Ear Reconstruction. Clinical and physiological evaluations.

Martin Öberg

Ear Reconstruction. Clinical and physiological evaluations.

Martin Öberg

Institutionen för kliniska vetenskaper, Malmö

Forskningsoutput: Avhandling › Doktorsavhandling (sammanläggning)

513 Nedladdningar (Pure)

Sammanfattning

Popular Abstract in Swedish
Mikroti är en medfödd avvikelse där ytterörat
inte utvecklats normalt. Defekten kan variera
från att örat nästan är normalt till att det saknas
helt och hållet, s.k. anoti. I Sverige inträffar detta
i c:a 2 fall per 100 000 nyfödda. Pojkar drabbas i
större utsträckning och höger sida är den vanligaste.
Båda sidor drabbas i c:a en tiondel av fallen.
Förträngning av yttre hörselgången ses hos
en majoritet av patienterna med mikroti och det
föreligger i dessa fall en hörselnedsättning eftersom
ljudet inte når innerörat.
En ensidig mikroti kan rekonstrueras i tre
seanser genom att använda det egna revbensbrosket.
Brosket formas till ett öra och placeras
i en ficka under huden på örats plats för att i ett
senare skede resas och slutligen finjusteras. Rekonstruktionen
kan påbörjas när bröstkorgsomfånget
är tillräckligt. Patienten skall också vara
välmotiverad och så långt möjligt är förstå vad
operationerna kommer att innebära i form av tid
på sjukhus, smärta, konvalescens etc. I praktiken
kan rekonstruktionsförfarandet därmed oftast
påbörjas vid 6–7 års ålder.
Under de tre kirurgiska stegen kommer mottagarområdet
att utsättas för ett flertal snitt där
såväl nerver som blodkärl måste delas. Vidare
görs en friläggning under huden så att brosket
kan få plats. Huden som täcker örat riskerar därmed
att mista viktiga skyddsfunktioner såsom
känsel för värme, kyla och tryck. Ett rekonstruerat
öra utan dessa skyddsfunktioner i huden
skulle mycket väl kunna löpa större risk för sårbildning
till följd av skador av olika slag. Ett sår
i huden skulle i sig kunna äventyra det underliggande
broskskelett och därmed hela rekonstruktionen.
Att utvärdera känsel för värme, kyla och tryck
i det rekonstruerade örat är således angeläget och
inom ramen för våra studier har detta skett. Vi
har också undersökt blodflödets återhämtning
och reglering.
Det rekonstruerade örat dimensioneras för
att matcha det normala örat. En sjuårings öra
växer mindre än 7,5 mm fram till 18 års ålder.
Huruvida det rekonstruerade örats brosk växer är
omdebatterat men klinisk erfarenhet samt vissa
vetenskapliga rön talar för att det finns en tillväxtpotential
hos det transplanterade brosket. I
ett led att på sikt kunna utvärdera brosktillväxten
i anslutning till öronrekonstruktion har vi i
första hand utvärderat mätmetoden digital morfometri,
dvs. storleksmätning på digitala foton
med därtill avsedd mjukvara. Metoden jämfördes
med de två manuella metoderna passare &
linjal samt skjutmått.
Våra fynd visar att det finns en hög grad av
återhämtning av känseln för värme och kyla i
det rekonstruerade örat även om något nedsatt
känsel för värme noterades i örats övre del. Känsel
för tryck visade samma mönster med en hög
återhämtning i kombination med något höjda
tröskelvärden i den övre delen. Blodflödet i det
rekonstruerade örat var väsentligen lika med det
normala örat och vid kroppsuppvärmning ökade
blodflödet på likartat sätt. Digital morfometri visade
samma grad av slumpfel som passare & linjal
samt skjutmått när normala öron mättes. Digital
morfometri kan visa hög precision även vid mätningar
på rekonstruerade öron, men det finns en
individuell variation från bedömare till bedömare.
Sammanfattningsvis återhämtar sig det rekonstruerade
örats känsel och cirkulation på ett
tillfredställande sätt. Digital morfometri förefaller
vara en lämplig metod för att mäta örats dimension
och tillväxt, förutsatt att man bestämmer
den enskilde användarens precision och förmåga
att reproducera sina resultat vid upprepade
mätningar.

Originalspråk	engelska
Kvalifikation	Doktor
Tilldelande institution	Institutionen för kliniska vetenskaper, Malmö
Handledare	Svensson, Henry, handledare Wikström, Sven-Olof, handledare
Tilldelningsdatum	2012 nov. 30
Förlag	Reconstructive Surgery, University of Lund
ISBN (tryckt)	978-91-86671-04-4
Status	Published - 2012

Bibliografisk information

Defence details

Date: 2012-11-30
Time: 09:00
Place: Inga Marie Nilssons gata 46, Skåne University Hospital, Malmö

External reviewer(s)

Name: Rautio, Jorma
Title: [unknown]
Affiliation: HUS (Hospital district of Helsinki and Uusimaa)

---

The information about affiliations in this record was updated in December 2015.
The record was previously connected to the following departments: Reconstructive Surgery (013240300)

Ämnesklassifikation (UKÄ)

Kirurgi

Tillgång till dokument

Oberg

2 Artikel i vetenskaplig tidskrift

Threshold of tactile perception in a reconstructed auricle.
Öberg, M., Svensson, H., Becker, M. & Wikström, S-O., 2011, I: Journal of Plastic Surgery and Hand Surgery. 45, 1, s. 23-27
Forskningsoutput: Tidskriftsbidrag › Artikel i vetenskaplig tidskrift › Peer review
Thermosensitivity in a reconstructed microtic ear.
Öberg, M., Becker, M., Arktander, M., Centerman, M., Svensson, H. & Wikström, S-O., 2008, I: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery. 42, 4, s. 190-193
Forskningsoutput: Tidskriftsbidrag › Artikel i vetenskaplig tidskrift › Peer review

Citera det här

@phdthesis{9aaac6d7876548f5a1e421cf084a1dcb,

title = "Ear Reconstruction. Clinical and physiological evaluations.",

abstract = "Microtia is a congenital malformation where the auricle is not fully developed. In some cases the malformation is complete and the auricle is absent. In Sweden the incidence of microtia is about 2 per 10,000 births. Reconstruction of the external ear is possible by using autologous rib cartilage in three surgical steps: rib cartilage transplantation, ear elevation and final adjustments. Although the aesthetic result is most essential, there are also functional aspects of a reconstruction of the outer ear. To keep the ear free from injury, the skin depends on a functioning alert system: sensitivity to touch, heat and cold. However, the process of ear reconstruction necessarily includes surgical trauma that endangers these protective systems. The blood supply of the skin cover is also impaired during the different reconstructive stages. Little is known about the level and time scale of recovery of sensitivity and blood supply to the reconstructed ear after surgical bisection of nerves and vessels. Symmetry is important in ear reconstruction and the new ear should match the normal ear at the time of reconstruction as well as in the adult life. The potential growth of the ear is a subject of debate. We decided to investigate the precision of today{\textquoteright}s tools for size measurements. With this knowledge the issue of growth hopefully can be elucidated. A total of 54 patients with unilateral ear reconstruction, and 30 individuals with normal ears, were included in the studies. We evaluated sensitivity to heat, cold and touch in the reconstructed and normal ear. We also assessed blood flow before and after body heating to investigate the pathophysiological dynamics in the reconstructed ear. Digital morphometry for measuring ear size was compared to the manual methods: compass & ruler and callipers. Measurements were performed on individuals with normal ears. In digital morphometry we also measured reconstructed ears. Our findings show that there is a high degree of restoration of thermosensitivity in the reconstructed ear but the upper parts of the ear still show signs of reduced sensitivity to heat. Tactile sensitivity followed that of thermal sensitivity, with a high degree of restoration in combination with elevated thresholds in the upper parts. The basal blood flow in the reconstructed ear is compatible with that of the normal ear and its dynamic response to indirect heating is also similar. Digital morphometry shows a similar reproducibility as compass & ruler and callipers for measurement of normal ears. Digital morphometry can show great precision in measurements of reconstructed ears but there is high inter-individual variation between different assessors.",

keywords = "Plastic surgery, autologous ear reconstruction, sensitivity, blood flow, digital morphometry",

author = "Martin {\"O}berg",

note = "Defence details Date: 2012-11-30 Time: 09:00 Place: Inga Marie Nilssons gata 46, Sk{\aa}ne University Hospital, Malm{\"o} External reviewer(s) Name: Rautio, Jorma Title: [unknown] Affiliation: HUS (Hospital district of Helsinki and Uusimaa) --- The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Reconstructive Surgery (013240300)",

year = "2012",

language = "English",

isbn = "978-91-86671-04-4",

series = "Lund University Faculty of Medicine Doctoral Dissertation Series ",

publisher = "Reconstructive Surgery, University of Lund",

type = "Doctoral Thesis (compilation)",

school = "Department of Clinical Sciences, Malm{\"o}",

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TY - THES

T1 - Ear Reconstruction. Clinical and physiological evaluations.

AU - Öberg, Martin

N1 - Defence details Date: 2012-11-30 Time: 09:00 Place: Inga Marie Nilssons gata 46, Skåne University Hospital, Malmö External reviewer(s) Name: Rautio, Jorma Title: [unknown] Affiliation: HUS (Hospital district of Helsinki and Uusimaa) --- The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Reconstructive Surgery (013240300)

PY - 2012

Y1 - 2012

N2 - Microtia is a congenital malformation where the auricle is not fully developed. In some cases the malformation is complete and the auricle is absent. In Sweden the incidence of microtia is about 2 per 10,000 births. Reconstruction of the external ear is possible by using autologous rib cartilage in three surgical steps: rib cartilage transplantation, ear elevation and final adjustments. Although the aesthetic result is most essential, there are also functional aspects of a reconstruction of the outer ear. To keep the ear free from injury, the skin depends on a functioning alert system: sensitivity to touch, heat and cold. However, the process of ear reconstruction necessarily includes surgical trauma that endangers these protective systems. The blood supply of the skin cover is also impaired during the different reconstructive stages. Little is known about the level and time scale of recovery of sensitivity and blood supply to the reconstructed ear after surgical bisection of nerves and vessels. Symmetry is important in ear reconstruction and the new ear should match the normal ear at the time of reconstruction as well as in the adult life. The potential growth of the ear is a subject of debate. We decided to investigate the precision of today’s tools for size measurements. With this knowledge the issue of growth hopefully can be elucidated. A total of 54 patients with unilateral ear reconstruction, and 30 individuals with normal ears, were included in the studies. We evaluated sensitivity to heat, cold and touch in the reconstructed and normal ear. We also assessed blood flow before and after body heating to investigate the pathophysiological dynamics in the reconstructed ear. Digital morphometry for measuring ear size was compared to the manual methods: compass & ruler and callipers. Measurements were performed on individuals with normal ears. In digital morphometry we also measured reconstructed ears. Our findings show that there is a high degree of restoration of thermosensitivity in the reconstructed ear but the upper parts of the ear still show signs of reduced sensitivity to heat. Tactile sensitivity followed that of thermal sensitivity, with a high degree of restoration in combination with elevated thresholds in the upper parts. The basal blood flow in the reconstructed ear is compatible with that of the normal ear and its dynamic response to indirect heating is also similar. Digital morphometry shows a similar reproducibility as compass & ruler and callipers for measurement of normal ears. Digital morphometry can show great precision in measurements of reconstructed ears but there is high inter-individual variation between different assessors.

AB - Microtia is a congenital malformation where the auricle is not fully developed. In some cases the malformation is complete and the auricle is absent. In Sweden the incidence of microtia is about 2 per 10,000 births. Reconstruction of the external ear is possible by using autologous rib cartilage in three surgical steps: rib cartilage transplantation, ear elevation and final adjustments. Although the aesthetic result is most essential, there are also functional aspects of a reconstruction of the outer ear. To keep the ear free from injury, the skin depends on a functioning alert system: sensitivity to touch, heat and cold. However, the process of ear reconstruction necessarily includes surgical trauma that endangers these protective systems. The blood supply of the skin cover is also impaired during the different reconstructive stages. Little is known about the level and time scale of recovery of sensitivity and blood supply to the reconstructed ear after surgical bisection of nerves and vessels. Symmetry is important in ear reconstruction and the new ear should match the normal ear at the time of reconstruction as well as in the adult life. The potential growth of the ear is a subject of debate. We decided to investigate the precision of today’s tools for size measurements. With this knowledge the issue of growth hopefully can be elucidated. A total of 54 patients with unilateral ear reconstruction, and 30 individuals with normal ears, were included in the studies. We evaluated sensitivity to heat, cold and touch in the reconstructed and normal ear. We also assessed blood flow before and after body heating to investigate the pathophysiological dynamics in the reconstructed ear. Digital morphometry for measuring ear size was compared to the manual methods: compass & ruler and callipers. Measurements were performed on individuals with normal ears. In digital morphometry we also measured reconstructed ears. Our findings show that there is a high degree of restoration of thermosensitivity in the reconstructed ear but the upper parts of the ear still show signs of reduced sensitivity to heat. Tactile sensitivity followed that of thermal sensitivity, with a high degree of restoration in combination with elevated thresholds in the upper parts. The basal blood flow in the reconstructed ear is compatible with that of the normal ear and its dynamic response to indirect heating is also similar. Digital morphometry shows a similar reproducibility as compass & ruler and callipers for measurement of normal ears. Digital morphometry can show great precision in measurements of reconstructed ears but there is high inter-individual variation between different assessors.

KW - Plastic surgery

KW - autologous ear reconstruction

KW - sensitivity

KW - blood flow

KW - digital morphometry

M3 - Doctoral Thesis (compilation)

SN - 978-91-86671-04-4

T3 - Lund University Faculty of Medicine Doctoral Dissertation Series

PB - Reconstructive Surgery, University of Lund

ER -

Ear Reconstruction. Clinical and physiological evaluations.

Sammanfattning

Bibliografisk information

Ämnesklassifikation (UKÄ)

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Fingeravtryck

Forskningsoutput

Threshold of tactile perception in a reconstructed auricle.

Thermosensitivity in a reconstructed microtic ear.

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