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[Sectional anatomical analysis of auricular and middle ear malformation in patients with microtia]
Juan Han1, Jiu-xing Lu, Ning Xing
1Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100144, China.
Objective:
To analyze the sectional anatomical features of auricular and middle ear malformation in patients with microtia so as to improve the clinical classification and the instruction of surgery.
Methods:
From Jun. to Dec. 2009, 36 cases with microtia were selected in the center of auricular reconstruction in Plastic Surgery Hospital, including 22 cases of unilateral microtia and 14 cases of bilateral microtia. 22 patients with unilateral microtia were studied with the contralateral healthy ears as controls. Spiral CT was performed for high-resolution scan of the temporal bone. The coronal, sagittal and 3D reconstruction images were created with Mimic software. Several distances and degrees were measured.
Results:
The patients were classified by Max classification. The anteroposterior diameter and the vertical diameter of tympanic cavity were (7.75 +/- 1.92) mm and (14.66 +/- 4.75) mm for type I; (6.17 +/- 2.56) mm and(14.35 +/- 5.12) mm for type II; (6.31 +/- 3.40) mm and (9.97 +/- 4.36) mm for type III (P = 0.001). The mastoid pneumatization degree for type I, II, III were 13.33%, 13.64%, 30.77% in sclerotic type, 13.33%, 18.18%, 7.69% in diploe type, 0, 9.09%, 38.46% in composite type, 73.33%, 59.09%, 23.08% in pneumatic type (chi2 = 24.11, P = 0.002). The cover of fenestra vestibuli by facial nerve was 21.43%, 47.62%, 54.55% (chi2 = 23.44, P = 0.002) for type I, II, III. There was a statistical difference between the microtia group and the control group.
Conclusions:
According to the Max classification, the middle ear malformation changed along the auricular malformation. The anatomical variations was complicated in type II microtia, which should be sub-classified.
Insights
Microtia malformations correlate with middle ear anatomical variations. Type II microtia exhibits complex anatomical differences requiring further sub-classification for improved surgical guidance.
Area of Science:
- Otolaryngology
- Plastic Surgery
- Medical Imaging
Background:
- Microtia is a congenital condition involving malformation of the auricle.
- Understanding associated middle ear anomalies is crucial for surgical planning.
Purpose of the Study:
- To analyze sectional anatomical features of auricular and middle ear malformations in microtia patients.
- To improve clinical classification and surgical instruction for microtia.
Main Methods:
- 36 microtia cases (22 unilateral, 14 bilateral) studied.
- High-resolution spiral CT scans of the temporal bone.
- 3D reconstructions using Mimic software for measurements.
Main Results:
- Significant differences in tympanic cavity dimensions across Max classification types (P = 0.001).
- Variations in mastoid pneumatization and facial nerve covering of the fenestra vestibuli observed (P = 0.002).
- Statistical differences noted between microtia and control groups.
Conclusions:
- Middle ear malformations correlate with auricular malformation severity based on Max classification.
- Type II microtia presents complex anatomical variations necessitating sub-classification.
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