Reconstruction of congenital tragal malformations accompanied by dystopic cartilage growth (accessory tragus)

Patients with solitary-type congenital tragal malformations accompanied by dystopic cartilage growth (accessory tragus) show not only a disfigured or absent tragus but also unnecessary tragal or pretragal lumps. Furthermore, an absent tragus causes a wholly exposed external auditory canal.

Sixty-five ears (54 patients) showing congenital tragal malformations accompanied by dystopic cartilage growth were reconstructed from March of 1991 to February of 2014. Reconstructions were reviewed using medical records and photographs, surgical methods were analyzed, and postoperative outcomes were evaluated.

Six kinds of tragal framework fabrication methods were used in the reconstructions: free cartilage grafting (n = 7); cartilage transposition and anchoring (n = 7); cartilage folding and anchoring (n = 46); vascularized chondrocutaneous island flap (n = 4); and costal cartilage grafting (n = 1). Immediate postoperatively, four cases showed congestion of the covered skin. Forty-three patients (78 percent) were followed up for an average period of 15 months. The following were observed: larger tragus (n = 3); flat tragus without peak (n = 2); posterior protrusion of the tragal wall (n = 2); and hypertrophic scar (n = 1). All cases with a wholly exposed external auditory canal were corrected. The average score of the aesthetic outcomes, rated on a four-point Likert scale (1 = poor, 2 = fair, 3 = good, 4 = excellent), was 3.8 points.

Cartilage and covered skin from the dystopic cartilage growth provided the best-available tissues for new tragal reconstructions. Different surgical techniques were used in accordance with the severity of the tragal malformation encountered. Most techniques provided aesthetically pleasing outcomes.

Therapeutic, IV.