Microtia – the principles in management

Dr. Subramania Iyer MS, MCh, FRCS

Congenital absence or anomaly of the pinna and external auditory canal is a common congenital malformation occurring in the face, even though

not as common as cleft lip and palate. Proper management of these is essential to rectify the emotional distress of these children as well as

rehabilitate their hearing problem. All the children should undergo a hearing evaluation as soon as possible by audiometry or in earlier age by a BERA testing. If the hearing is found to be normal on one side, the hearing deficit of the other side can be left alone. If bilateral, hearing rehabilitation

is started as early as possible using a bone conduction hearing aid and later on by a BAHA ( bone anchored hearing aid) placement. The reconstruction of the pinna is best carried out in staged manner. The costal cartilage is harvested in the first stage and sculpted to the shape of the auricular cartilage. The helical and antihelical prominences are given special attention to while this is carved out. A suitable pocket is made in the area of the ear and the framework is placed. After a gap of six months the framework and the overlying skin is elevated and a skin graft is placed on

the posterior surface. The next stage is considered after another six months to do refinements like lobule rotation, deepening of concha etc, if not done earlier. The reconstruction of the pinna gives a satisfactory aesthetic result as well as allows the patient to wear the spectacles properly, if they need one.

Management of the eye in facial paralysis

Dr. Subramania Iyer MS, MCh, FRCS

Facial nerve paralysis of LMN type occurs mainly after trauma, parotid surgery, skull base surgery, mastoidectomy and occasionally due to

unrecovered Bell’s palsy. The most devastating problem in these patients is the inability to close the eye. This could lead to exposure keratitis and

epiphora. There are different methods to address the problem either as short term measure or as a permanent one. Lateral tarsorraphy which is

commonly practiced gives an inferior result both

aesthetically and with its ability to close the eye completely. The better alternative as a short term or permanent measure is the implant of a gold weight on to the upper eye lid. The gold weight (usually of 1.4 to 1.8 gms) is inserted under the skin over the tarsal plate. The gold weight works with gravity and allows the eye to close. This is not a dynamic movement and also does not

address the problem of lower lid laxity. The only way to provide a dynamic movement to both the lids is to transfer a slip of temporalis muscle on to both the lids. Two strips of the muscle with the facia is tunneled under skin and anchored to each other over the medial canthal tendon. The patients are now reeducated to close the eye with a teeth clenching action. This, they learn in few months and gives excellent results.

 

Hair Transplant

Dr. Sundeep Vijayaraghavan MS, MCh, DNB

Follicular Unit Hair transplant has revolutionized hair restoration. The steps in doing it and results were shown. The new medical management, cyclical hair therapy has also improved hair growth and density. Physical methods like electrostatic natural micro fibers to improve hair density without wigs were also discussed.

 

Brachial Plexus injury

Dr. Kishore P. MS MCH

Brachial Plexus injury is a neglected problem because of lack awareness among public and even in our own medical fraternity. Patients are usually referred from pillar to post wasting valuable time for repair. Majority of the Plexus injuries are due to RTA. Obstetric injuries are also not uncommon. If there is no progressive recovery with in first three months of injury Plexus reconstruction is indicated. Recent advancement in microsurgical techniques like microneural repair, distal neurotisations, functioning muscle transfers, intraoperative electrophysiology have remarkably improved the results. Even in late cases,secondary procedures like tendon transfers, muscle balancing procedures, osteotomies, arthodesis etc can provide prehensile function of the paralyzed limb