China
Africa
Explore chapters and articles related to this topic
Local Infiltration Anesthesia
Published in Marwali Harahap, Adel R. Abadir, Anesthesia and Analgesia in Dermatologic Surgery, 2019
Christie T. Ammirati, George J. Hruza
Infiltration of anesthesia around the base of the ear anesthetizes the auriculotemporal branch of the trigeminal nerve (V3), the greater auricular (C2, C3), and lesser occipital (C2, C3) nerves. This blocks the sensation of the external ear, with the exception of the conchal bowl, external auditory canal, and postauricular sulcus. These regions are supplied by branches of cranial nerves VII, IX, and X and must be injected directly to obtain reliable anesthesia. To perform this block, the needle is inserted at the inferior auricular sulcus, near the attachment of the lobe. Anesthetic is infiltrated anterosuperiorly toward the tragus in the subcutaneous plane. The needle is then withdrawn and redirected posterosuperiorly along the postauricular sulcus. Anesthetic is sequentially infiltrated toward and across the superior auricular sulcus. Next, the needle is placed at the tragus and the anesthetic is infiltrated superiorly along the preauricular sulcus to completely encircle the ear. Branches of the temporal artery lie within the path of infiltration, and care must be taken to avoid them. Lastly, the concha and external auditory canal must be anesthetized directly to complete the block.
Aesthetic
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Preauricular Pretragal usually safer and faster. For men, the sideburn area will be distorted; the alternative would be to place the incision more anteriorly, which would be more visible.Retrotragal – scar is hidden but may evert/alter contour of tragus, with risk of necrosis.
Surgical Rejuvenation of the Ageing Face
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Gregory S. Dibelius, John M. Hilinski, Dean M. Toriumi
After tightening the SMAS, the skin flap advances easily over the face. The postauricular skin is pulled superiorly and slightly anteriorly, whereas the preauricular skin is pulled superiorly and slightly posteriorly. The postauricular skin is temporarily anchored at its superior margin with staples. Similarly, the superior margin of the preauricular skin is anchored to the temporal hairline. After careful measurement, the excess skin is sharply trimmed. The tragal skin flap should be thinned sufficiently to allow natural redraping over the cartilage. It is imperative to avoid excess skin tension as displacement of the tragus can easily result. Meticulous care should be taken to realign the occipital and temporal hairline.
Total auricular reconstruction concomitant with BONEBRIDGE implantation using a retrosigmoid sinus approach
Published in Acta Oto-Laryngologica, 2022
Danni Wang, Bingqing Wang, Ran Ren, Yue Wang, Jinsong Yang, Peiwei Chen, Shouqin Zhao, Qingguo Zhang
General anesthesia was selected. Stage III of the auricular reconstruction was first performed by the plastic surgical team. The residue was cut open, and the deformed auricular cartilage was removed to reconstruct the tragus. The flap on the surface of residual ear was translocated and connected to the lower part of the reconstructed auricle to create the auricular lobule. The residual soft tissue was removed to deepen the cavity of the auricular concha. Secondly, the previous scalp incision for expander incision was used for BONEBRIDGE implantation (see Figure 2). Lower margins of temporal muscle and the mastoid periosteum were raised forward, and a triangular incision was fabricated to expose the mastoid cortex. An implant bed for the bone conduction-floating mass transducer (BC-FMT) was drilled based on preoperative 3D plan. The implant was secured in place with 2 titanium screws. For patients with extensive dura exposure, Lifts of 2–3 mm could be used to reduce compression on the dura (see Table 1 for specific information). The incision was closed by layers, and then compression dressing was applied around the implant. Mild compression dressing was used on the reconstructed auricle.
Endoscopic transtympanic cartilage push-through myringoplasty without tympanomeatal flap elevation for tympanic membrane perforation
Published in Acta Oto-Laryngologica, 2021
EPM without tympanomeatal flap elevation was performed using a standard 0-degree 11/14 cm rigid endoscope with a diameter of 2.7/3.0 mm under general anesthesia. Cartilage graft with perichondrium on one side was harvested from the ipsilateral tragus. The cartilage graft was trimmed to be about 1–2 mm wider than the diameter of the perforation, and the connected perichondrium was at least 2 mm larger than the cartilage. A notch was cut in the cartilage, but not in the perichondrium, to accommodate the exposed malleus handle, if any. The edge of the perforation was deepithelized, and the middle ear, especially the eustachian tube orifice, was tightly packed with Gelfoam to the level of the perforation to prevent the graft from shifting. The cartilage graft was pushed through the perforation directly with the connected perichondrium facing outward and was placed in the inner side of the remnant tympanic membrane without tympanomeatal flap elevation. The external auditory canal was filled with Gelfoam to the tragus incision. All patients were followed up in the ear outpatient department 2 weeks, 1 month, 3 months after the surgery.
Comparison of clinical outcome between endoscopic and postauricular incision microscopic type-1 tympanoplasty
Published in Acta Oto-Laryngologica, 2021
Yonglan Zhang, Wei Wang, Kaixu Xu, Ming Hu, Yuanxu Ma, Peng Lin
The affected ear was lifted upwards. An incision (∼1 cm) was made in the longitudinal direction at the inner edge of the tragus. The medial perichondrium of the tragus (about 1.5 cm × 1.0 cm) was excised. The incision in the tragus was sutured. Under the otoscope, a graft bed was made at the border of the perforating hole of the TM. Local anesthesia was induced at the junction of the bone and cartilage of the posterior wall of the ear canal. At 3–4 mm from the TM ring, a circular knife was used to cut the EAC skin in a U-shape. The tympanomeatal flap was elevated. The TM was separated from the surface of the handle of the malleus if the perforation was at the front or if the perforation was large. The tympanic cavity, eustachian ostium, and ossicular chain were explored. The perichondrium of the tragus was placed under the perforation margin of the TM through the TM. The perichondrium of the tragus was placed between the handle of the malleus and the TM if the perforation was at the front or if the perforation was large. The TM was filled with gelatin sponge for support. The tympanomeatal flap of the auditory canal was restored. The lateral auditory canal was filled with NasoPore bioresorbable dressing (Stryker, Kalamazoo, MI).