Secondary Auricular Reconstruction #2

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Representative Auricular Reconstruction Cases
- Secondary Auricular Reconstruction

Secondary auricular reconstruction is sought by patients who had auricular reconstruction previously at a different institution that resulted in unfavorable outcomes. Such cases have been rapidly increasing in the last 10 years. It is necessary to remove the cartilage framework from the primary auricular reconstruction, fabricate a new 3-D frame and graft it to its proper anatomical location. This surgery can be more meticulous and complicated at times compared to other reconstruction surgeries due to possible severance of the superficial temporal artery (STA) from the primary auricular reconstruction. However, by using Nagata method for secondary auricular reconstruction with careful surgery planning in advance, favorable and satisfactory results can be attained.

Case 1: Secondary auricular reconstruction for the auricle reconstructed with modified Tanzer method

Preoperative Appecfance

Preoperative appearance

Preoperative Appecfance

Preoperative appearance

Preoperative Appecfance

Preoperative appearance

Post-operative Appearance

Post-operative appearance with Nagata method

Post-operative Appearance

Post-operative appearance with Nagata method

Post-operative Appearance

Post-operative appearance with Nagata method

Post-operative Appearance

Post-operative appearance with Nagata method

Preoperative appearance: Preoperative appearance reveals the mismatch in color of skin grafted to the conchal vault (a part supposed to be an earhole) and the resorption of the helical rim region of the cartilage framework causing the deformation of the framework in general. In addition, the skin grafted to the back side of auricle was too wide resulting in the abnormal hairline.
2nd stage post-operative appearance with Nagata method: The secondary reconstructed auricle with Nagata method is properly projected with the hairline of the mastoid surface (behind the auricle) corrected and well maintained. In the close-up photograph, it appears as if there exists an acoustic meatus beneath the constructed tragus and the color match of the conchal vault with the auricle in general is excellent.

Case 2: Secondary auricular reconstruction for unfavorable primary auricular reconstruction for hemifacial microsomia further complicated with low hairline and abnormal location of the reconstructed auricle

Preoperative Appecfance

Preoperative appearance   Intra-operative appearance

Post-operative Appearance

Post-operative appearance with Nagata method

Preoperative appearance: Preoperative appearance of a hemifacial microsomia case on which the primary auricular reconstruction was performed at a different institution resulted in the patient requesting for a secondary auricular reconstruction with Nagata Method.
Intra-operative appearance: The intra-operative appearance with the outline reveals the reconstructed auricle located in an improper anatomical location (too anteriorly) due to avoidance of hair-bearing skin and the mismatch in color of skin grafted to the conchal vault (a part supposed to be an earhole). Also, the operative procedure is more complicated due to the low hairline; the auricle to be reconstructed penetrates into the hair-bearing skin.
2nd stage post-operative appearance with Nagata method: All the features of the auricle can be reconstructed. Also, the auricle is in the normal anatomical location and a pseudo acoustic meatus is created. The color match of the skin cover on the conchal vault is excellent.

Case 3: Secondary auricular reconstruction for unfavorable primary auricular reconstruction for hemifacial microsomia (bilateral) complicated with low hairline

Preoperative Appecfance

Preoperative appearance  Intra-operative appearance

Post-operative Appearance

Post-operative appearance with Nagata method

1st stage

Preoperative appearance: Preoperative appearance of a hemifacial microsomia case (bilateral) on which the primary auricular reconstruction was performed at a different institution.
Intra-operative appearance: Intra-operative appearance reveals that auricle reconstructed from the primary reconstruction was located at a great distance from the normal anatomical location (reconstructed on the cheek) as confirmed from the surgical outline and many surgical scars from the primary auricular reconstruction were seen. In addition, this case was further complicated with low hairline.
2nd stage post-operative appearance with Nagata method: All the features of the auricle can be reconstructed. Also, the auricle is in its normal anatomical location with being projected properly.

Case 4: Secondary auricular reconstruction with the severed superficial temporal artery

Preoperative Appecfance

(Left) Preoperative appearance
(Right) Preoperative appearance, Close-up photo

Post-operative Appearance

Post-operative appearance with Nagata method

Preoperative appearance: Preoperative appearance for an unfavorable primary auricular reconstruction at a different institution with mismatch in color of skin grafted from the groin region. Note that, when the patient reaching puberty, pubic hair growth was seen in the helical rim region and the back side of the auricle where the skin grafted from the groin region.
2nd stage post-operative appearance with Nagata method: All the features of the auricle can be reconstructed with the auricle being projected properly. The reconstructed auricle has no unwanted hair growth.

Information on Microtia Surgeries

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◆Mar. 10, 2017 Updated:
Clinic Closed on the following dates:
Sep. 25 (Mon) 2017,
Oct. 4 (Wed) 2017, and
Oct. 7 (Sat) 2017.
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◆Mar. 10, 2017 Updated:
Attending the following Meetings:
ISAR (Beijing, China) from Sep. 22 to Sep 24, 2017
and ASPS (Florida, USA) from Oct. 6 to Oct. 10, 2017.
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◆Nov. 4, 2016 updated: Clinic outpatient service will be closed on Jan. 30 (Mon), Feb. 22 (Wed) and Feb. 25 (Sat), 2017.
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◆Jun. 11, 2016 updated: Clinic closed from Sep. 21 (Wed.) to Sep. 24 (Sat.) 2016 for attending ASPS meeting in the U.S.
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◆May 14, 2016 updated: Clinic closed on Oct. 8 (Sat.) 2016 for delivering a lecture at Aichi Gakuin University.
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◆Oct. 30, 2015 updated: Clinic outpatient service will be closed from Dec. 27 (Sunday), 2015 to Jan. 3 (Sunday), 2016 for year-end & new-year holidays.
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◆Aug. 7, 2015 updated: Clinic outpatient service will be closed on Sep. 14 (Mon), Oct. 14 (Wed.) and Oct. 17 (Sat.) 2015 for attending meetings in Japan and the U.S.
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◆Apr. 16, 2015 updated: Clinic closed from Oct. 14 (Wed.) to Oct. 18 (Sun.) 2015 for attending ASPS meeting in the U.S.
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Auricular
Reconstruuction Nagata Method

Accuracy evaluation on proportions of the reconstructed auricle / microtia surgery.

To reconstruct an auricle that will not melt

Microtia surgery without pain or deformity in the chest

Reconstructive Surgery

Aesthtics Surgery

Clinic Appointment

Academic exchange with doctors from overseas