What is ear surgery with cartilage used for?

Ear Surgery with Cartilage: Applications and Techniques

Ear surgery using cartilage is primarily used for tympanic membrane reconstruction, rhinoplasty, and correction of prominent ears, with cartilage tympanoplasty showing superior structural outcomes (92.4% graft integration) compared to traditional techniques. 1

Tympanic Membrane Reconstruction

Cartilage is an excellent material for tympanic membrane reconstruction due to its superior structural properties:

• Superior outcomes: Systematic reviews demonstrate cartilage reconstruction (CR) has better structural outcomes than temporalis muscle fascia (TMF), with 92.4% vs 84.3% graft integration rates 1
• Lower revision rates: CR has a 10% revision rate compared to 19% for TMF 1
• Clinical applications:
  • Chronic tympanic membrane perforations
  • Recurrent perforations after previous repair attempts
  • Eustachian tube dysfunction cases
  • Cholesteatoma repair

Technique

• Tragal and conchal cartilage are commonly harvested
• Palisaded cartilage fragments with perichondrium are placed parallel to the malleus in type I tympanoplasties 2
• For type II or III procedures, cartilage is placed parallel to the long process of the incus 2

Rhinoplasty Applications

Auricular cartilage serves as a versatile grafting material in both primary and secondary rhinoplasty:

• Common uses:

  • Tip grafts
  • Dorsal onlays
  • Spreader grafts
  • Septal replacements
  • Alar battens
  • Composite grafts 3

• Benefits:

  • Low donor site morbidity
  • Minimal pain post-harvest
  • No reported graft resorption or infection 3
  • Excellent alternative when septal cartilage is unavailable

Harvest Technique

• Maximizes graft volume while preserving auricular cosmesis
• Allows for obtaining the largest possible graft without compromising ear appearance 4

Correction of Prominent Ears

Multiple techniques utilize cartilage manipulation to correct prominent ears:

• Double triangular cartilage excision otoplasty:

  • Stitchless technique based on specific cartilage excision
  • Mechanically collapses the ear without sutures through cartilage
  • Low complication rate (6%) with high patient satisfaction 5

• Full-thickness cartilage strip technique:

  • Incomplete cutting technique for various degrees of prominent ear
  • Shows excellent results in 58.7% of patients and good results in 28.6%
  • Very low incidence of complications 6

Nasal Bone Deviation Correction

For severe nasal bone deviations:

• Sequential osteotomies should be used, working from the less deviated side
• Start with lateral osteotomy, followed by medial osteotomy, ending with outfracturing
• The septum should be positioned into midline using a transverse root osteotomy 7

Complications and Considerations

• Auricular complications: Perichondritis and perichondrial abscess typically occur in the first month after procedures involving ear cartilage 1
• Infection management: Pseudomonas aeruginosa, S. aureus, and S. pyogenes are common pathogens, often responding to fluoroquinolone antibiotics 1
• Surgical failure: Poorly performed surgery raises the risk for recurrence or need for additional treatment modalities 1
• Monitoring: Patients who remain symptomatic after treatment should have follow-up with history, physical examination, radiographs, and/or MRI to assess healing 1

Key Advantages of Cartilage in Ear Surgery

1. Superior structural integrity compared to fascia grafts
2. Lower recurrence rates for tympanic membrane repairs
3. Versatility across multiple applications
4. Minimal donor site morbidity
5. Long-term stability with autologous material

When performed properly by experienced surgeons, ear surgery with cartilage provides excellent functional and cosmetic outcomes with low complication rates.