
Anterior scoring, 336, 337
Antihelical root, relapse of, 335
Antihelix adding, to base, 14-15 in burns, 177 infection resulting in defect of, 338 minor anomalies in, 302-304 overly marked posterior root of, 49 in overly narrow conchal bowl, 48 partial defect of, 261 posterior root of, 310-312 in projection piece, 11-12, 19 in prominent ears, 322 in prosthesis placement, 248 in sculpting, 44-45 unfolded, 322-323
Antitragus carving, in first stage, 15 in projection piece, 13 in sculpting, 45 in trauma, 158-159
Arteriovenous malformation, of ear, 183-184
Asian patients helical root in, 18 retroauricular sulcus in, 74
Asymmetry contralateral procedures for, 147 facial, 125 zygomatic, 125-128
Atresiaplasty, 156
Atypical auricular remnants, in microtia, 101
Auditory canal, ectopic remnants and, 137-138
Auditory function device bone conduction, 155 indications for, 155-156 options for, 155-156 transcutaneous, 155 in Treacher Collins–Franceschetti syndrome, 94
Aural atresia, auditory function devices and, 155
Auricular fascial anatomy, 57-58
Auricular injury, in burns, 178-179
Auricular prosthesis; see Prosthesis
Auricular skin, preference for, 4
B Baha, 155
Bilateral aural atresia, auditory function devices and, 155
Bilateral microtia, overview of, 141
Bite dog, 237 human, 158, 262
Bone-anchored hearing aids, in Treacher Collins–Franceschetti syndrome, 94
Bone conduction hearing aid, 155
Brånemark implants, 248
Brent technique, 15, 58 modified, 68-69
Burn(s), 172, 175
bilateral auricular injury in, 178-179 chondritis in, 178 remnants in, 177 surrounding tissues skin graft in, 180-182
C
Cadaveric cartilage, in training, 20
Canal atresiaplasty, 156
Canalplasty, in secondary correction, 207
Carcinoma excision, 158
Cartilage cadaveric, in training, 20 conchal costal cartilage versus, 4 harvesting of, 4, 269-270 in partial defect repair, 263, 269-273 thoracic development and, 26-27 costal banking of, for second stage, 33 in children versus adults, 45 conchal cartilage versus, 4 different configurations of, 29-30 harvesting of, 26-27, 28, 30, 39-43
ipsilateral, 27, 30 ossification of, 24-25, 47-48 in partial defect repair, 263, 273-280 with perichondrium, 28 positioning, for framework, 32-34 in preoperative consultation, 24-25, 26-34 thoracic development and, 26-27, 29 unusual segment configurations with, 34 pig, in training, 20 preference for, over skin-only flaps, 4 quality, 45-48 selection, 26-34
Case examples of acquired posttraumatic defects, 169-171 of complications, 340-343
Cervical spinal cord malformations, 129
Children costal cartilage in, 45 minimum age of, for reconstruction, 83 prominent ears in, 321
Chondritis after piercing, 158 in burns, 178
Chondroepidermal pouch, in hemifacial microsomia, 86-89 Clay, in training, 20 Cleft lobule, 307 Clobetasol, 253 Cochlear Vistafix, 248 Complementary stages, 147-150 Complex facial malformations, 95, 135
Complication(s) after first stage, 215-218, 224-232 after second stage, 218-219, 232-237 with anterior scoring, 336, 337 antihelical root relapse as, 335 case examples, 340-343 exposure as, 227-231 extruded wire sutures as, 220-221 facial nerve palsy as, 234 fascial failure as, 232-233 fighting and, 234-237 flap failure as, 232-233 fracture of framework as, 232 framework fracture as, 232 graft failure as, 218-219, 232-233 incisural inflammation as, 218 infection as, 224-226, 338 keloid as, 222 long-term, 219-223 necrosis as, 215-217 overset-back ears as, 339 partial defects as result of, 338 psychological aspect of, 337
severe, 224-237 small, 215-223
sulcus retraction as, 222-223 temporal scarring as, 219-220
Computed tomography (CT), in preoperative consultation, 24-25
Concha in acquired posttraumatic defects, posterior wall of, 161 hypertrophy of posterior wall of, 324-325, 330 in projection piece, 11-12 small, 314 valgus of, 323-324, 330
Conchal bowl in conchal cartilage harvesting, 270 deepening of, 149-150 overly narrow, 48 partial defect in posterior wall of, 280
Conchal cartilage
costal cartilage versus, 4 harvesting of, 4, 269-270 in partial defect repair, 263, 269-273
Conchal-type microtia, 101 atresiaplasty in, 156 projection piece in, 10 small, 100
Constricted ear, 298-300
Contralateral procedures, for symmetry, 147
Costal cartilage
banking of, for second stage, 33 in children versus adults, 45 conchal cartilage versus, 4 different configurations of, 29-30 harvesting of, 26-27, 28, 30, 39-43 ipsilateral, 27, 30 ossification of, 24-25, 47-48 in partial defect repair, 263, 273-280 with perichondrium, 28 positioning, for framework, 32-34 in preoperative consultation, 24-25, 26-34 quality, 45-48
thoracic development and, 26-27, 29 unusual segment configurations with, 34
Cryptotia, 313-314
Cultural differences, sulcus procedure choice and, 74
D
Deep temporal fascia, 58
Dog bite, 237
Doppler mapping, in preoperative consultation, 25
Doppler ultrasonography, in preoperative preparation, 37
Drawing of landmarks, 35-36
Dressing for retroauricular sulcus reconstruction, 76 for scalp skin harvesting, 55-56
E
Ear mold, 76
Ear nose and throat (ENT) consultation, 26
Ear piercing after reconstruction, 153 chondritis after, 158 in first stage of reconstruction, 152 framework reduction in, 153 importance of, 150-151 partial defect after, 271 retention of existing, 151 in second stage of reconstruction, 152-153 transcartilaginous, 154 unusual, 289
Ear reconstruction age for, minimum, 83 of both ears in one stage, 142 complementary stages in, 147-150 contralateral, for asymmetry, 147 cultural differences in, 74 first stage adaptation of skin to underlying framework in, 51 cartilage sculpture in, 43-45 complications after, 215-218, 224-232 photography in, 23-24 piercing in, 152 postoperative follow-up in, 52 preoperative consultation in, 23-26 preoperative preparation in, 35-38 secondary reconstruction after, 196-199 second stage and, 73-74, 79 patient preferences in, 75 principles of, 4 second stage auricular fascia anatomy in, 57-58 cartilage banking for, 33 complications after, 218-219, 232-237 dressing in, 76 ear mold after, 76 expanded skin in, 80 first stage and, 73-74, 79 framework elevation in, 63-64 hair on helix in, temporal fascia for, 67 mastoid fascial flap in, 69-70 in microtia surgical classification system, 123
Ear reconstruction—cont’d second stage—cont’d
modified Brent’s technique in, 68-69
Nagata’s technique in, 59 objectives of, 53 piercing in, 152-153
postoperative considerations in, 76-77
refinements in, 77-79
retroauricular skin advancement in, 65-67
retroauricular sulcus in, 53-80 scalp skin in, 54-56
secondary correction after, 200-206 sulcus reconstruction potions in, 57 superficial temporal artery in, 62-63
temporal fascia elevation in, 64-65
temporal fascia skin coverage in, 65-67
temporofascial flap in, 60-67
tunneling in, 71-72
three stage, 144-145
ultimate goal of, 3
Ectopic remnants; see also Remnants with auditory canal, 138 without auditory canal, 137 in microtia, 137-140 very, 139-140
Elderly patients, prosthesis in, 246
Electrocution, 172
Epidermolysis bullosa, 185
Epilation for low hairline, 135 in partial defects, 283
Excess skin, in microtia, 118-122
Expanded skin direct, 190-191 indirect in acquired posttraumatic defects, 166-167 in secondary correction, 203 in retroauricular sulcus construction, 80
Exposure, as complication, 227-231
Extruded wire suture as complication, 220-221 removal of, 52
F
Facial asymmetry, 125-128
Facial malformations, complex, 95, 135
Facial nerve palsy, 234
Fascial flaps; see also specific flaps failure of, 232-233 in secondary correction, 204-206
Fascial layer anatomy, auricular, 57-58
Fighting, 234-237
Firmin’s classification, of skin approach, 8
Firmin trainer, 20
Flap(s) in acquired posttraumatic defects, 167-168 failure of, 232-233
mastoid fascial, in retroauricular sulcus construction, 69-70 occipital fascia, in secondary correction, 205 random-pattern fascial in acquired posttraumatic defects, 168, 171 in secondary correction, 206 superficial temporal artery fascial, in acquired posttraumatic defects, 168 temporofascial in retroauricular sulcus reconstruction, 60-67 in secondary correction, 204 temporoparietal fascial, 8 anatomy, 58 technique, 60-67
Framework adaptation of skin to underlying, 51 classification, 9-13 complete, 9 complications with, 232 evolution of, 14-19 fracture, 232 in microtia surgical classification system, 123 in piercing, reduction of, 153 positioning of costal cartilage pieces for, 32-34 projection pieces, 9-13 thickness of, after elevation, 50 without tragus, 9 without tragus and antitragus, 9 Functional considerations, 155-156 Functional surgery for hearing, 145-146 secondary correction and, 207
G
Genetics, in microtia, 96-98
Giant melanocytic nevus, 182-183
Glasses, facial asymmetry and, 126-128
Goldenhar syndrome; see Hemifacial microsomia (HFM)
Graft failure, 218-219, 232-233
H
Habits, strange, 287
Hairline
laser hair removal for, 135 in microtia, 132-135 in Treacher Collins–Franceschetti syndrome, 90, 93
Hair removal for low hairline, 135 in partial defects, 283
Harvesting conchal bowl in, 270 of conchal cartilage, 4, 269-270 of costal cartilage, 26-27, 28, 30, 39-43 of scalp skin, 54-56 transverse muscle incision in, 40 vertical transaponeurotic approach in, 41-43
Hearing, previous functional surgery for, 145146
Hearing aids bone-anchored, in Treacher Collins–Franceschetti syndrome, 94 bone conduction, 155 indications for, in microtia, 155 options for, 155-156 transcutaneous, 155
Helical rim, in burn patients, 177
Helical root in Asian patients, 18 evolution of, 18-19 in projection piece, tragus and, 9-10
Helix adhesion of, 298 in constricted ear, 298-300 costal cartilage for, 27-28 hair on, temporal fascia to excise, 67 infection resulting in defect of, 338 lengthening, 17 minor anomalies in, 293-298 partial defect of, 259, 260 pointed, 295 in sculpting, 44, 48 transfixion excision of, 311 unfolded, 294, 296-297
Helmet, for prosthesis wearers, 253
Hemifacial microsomia (HFM) chondroepidermal pouch in, 86-89 genetics in, 97 hairline in, 132, 134 mandibular hypotrophy in, 130 mastoid hypoplasia in, 130 overview of, 85-89 preauricular sideburn in, 86 projection piece in, 13 secondary correction in, 148 superficial temporal artery in, 87 very ectopic remnants in, 139-140 zygomatic asymmetry in, 126
Human bite, 158, 262
Hypertrophic lobule, 308
Hypertrophic scar, 222
IImplants, in prosthesis placement, 247-252
Incision in costal cartilage harvesting, 39-41 decision on, 5 in Firmin’s classification, 8 in microtia, 102-113 skin-only, 7-8, 108-113, 163-165 in temporoparietal fascial flap, 8 transfixion, with adhesion, 6, 105-107, 161163
Z-plasty, 6
Incisural inflammation, as complication, 218
Indirect skin expansion in acquired posttraumatic defects, 166-167 in secondary correction, 203
Infection, as complication, 224-226, 338
Inflammation
incisural, as complication, 218 in prosthesis placement, 253
Innominate fascia, 58
Isolated microtia genetics in, 96 overview of, 84
K
Keloid as complication, 222 in partial defect secondary correction, 284 Kirkham technique, 149-150
LLandmarks drawing of, 35-36 in prosthesis placement, 247
Laser hair removal for low hairline, 135 in partial defects, 283
Lobular transposition, 102-105
Lobular-type microtia, 100, 133 complete framework for, 12 projection piece in, 12
Lobule absent, 309 anomalies, 305-309 cleft, 307 hypertrophic, 308 in partial defect, 278-279 in projection piece, 13 in prominent ears, 325-326
Lobule implantation point, immobile, 104-105
Long-term complications, 219-223
M
Malformations; see also Microtia
cervical spinal cord, 129 complex facial, 95, 135
Mandibular hypoplasia, 12
Mandibular hypotrophy, 130
Mastoid bone, in prosthesis placement, 248
Mastoid fascial flap, in retroauricular sulcus construction, 69-70
Mastoid hypoplasia, 130
Mastoid process, hypoplastic, 13
Mastoid skin flap, poor vascularization of, 103
Meatal stenosis, 187
Melanoma, 27, 283
Microtia
analysis of auricular remnants in, 98-101 atypical remnants in, 101 atypical skin approaches in, 117-118 auditory function devices in indications for, 155 options for, 155-156 bilateral, overview of, 141 canal atresiaplasty in, 156 cervical spinal cord malformations and, 129 in complex facial malformations, 95 conchal bowl deepening in, 149-150 conchal-type, 101 atresiaplasty in, 156 projection piece in, 10 small, 100 context of, 83-98 ectopic remnants in, 137-140 excess skin in, 118-122 facial asymmetry and, 125 functional considerations in, 155-156 genetics in, 96-98 hairlines in, 132-135 in hemifacial microsomia, 85-89 isolated genetics in, 96 overview of, 84 lobular transposition in, 102-105 lobular-type, 100, 133 complete framework for, 12 projection piece in, 12 lobule implantation point immobility in, 104105
mandibular hypoplasia and, 12
mandibular hypotrophy and, 130 mastoid hypoplasia and, 130 mastoid skin flap vascularization in, 103 piercings in, 150-154
and previous functional surgery for hearing, 145-146
prosthesis in, 242-243 secondary correction in, 147-148 skin approach in, 102-113 skin-only incision in, 108-113 superficial temporal artery in, 136 surgical classification system for, 123-124 tragus projection in, 149 transfixion incision with adhesion in, 105-107 in Treacher Collins–Franceschetti syndrome, 90-94
zygomatic asymmetry and, 125-128
Microtrauma, 287-288
Middle ear implant, transcutaneous, 155
Minor anomalies
abnormal shape, 301 aesthetic variations in, 292 in antihelix, 302-304 constricted ear, 298-300 helical adhesion, 298 in helix, 293-298 unfolded helix, 296-297 of upper ear, 293-304 in upper third, 292
Modeling in auricular defect analysis, 99 in preoperative consultation, 24 in Ten Commandments, 4 Modified Brent technique, 68-69 Motor vehicle accident, 158, 172, 174
N
Nagata’s technique, 59
Necrosis, as complication, 215-217
Nerve palsy, facial, 234
Nevus, giant melanocytic, 182-183
O
Occipital fascia, in secondary correction, 205
Oculoauriculovertebral spectrum, 85
OMENS, 85
Operative field establishment, 38
Oriental cultures, retroauricular sulcus in, 74; see also Asian patients
Ossification, of costal cartilage, 24-25, 47-48
Osteointegrated implants, in prosthesis placement, 247-252
Otomandibular syndrome; see Hemifacial microsomia (HFM)
Otoplasty; see Ear reconstruction
Overset-back ears, 339
PPangen, for scalp skin harvesting, 56
Partial defect(s) analysis of, 259-261 anatomic subunits in, 261 complications resulting in, 338 conchal cartilage in, 263, 269-273 costal cartilage in, 273-280 demonstrative cases in, 271-272 epilation in, 283 keloid in, 284 in lobule, 278-279 in lower third, 278-279 in middle third, 275-277 one- versus two-stage repair of, 266-267 pitfalls to avoid with, 272-273 in posterior wall of conchal bowl, 280 secondary correction in, 281-282 support choice for, 262-266 in upper third, 273-275
Patient motivation, prosthesis and, 244
Patient preferences, in retroauricular sulcus construction, 75
Pediatric patients costal cartilage in, 45 minimum age of, for reconstruction, 83 prominent ears in, 321
Photography, in ear reconstruction, first stage, 23-24
Piercing after reconstruction, 153 chondritis after, 158 in first stage of reconstruction, 152 framework reduction in, 153 importance of, 150-151 partial defect after, 271 retention of existing, 151 in second stage of reconstruction, 152-153 transcartilaginous, 154 unusual, 289
Pig cartilage, in training, 20
Pointed ear, 295
Postburn chondritis, 178; see also Burn(s)
Postoperative considerations, in retroauricular sulcus reconstruction, 76-77
Postoperative follow-up in ear reconstruction, first stage, 52 extruded wire suture in, 52 thoracic scar in, 52
Posttraumatic defects, acquired; see Acquired posttraumatic defect(s)
Preauricular sideburn in hemifacial microsomia, 86 in Treacher Collins–Franceschetti syndrome, 90, 91
Preoperative consultation cartilage selection in, 26-34 computed tomography in, 24-25 costal cartilage in, 24-25 Doppler mapping in, 25 in ear reconstruction, first stage, 23-26 with ENT specialist, 26 modeling in, 24 photography in, 23-24
Preoperative preparation Doppler ultrasonography in, 37 drawing landmarks in, 35-36 in ear reconstruction, first stage, 35-38 operative field establishment in, 38 in temporofascial flap, 62-63
Projection pieces antihelix and posterior wall of concha, 11-12 in framework classification, 9-13 helical root and tragus, 9-10 lobule and antitragus, 13 in mastoid hypoplasia, 130 in microtia surgical classification system, 123
Prominent ears as aesthetic variation versus congenital anomaly, 321 analysis of, 322-326 antihelical fold management in, 328 antihelix in, 322 complementary correction of, during otoplasty, 333-334 conchal posterior wall hypertrophy in, 324325, 330 conchal posterior wall reduction in, 331 correction of, 326-331 lobule in, 325-326 lobule position correction in, 329 posterior approach in, 327 results with, 332 scapha reduction in, 334 valgus of concha in, 323-324, 330
Prosthesis placement antihelix in, 248
Brånemark implants in, 248 Cochlear Vistafix in, 248 in elderly patients, 246 for failed reconstruction with difficult tissue conditions, 244-246 field preparation in, 248 indications for, 188, 239-246 inflammation after, 253 landmarks in, 247 long-term follow-up in, 254-255 maintenance of prosthesis and, 253 mastoid bone in, 248 in microtia, 242-243
Prosthesis placement—cont’d one stage, 248-251
osteointegrated implant placement with, 247252 in posttraumatic cases, 240-241 prosthesis in, 253 in secondary correction, 209, 242-243 technique for, 247-256 in two stages, 252 for unmotivated patients, 244
Pseudomonas, 224
R
Random-pattern fascial flap in acquired posttraumatic defects, 168, 171 in secondary correction, 206
Rare anomalies, 314-317
Rare skin pathology, 185
Reimplantation
sacrifice of retroauricular skin in, 188-189 secondary correction and, 285-286
Remnants in burns, 177 in microtia atypical, 101 ectopic with auditory canal, 138 without auditory canal, 137 in microtia, 137-140 very, 139-140
Retroauricular skin
acquired posttraumatic defect with compromised, 167-171 acquired posttraumatic defect with intact, 157-167 advancement, 65-67 sacrifice of, in reimplantation, 188-189
Retroauricular sulcus in cryptotia, 313-314 in partial defect, 266
Retroauricular sulcus graft, in conchal bowl deepening, 149-150
Retroauricular sulcus reconstruction in Asian patients, 74 cultural differences and, 74 ear mold after, 76 in ear reconstruction, 53-80 expanded skin in, 80 framework elevation in, 63-64 hair on helix in, temporal fascia for, 67 mastoid fascial flap in, 69-70 modified Brent’s technique in, 68-69 objectives with, 53
patient preferences in, 75 postoperative considerations in, 76-77 refinements in, 77-79
retroauricular skin advancement in, 65-67 scalp skin for, 54-56 sulcus reconstruction in, 57 sulcus retraction after, 222-223 superficial temporal artery in, 62-63 temporal fascia elevation in, 64-65 temporal fascia skin coverage in, 65-67 temporofascial flap in, 60-67 tunneling in, 71-72
Revision surgery; see Secondary correction
Rib cartilage; see Costal cartilage
S
Scalp skin cleaning, 76 harvesting of, 54-56 preference for, 54 in retroauricular sulcus creation, 54-56
Scapha, in constricted ear, 298-300
Scapha reduction, 334
Scar hypertrophic, 222 keloid, 222 overset-back ears and, 339 temporal, 219-220 thoracic, 52
Sculpting antihelix, 44-45 in ear reconstruction, first stage, 43-45 helix, 44, 48 technique, 44-45 training, 20-21
Secondary correction after first-stage reconstruction, 196-199 after second-stage reconstruction, 200-206 canalplasty in, 207 commandments of, 196 fascial flaps in, 204-206 indirect expansion in, 203 occipital fascia in, 205 overview of, 147-148, 195 in partial defects, 281-282 prosthesis in, 209, 242-243 reimplantation and, 285-286 temporal fascia in, 204 in traumatic amputation, 210-213 when local skin can by used, 201-202 when partial reconstruction is possible, 208
Severe complications, 224-237
Silicone block, 43 Silicone ear mold, 76
Skin approach in acquired posttraumatic defects, 161-165
atypical, 117-118 classification, 5-8 in microtia, 102-113 in microtia surgical classification system, 123
Skin cancer, of ear, 182
Skin necrosis, as complication, 215-217
Skin-only incision in acquired posttraumatic defects, 163-165 one stage, 7 two stages, 7-8
Skin pathology, rare, 185
Small conchal anomaly, 314
Spinal cord malformations, cervical, 129
Sports, microtrauma in, 287-288
Stahl ear, 310-312
Steroids, 253
Strange shape, 316
Subgaleal fascia, 58
Sulcus; see Retroauricular sulcus
Sulcus reconstruction, 57
Sulcus retraction, as complication, 222-223
Superficial temporal artery (STA), 37 in hemifacial microsomia, 87 in microtia, 136 temporofascial flap and, 62-63 trauma, 176 in Treacher Collins–Franceschetti syndrome, 90, 91-92
Superficial temporal artery fascial flap, in acquired posttraumatic defects, 168
Surgical amputation, 182
Suture extruded wire as complication, 220-221 removal of, 52 in sequestration of excess skin, 119
Synchondrosis, 45, 46
T
Temporal fascia
elevation, in retroauricular sulcus reconstruction, 64-65 to excise hair on helix, 67 in secondary correction, 204 skin coverage, in retroauricular sulcus reconstruction, 65-67
Temporal scarring, 219-220
Temporofascial flaps in retroauricular sulcus reconstruction, 6067 in secondary correction, 204
Temporoparietal fascia (TPF), 58 failure of, 233
Temporoparietal fascial flap, 8 anatomy, 58 technique, 60-67
Ten Commandments, 4
Thoracic development, costal cartilage and, 2627, 29
Thoracic scar, 52
Tissue expansion direct, 190-191 indirect in acquired posttraumatic defects, 166167 in secondary correction, 203 in retroauricular sulcus construction, 80
Tragal anomaly, 315
Tragus carving, in first stage, 15 evolution of, in framework, 16 improving projection of, 149 in projection piece, 9-10 in traumatic amputation, 158-159
Tragus-antitragus complex, in sculpting, 45
Training, to sculpt, 20-21
Transcartilaginous piercing, 154
Transcutaneous hearing device, 155
Transcutaneous middle ear implant, 155
Transfixion excision of helix, 311
Transfixion incision, with adhesion, 6 in acquired posttraumatic defects, 161163 in microtia, 105-107
Transverse muscle incision, in costal cartilage incision, 40
Traumatic amputation; see also Acquired posttraumatic defect(s) adaptation of skin to underlying framework in, 51 photography in, 23-24 projection piece for, 10 prosthesis for, 240-241 in secondary correction, 210-213
Treacher Collins–Franceschetti syndrome (TCF)
airway management in, 93 ear position in, low, 94 genetics in, 97-98 hairlines in, 93, 132 hearing aids in, bone-anchored, 94 multidisciplinary approach in, 93 overview of, 90-94 pathognomic features of, 90 preauricular sideburn in, 91
Treacher Collins–Franceschetti syndrome (TCF)—cont’d
secondary correction in, 148 superficial temporal artery in, 91-92
Tunneling, in retroauricular sulcus construction, 71-72
U
Ultrasonography; see Doppler
Umotivated patients, prosthesis for, 244
Unfolded helix, 294, 296-297
Unilateral aural atresia, auditory function devices and, 155