We are looking for a surgeon to remove the “hangers”. Atlas_Operative_Otorhinolaryngology How to remove the appendage of the auricle for a child

According to the World Health Organization, up to 15% of children are born with clear signs various developmental anomalies. However congenital anomalies may appear later, so in general the frequency of malformations is much higher. It has been established that in children born to older mothers, anomalies occur more often, since the older the woman, the greater the volume harmful effects external environment (physical, chemical, biological) on her body. Developmental anomalies in children born from parents with developmental anomalies are 15 times more common than in children born from healthy parents.

Congenital malformations of the outer and middle ear occur with a frequency of 1-2 cases per 10,000 newborns.

Inner ear appears already in the fourth week of embryo development. The middle ear develops later, and by the time the baby is born, the tympanic cavity contains jelly-like tissue, which subsequently disappears. The outer ear appears in the fifth week intrauterine development.

In a newborn, the auricle can be enlarged (hypergenesis, macrotia) or reduced (hypogenesis, microtia), which is usually combined with closure of the external auditory canal. Only some of its parts (for example, the earlobe) can be excessively enlarged or reduced. Developmental anomalies can be unilateral or bilateral and manifest themselves in the form of ear appendages, several auricles (poliotia). There are cleft lobes, congenital ear fistulas, and atresia (absence) of the external auditory canal. The auricle may be absent or occupy an unusual place. With microtia, it can be located in the form of a rudiment on the cheek (cheek ear), sometimes only the lobe is preserved auricle or a skin-cartilaginous roller with a lobe.

The auricle can be rolled, flat, ingrown, corrugated, angular (macaque ear), pointed (satyr ear). The auricle may have a transverse cleft, and the lobe may have a longitudinal cleft. Other defects of the lobe are also known: it can be adherent, large, or lagging. Combined forms of external ear defects are not uncommon. Anomalies in the development of the auricle and the external auditory canal are often combined in the form of its partial underdevelopment or complete absence. Such anomalies are described as syndromes. Yes, a developmental defect connective tissue, in which many organs are affected, including the ears, is called Marfan syndrome. There are congenital deformities of both ears in members of the same family (Potter syndrome), bilateral microtia in members of the same family (Kessler syndrome), and orbital-auricular dysplasia (Goldenhar syndrome).

For macrotia (increase in the size of the auricle), taking into account the variety of changes, a number of surgical interventions have been proposed. If, for example, the auricle is enlarged evenly in all directions, i.e., has an oval shape, excess tissue can be excised. Operations to restore the auricle in the absence of it are quite complex because skin is needed, and it is necessary to create an elastic skeleton (support) around which the auricle is formed. To form the skeleton of the auricle, rib cartilage, cartilage of the auricle of a corpse, bone and synthetic materials are used. The ear pendants located near the auricle are removed along with the cartilage.

Among the anomalies in the development of the external auditory canal are its atresia (usually in combination with an anomaly in the development of the auricle), narrowing, bifurcation and closure by a membrane.

Updated: 2019-07-09 23:40:07

The World Health Organization has found that the peoples of the Mediterranean (Sicily) suffer from certain types of cancer 100 times less often,

12.10.2011, 22:40

Dear surgeons, hello! Help me find the truth! I have a daughter - 3.5 months old! She was born with rudiments on both ears. On the left there are, as it were, two droplets at the ear canal - without cartilage tissue, and on the right there is a droplet on the earlobe and a thing at the ear canal that affects the ear canal (I’m not sure, I call it correctly, but in general there is clearly cartilage there it needs to be removed and probably undergo plastic surgery - although I am far from surgery or medicine in general, these are just my suspicions)!
Tell me, at what age can this (delete) be done!??? Interested - the most early age! In Filatovskaya, a certain Khusainov said that let your girl come to me herself and say that this is bothering her, then I will remove it, before that I will not touch the child! Simashko said - the sooner the better - you can do without general anesthesia while the child still doesn’t understand anything! (I suspect that there is no way with the right ear without general anesthesia)! In Children's City Clinical Hospital No. 2 they were told to come back after a year, then they will be removed!
Tell me when and why exactly then these rudiments can be removed!
I really want it to go faster - it’s very ugly! But definitely stuff the child general anesthesia I’m not going unreasonably early!
I just want to hear at what age it is optimal to remove it and why at this age!
At 1.5 years old the girl will go to kindergarten - I’m afraid she’ll be teased! Children are cruel, you can’t explain it to them!
Help!

12.10.2011, 23:40

Most ear abnormalities are not disfiguring, not dangerous, and do not require intervention
I doubt that your panic and obsessive desire to cut off are justified
post a photo

13.10.2011, 10:48

I'll post a photo now! Definitely must be removed! It all looks ugly!

13.10.2011, 10:54

alas, I don’t know how to reduce the doses, but they are more than 4 mg!
but it looks terrible! I will delete it! The main thing is to understand at what age and what examinations to undergo before general anesthesia!

13.10.2011, 10:57

The number of exclamation points does not help the consultation. The easiest option to reduce photos is to post them on Radikal.ru, checking the “Reduce to 640 pixels” checkbox. There is no such thing as “general” anesthesia. It's just anesthesia. Healthy children do not need preliminary examinations before planned anesthesia for low-traumatic interventions.

13.10.2011, 11:09

Ear pendants themselves are not dangerous in any way. They are removed for cosmetic reasons. There is NO need to do this urgently.
Since this anomaly is possibly genetic, according to statistics, there is a possibility of a kidney anomaly. Therefore, there are recommendations, when a child is born with ear appendages, to perform an ultrasound of the urinary system.
PS. The recommendation was given on the forum earlier, when discussing a similar problem.
Since we have not seen the photo, it is quite possible that we are talking about preauricular papillomas, and this is not regarded as ear appendages.

13.10.2011, 12:07

These are just rudiments! A surgeon looked at us in the maternity hospital, and in the hospital - we were lying like premature babies - we were gaining weight, and in the children's clinic the surgeon and we also took her to Filatovskaya! Everyone said in unison that these are rudiments, they do not pose any danger, and you don’t have to remove them at all if you don’t want to!
But I want! Because it's a girl! because it doesn't look very nice! And I want to remove it as quickly as possible, so that no one has time to cause psychological trauma to her (I understand that she’s unlikely to understand anything until she’s 3-4 years old), I also would like for her not to remember this removal and not to be afraid of doctors , so I really would like to remove this for her at least when she’s a year old!
And my question is: is it possible to remove it in a year and what examinations need to be completed before removal, under anesthesia!?
If anyone answers, I will be very grateful!
And if someone sends me a link to a topic similar to mine, I will be immensely happy and grateful!

13.10.2011, 12:09

I’ll try to figure out how to reduce the photos and post them soon

13.10.2011, 12:24

I can “throw” a ban for flooding, because we don’t read, we only write (regarding examinations and anesthesia), and nothing but emotions has been written yet.
Moderator.

13.10.2011, 13:05

Why nothing but emotions! ? It even became offensive! I have a specific question! My 3.5 month old daughter has rudiments on her ears - 2 on the left and 2 on the right! I am interested in at what age (I would like as early as possible) to actually remove them, and what examinations need to be done before removal, before general anesthesia?
The fact that these are the rudiments was said by the surgeon in the maternity hospital (moniyag), in the hospital - they were lying due to prematurity, and in the Filatov hospital - they were specially taken to the surgeon about removal!

And about the fact that in this forum you can’t throw links to such topics - sorry, I didn’t know! It seemed to me that it was natural to want to read about a similar problem, draw some conclusions, and gain information! If the site had a good “search”, I might not have written my own post, but simply read all the available information on a problem similar to my one!

They did an ultrasound of everything in the world, including the kidneys - everything is fine, there are no problems in any area (ugh three times)

13.10.2011, 13:14

13.10.2011, 13:52

Yep, we started a discussion! :-)
Dear topicstarter, your concern is understandable. Photos would certainly make the consultation easier... Such formations can be removed at any age. They really do not have any effect on the growth and development of the child. From my own experience I can say that if the formations are on a thin stalk, then they can be removed under local anesthesia at the age of your child, but where plastic surgery is needed, general anesthesia is required, otherwise it will not work. If you wait until the child is older, then local anesthesia is generally impossible, the child will be larger, stronger and you will not be able to hold him, and he will not tolerate being in the wrong hands. Therefore, my advice is to remove everything at once under anesthesia closer to the year, so that the child is mature enough for these adventures. All the best!

How is it?

13.10.2011, 20:13

And isn’t it necessary to donate blood and do an ECG before the child is given anesthesia!? Or maybe she has an allergy - can this be checked somehow?
I’m just 33, this is my first and I think my only child! We got it using the IVF method! I'm really worried about her, she's everything to me!

14.10.2011, 07:43

Is a one-year-old child really mature enough for general anesthesia?
And isn’t it necessary to donate blood and do an ECG before the child is given anesthesia!?

In my opinion, a one-year-old child will be quite mature for such an operation. Of course, before a planned operation, your child will be given a serious examination, including blood tests, an ECG and a number of other items. Allergy preparedness for anesthesia drugs is not carried out, but there is no need to worry about this.
And - a separate opinion from my father - save your emotions for more serious problems, from which no one is safe. You are completely unnecessarily worried about simple preauricular processes. Your task is to turn to competent specialists; they are in the list of consultants you provided. And they will do everything as it should, without problems for your child. All the best!

EXTERNAL EAR [auris externa(PNA, JNA, BNA)] - part of the hearing organ, consisting of the auricle and external auditory canal. Phylogenetically develops in connection with the emergence of animals on land as an adaptation to air conduction of sounds.

Embryology

The outer ear begins to form in the embryo at the end of the 1st month. from the elements of the first (maxillary) and second (hyoid) arches and the first pharyngeal groove. In an embryo measuring 12 mm, three tubercles appear at the dorsal ends of these arches, more pronounced on the hyoid train. In an embryo measuring 18 mm, the tubercles of the jaw arch merge into a single thickening, from which the tragus develops. By fusion of the more developed tubercles of the hyoid arch, the rest of the auricle is formed, with the exception of the tragus. Most of the external auditory canal is formed from the first pharyngeal groove; by the end of the 2nd month. During embryogenesis, the ectoderm of the bottom of the first pharyngeal groove grows into the location of the future tympanic cavity, separated from it by a layer of compacted mesoderm (with the handle of the malleus developing in it), lined from the inside with endoderm, and on the outside by ectoderm.

Anatomy

The auricle (auricula) forms an angle of approx. 30° with the side surface of the head; on its lateral surface there are elevations and depressions (Fig. 1). The most pronounced depression is the conch of the ear (concha auriculae), the edges are divided by a protrusion - the leg of the helix (crus helicis) into upper and lower parts; the latter directly continues into the external auditory canal. The helix (helix), forming a thickening of the free edge of the auricle, borders it in front, above and behind. Near the transition of the upper part of the curl to the descending part, a tubercle (tuberculum auriculae) stands out. Anterior to the descending segment of the helix, a second elevation is noticeable - the antihelix (anthelix), from which the diverging legs (crura anthelicis) continue upward, limiting the triangular fossa (fossa triangularis). The helix is separated from the antihelix by a longitudinal groove - the scapha.

In front, the concha of the ear is covered by a tongue-like protrusion - the tragus; slightly lower and posteriorly the antitragus stands out, separated from the tragus by the intertragus notch (incisura intertragica). Below the notch is the earlobe, or ear lobe (lobulus auriculae), the edges do not have a cartilaginous base. Elevations on the medial surface of the auricle correspond to depressions on the lateral surface. The auricle has gender, age and individual characteristics: in women it is thinner and smaller in size than in men; in a newborn it is 1/3 the size of an adult’s ear; in old age it becomes wider and longer.

The muscles of the auricle in humans are poorly developed and have no function.

The cavity of the auricle, deepening like a funnel, passes into the external auditory canal (meatus acusticus ext.), ending with the eardrum. The length of the ear canal in an adult is on average 24 mm, dia. 7 mm. According to the oblique position of the eardrum, the anterior and lower walls of the external auditory canal are longer than the upper and posterior ones. The external auditory canal (Fig. 2) consists of a lateral (cartilaginous) part, 8 mm long, and a medial (bone) part, 16 mm long. The external auditory canal is tortuous and can be divided into three segments: lateral, intermediate and medial. The lateral segment has a bend, the convexity is directed forward and slightly upward, the convexity of the bend of the intermediate segment is directed backward, the medial segment is directed forward and slightly downward. In a cross-section, the external auditory canal has the shape of an ellipse with the largest diameter in the direction from top to bottom and posteriorly. Starting from the auricle, the external auditory canal gradually narrows to the medial end of the cartilaginous part; at the beginning of the bony part it widens, and then narrows again at its medial end.

The narrowest segment of the external auditory canal, called the isthmus, is located at a distance of 20 mm from the bottom of the concha; the medial end, which has a rounded shape, is closed by the tympanic membrane (see).

In the anteroinferior wall of the cartilaginous part of the external auditory canal there are fissures made of fibrous connective tissue (Santorini). Thanks to the presence of gaps, greater mobility of the external auditory canal and auricle is created. Through these cracks it can spread inflammatory process from the external auditory canal to the parotid gland and vice versa. The external auditory canal is widest when the mouth is opened. Most of the head lower jaw lies in front of the bony part of the external auditory canal, only a small section of it borders on the cartilaginous part, to which the parotid gland is directly adjacent; posterior to the bony part of the external auditory canal are air cells mastoid process temporal bone.

Blood supply The external ear is carried out by the branches of the superficial temporal (a. temporalis superficialis) and posterior auricular (a. auricularis post.) arteries; the veins flow into the posterior auricular and maxillary veins (v. auricularis post, and v. retromandibularis). Lymph flows to the anterior and posterior ear nodes (nodi lymphatici auriculares ant. et post.). Motor innervation of the muscles of the auricle is carried out by branches facial nerve. The auricle is supplied with sensory nerves by the auriculotemporal and greater auricular nerves (n. auriculotemporalis and n. auricularis magnus); sensitive branches The vagus and auriculotemporal nerves give off to the skin of the external auditory canal.

Histology

The base of the auricle is formed by elastic cartilage, rich in cells; the skin of the auricle is thin, smooth, with a poorly developed layer of epidermis and unevenly expressed papillae, on the lateral surface tightly fused with the underlying perichondrium. Continuing deeper, the skin lines the walls of the external auditory canal in the form of a tube.

It is up to 2 mm thick in the initial part of the ear canal and becomes thinner in its depth.

On the medial surface of the auricle, the skin is mobile due to a well-developed subcutaneous base. In the area of the concha and the triangular fossa, the skin contains greatest number sebaceous glands; sweat glands concentrated on the medial surface. In the area of the tragus, antitragus and intertragal notch there are hairs, sometimes (in older men) quite long.

The skin lining the cartilaginous part of the external auditory canal is equipped with sebaceous and ceruminal glands that secrete earwax. In the bony part of the ear canal, the skin is thinned and devoid of hairs and glands.

Physiology

The auricle performs two functions - catching sound wave and protective. Compared to the auricle of animals, the human auricle performs the first function poorly. A person cannot turn it towards the sound source, as certain animals (dogs, horses, etc.) do. The protective function of the auricle is due to the fact that its unique configuration prevents dust from entering the external auditory canal and further to the eardrum. The natural lubricant of the external auditory canal is earwax, which is secreted in normal conditions in small quantities. Wax is removed from the external auditory canal due to the movements of the lower jaw; small particles are removed along with earwax foreign bodies and dust particles stuck to it.

Research methods

The lateral and inner surfaces of the auricle are examined by inspection. Pulling the auricle upward and backward (in adults) and posteriorly and downward (in infants), the cartilaginous part of the external auditory canal is examined, then an otoscopy is performed using an ear funnel (see). If pain occurs when palpating the tragus area, this indicates inflammation in the external auditory canal. By special indications in some cases, rentgenol is also used. methods, in particular Fistulography (see).

Pathology

Developmental defects

There may be a complete absence of the auricle - anotia. Excessively large ears are also observed - macrotia (Fig. 3, 1) or too small - microtia (Fig. 3, 2). There are various deformities of the auricle: a pointed auricle (satyr's ear), an angular auricle (macaque ear), an ear with a large irotivoz-helix (Wildermuth's ear), etc. In the area of the tragus there may also be appendages, or appendages, of the auricles, to They usually consist of skin and subcutaneous tissue, but sometimes also of cartilage.

Often, a congenital preauricular fistula (fistula) is found somewhat anterior to the peduncle of the helix - a trace of non-closure of the first branchial cleft. Congenital cysts can form in this same place.

Developmental defects such as the complete absence of the external auditory canal or an unusually sharp narrowing of its lumen are also possible. This pathology is often combined with malformations of the auricle.

Treatment of developmental defects is surgical. The pendants are excised along with the cartilage. It must be remembered that the fistulous tract has a very narrow lumen, as a result of which it cannot be completely identified during fistulography. Most often it ends at the surface of the scales of the temporal bone. Excision of the fistula must be carried out along its entire length. With incomplete removal, relapses are usually observed. A number of operations are performed to restore the external auditory canal.

Damage

There are bruises, cut wounds auricle, bites, etc. During the war, gunshot wounds auricle and external auditory canal. Such injuries were most often combined with violations of the integrity of the tissues surrounding the ear. The consequences of these injuries can be divided into three groups: deformation of the auricle, narrowing or fusion of the external auditory canal, and combinations of these injuries. Treatment - plastic surgery.

Diseases

Sulfur plug. Earwax, produced by special glands of the external auditory canal, is a natural lubricant of its walls, the edges are constantly removed. Normally, it is released in small quantities. But in some cases, earwax acquires a denser consistency and accumulates in the external auditory canal in the form of sometimes a very dense mass that gradually fills its lumen. As long as there remains at least a small gap between the cerumen mass and the wall of the external auditory canal, hearing is usually not severely impaired. When water gets into the ear, earwax swells and complete obstruction of the external auditory canal can occur with a significant decrease in hearing due to damage to the sound-conducting apparatus. Patol, the accumulation of earwax in the external auditory canal is called “cerumen plug”.

In most cases, wax plug can be removed by rinsing the external auditory canal with 2% sodium bicarbonate solution using a 100-200 ml syringe. The auricle is pulled upward and backward, and the stream of flushing liquid, heated to t° 37°, is directed to the superoposterior wall of the external auditory canal (see Ear rinsing). IN in some cases The cerumen plug can be very dense, then the patient is prescribed instillation of 2% sodium bicarbonate solution or hydrogen peroxide into the ear for 3-4 days several times a day. These solutions soften the sulfur plug, and removing it by washing is not difficult. Cases have been described in which cerumen plug was the cause of vestibular disorders.

Inflammatory diseases the external auditory canal (otitis externa) and the auricle are limited (boils) and diffuse.

Boils are observed only in the cartilaginous part of the external auditory canal. Characteristic symptoms: pain when chewing and pressure on the tragus, sometimes decreased hearing (usually with multiple boils, which is noted with general furunculosis), narrowing of the lumen of the external auditory canal.

Treatment: antibiotics corresponding to the suspected or identified pathogen, sulfonamide drugs, as well as sulfur preparations (Sulfur depuratum) but 0.5 g 3 times a day; Turundas with 3% boric solution in 70% alcohol are injected into the external auditory canal, and then 1% yellow or 3% white sedimentary mercury ointment is applied. It is necessary to prevent contamination of the skin of the external auditory canal with pus secreted from the boil to prevent the occurrence of new boils. Sometimes diffuse inflammation of the skin of the external auditory canal and auricle occurs. Skin eczema is also observed.

Diffuse skin inflammation Well. in some cases it is caused by mycelium of fungi (see Otomycosis). The main symptoms: discharge of purulent secretion from the external auditory canal, itching in it, sometimes decreased hearing, concentric narrowing of the lumen of the auditory canal. If purulent discharge reaches the eardrum, then it is also involved in the process. In these cases, otoscopy reveals redness and infiltration of the eardrum, its characteristic morphological characteristics are difficult to determine.

Treatment: thorough cleaning of the walls of the external auditory canal with alcohol, potassium permanganate solution, furatsilin, and then lubricating with 2-3% silver nitrate solution, Lassar paste, 1% salicylic paste, etc.

Perichondritis external ear infection develops when infection penetrates into the perichondrium of the auricle. Moreover, the skin of the Outer Ear is involved in the process. It is characterized severe pain in the area of the auricle, hyperemia and swelling, increased temperature. IN case of lung During the course of the process, the process ends at this stage; in severe cases, suppuration occurs. Purulent exudate accumulates between the perichondrium and cartilage, and purulent melting of the cartilage occurs. The skin wrinkles, the auricle becomes deformed.

Treatment: at the beginning of the disease, warm compresses, antibiotics, and UHF therapy are used. When suppuration occurs, a wide incision is made along the edge of the auricle and all necrotic areas of cartilage are removed. Antibiotics are injected into the wound. If the auricle is deformed, plastic surgery is indicated.

Lupus outer ear is most often the result of a process spreading from the face. Nodules appear, sometimes with ulceration of the skin in the area of the auricle, most often the earlobe; tuberculous perichondritis is possible. The diagnosis is made based on the presence of other tuberculous lesions and biopsy results. For treatment, specific anti-tuberculosis drugs are used - see Skin tuberculosis.

Syphilis external ear is usually observed in the second stage of the disease, less often in the third. It manifests itself as a secondary syphilitic rash, syphilitic (gummy) chondritis. The diagnosis is made on the basis of other manifestations of syphilis, medical history, course of the disease, serological data, and research. Treatment is carried out with specific means - see Syphilis.

Exostoses

Sometimes, in the external auditory canal, bony protrusions of exostoses (see), narrowing its lumen, develop. For small exostoses that do not cause hearing impairment, treatment is not required. If the exostosis is of significant size and it prevents a free approach to the eardrum during hearing-improving operations, in particular myringoplasty (see), perform surgical removal. Exostoses can be easily removed with a chisel from the side of the ear canal.

Other diseases. Among other patols, processes in the area of the External Ear there is hematoma (see) as a result of injury, frostbite (see). Subsequently, as a result of these pathol processes, ossification of the auricle may develop, when its cartilage is partially replaced by bone tissue.

Due to damage or long-term otitis externa, narrowing or even complete closure of the lumen of the external auditory canal (atresia) sometimes occurs. In such cases, carry out surgical treatment(see Otoplasty).

Foreign bodies may be found in the external auditory canal, more often in children (see).

Bibliography: Andronescu A. Anatomy of a child, trans. from Romanian, p. 231, Bucharest, 1970; K ruchinsky G.V. Plastic surgery of the auricle, M., 1975, bibliogr.; JI Apchenko S. N. Congenital malformations of the external and middle ear and their surgical treatment, M., 1972, bibliogr.; Multi-volume guide to otorhinolaryngology, ed. A.G. Likhacheva, vol. 1 - 2, M., 1960; Patten B.M. Human embryology, trans. from English, M., 1959; T o n k o v V. N. Textbook of normal human anatomy, p. 717, JT., 1962; N o g i e g P. F. Treatise of auri-, culot.lierapy, P., 1972.

N. Potapov; V. S. Revazov (an.).

26. Surgery for a small bulla (a - d).

28. Osteoplastic surgery for bullous middle turbinate. a-c - stages of the operation.

on the line of continuation of the oral fissure, often as additional, ectopic auricles.

The surgical technique for the surgical treatment of various types of ear appendages has specifics from the point of view of both the radicality of removal and the obtaining of a cosmetic effect (Fig. 29, a, b). The operation is usually performed under local anesthesia. An anesthetic solution is injected under the ear pedicle. The skin incision is lens-shaped, with a long axis along the skin lines.

There is always a rather large arterial trunk or vascular bundle, which must be clamped and bandaged. One or two atraumatic sutures are applied to the skin, which are removed on the 5-6th day. !

Removal of ear appendages with cartilaginous inclusions (ectopic rudiments of the auricle) is technically more complex (Fig. 30, a, b, c). The operation is carried out under local anesthesia, the zone of which should extend 1-2 cm around the rudiment and under its base, since under the skin of the cheek in soft tissues a significant part of the rudiment may be hidden, as a result of which expansion of the volume is required surgical intervention during the operation. After removal of the appendage in the soft tissues of the cheek

a rather large defect is formed, which requires special plastic techniques. It is necessary to mobilize the subcutaneous fatty tissue surrounding the defect and fill the resulting cavity with it, and only after that apply an atraumatic suture to the skin (see Fig. 30, a, b).

Ear appendages quite often occur in combination with congenital malformations of the outer and middle ear; in this case, simultaneous radical surgical correction of both defects is carried out [Lapchenko S.N., 1972, 1982].