๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Introduction
CHAPTER 41 Reconstruction of the
Ears
Joseph F. Sobanko Jeremy Etzkorn Thuzar M. Shin Christopher J. Miller
SUMMARY
Goals of auricular reconstruction include maintaining a patent external auditory
canal and restoring the projection and complex contours of the external ear.
The ear has highly variable topography but consistent silhouette and positioning.
Beginner Pearls
Canalicular cartilage creates the lateral external auditory canal (EAC) and must
remain patent.
Since the EAC is only 7 mm in diameter, any reduction in circumference from scarring
can diminish hearing.
Because the thin skin of the anterior ear adheres to the cartilage, flaps may be used to
mobilize the thicker, looser skin of the helical rim and posterior ear.
Expert Pearls
The oval contour of the free margin of the helical rim and earlobe, more so than the
complex topography of the anterior ear, influences perception of an ear as normal.
Minor variations in ear height or topography rarely impact cosmesis.
Helical rim advancement flaps are workhorse reconstructions for full-thickness, short
helical rim defects.
Donโt Forget!
Deep defects of the concha and antitragus can be reconstructed with an island pedicle
that pulls skin from the postauricular sulcus and mastoid areas into the defect.
Chondrocutaneous advancement flaps are useful for even large defects, relying on a
broad pedicle derived from the posterior auricular skin.
Pitfalls and Cautions
Always take time to assess whether a patient regularly wears glasses, as recreating a
convenient and comfortable eyeglass resting place is important for patient comfort and convenience.
Meticulous suturing is helpful to avoid wound edge inversion along the helical rim that
could otherwise lead to clinically obvious notching.
Patient Education Points
Always gauge a patientโs willingness to undergo and recover from an extensive
procedure before it is initiated.
Some patients may prefer a small partial closure to a more involved and much larger
flap.
Warn patients against having their glasses repeatedly rub against nascent surgery sites
in the immediate postoperative period.
Billing Pearls
Random pattern single stage flaps on the ears are coded with 14060 or 14061, and
these codes include the excisional component; it is not appropriate to bill both an excision and a flap repair code simultaneously, except for Mohs excision codes.
When coding a flap, graft, or linear repair, medical necessity is the ultimate arbiter of
appropriateness.
CHAPTER 41 Reconstruction of the