Aesthetic and functional reconstruction of bilateral cryptotia.

Sir: Cryptotia is a congenital anomaly in which the upper part of the retroauricular sulcus is absent and buried under the temporal skin. Various surgical techniques have been reported for correction of cryptotia following Kubo's V-Y plasty in 1933.1 Conventional methods using local flap, skin grafting,2 tissue expander,3 Z-plasty,4 and any combined approaches supply the skin deficiency of the upper auricle. However, cosmesis can still be unsatisfying because of a visible periauricular scar, color mismatch, or a contracture deformity. The long-term results were usually sparse and undetermined in these previous reports. In brief, the goal in correcting cryptotia is not only maintaining a long-term aesthetic upper auricular contour but also basic function so that glasses or masks can be worn. The subjects in whom this new method was applied consisted of two sisters, a 9-year-old and a 7-year-old. We used a temporoparietal fascia flap to wrap around a resorbable plate as an internal splint to pull the buried upper auricle out. The temporoparietal fascia was exposed from a short vertical straight incision continuing a 60-degree zigzag at 1 cm up toward the midpoint of the superior auricular sulcus line, with care taken to avoid disturbing the hair follicle bases located immediately superficial to the plane of dissection (Fig. 1, left). The inferiorly based flap was designed 4 to 5 cm in width. The anterior edge of the fascia flap was divided just posterior to the superficial temporal vessels. The cephalad part of the fascia was incised at the upper edge of the temporal fossa. Then, the prefabricated six-hole resorbable plate (BioSorbFX, 1.5 Plate; Bionx Implants, Inc., Blue Bell, Pa.), bent as an inverse horse saddle shape, was wrapped around into the rolling-over flap. The wrapped plate was intended to be placed into the intended retroauricular sulcus to lift and pull out the buried part of the upper auricle (Fig. 1, right). Meanwhile, the contour of the upper auricle could be determined while we were adjusting the plate curvature. The rolling flap with a plate was then sutured and fixed. The postoperative fixation was maintained by tied over rolls (Fig. 2). The dressings were intended to be removed 1 month later. There was no wound infection, hematoma, or partial alopecia noted.Fig. 1.: (Left) A vertical straight incision was made upward from the midpoint of the superior auricular sulcus line on the temporal skin parallel to the hair follicle and then continued as a 60-degree zigzag incision. (Right) A six-hole resorbable plate was wrapped into a rolling-over flap and the desired contour was designed. The rolling flap was then turned down and put into the intended retroauricular sulcus. The inverse horse saddle–shaped plate, as an internal splint, makes the buried part of the auricle pull out.Fig. 2.: Left cryptotia in a 9-year-old girl after surgical correction, with the superior auricular sulcus buried under the temporal skin. Postoperative fixation is maintained by mattress sutures tied over rolls.Based on Matsumoto's study, the length of the ear medioinferiorly from the auricle tubercle is shorter in cryptotia.5 At 1 month, 1 year, and 5 years postoperatively, the measurements in the length for cryptotia correction were all increased (Table 1). The patient was able to wear eyeglasses up to 5 years after surgery (Fig. 3).Table 1: Length Affected in Cryptotia of a 9-Year-Old Girl Measured before Surgery and 1 Month, 1 Year, and 5 Years PostoperativelyFig. 3.: Appearance at 5 years postoperatively. The patient is able to wear eyeglasses.Our method resulted in higher cosmetic satisfaction because of the hidden scar. The temporoparietal fascia flap with good vascularity and pliability is suitable for wrapping the resorbable plate around to prevent plate migration or exposure. A resorbable plate as an internal splint can provide sufficient force to pull out the buried part of the upper auricle in the transition of resorption up to 2 years. The procedure is performed easily, with a lasting satisfactory contour. Chang-Cheng Chang, M.D. Department of Plastic Surgery Chang Gung Memorial Hospital Chang Gung University College of Medicine Taoyuan, Taiwan Chao-I Wu, M.D. Sophia Chia-Ning Chang, M.D., Ph.D. Department of Plastic and Reconstructive Surgery China Medical University Hospital and School of Medicine China Medical University Taichung, Taiwan DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.