Guo Fengfeng, Yu Xiaobo, Chen Weiwei, Yang Qinghua, Pan Bo, Lin Lin, Jiang Haiyue
Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
J Craniofac Surg. 2019 Jan;30(1):e28-e32. doi: 10.1097/SCS.0000000000004943.
Autogenous rib cartilage graft procedure for microtia reconstruction has been adopted as the most standardized current method. But calcification would make it difficult for cartilage harvesting and ear framework sculpting. The objective of this study was to explore the rate, degree, and pattern of rib cartilage calcification in microtia and to guide rib cartilage harvesting and the optimal timing of auricular reconstruction. A retrospective study was performed with the imaging data from 320 consecutive patients who received a preoperative 3-dimensional chest computed tomography (CT). Overall, calcification rate of cartilages in female patients was higher than male's (P < 0.05). In 6 to 15 years group, calcification rates of male and female had a similar rate, while female's were higher than male's in other 3 groups. Furthermore, the moderate-to-severe calcification rate was higher in female than in male patients (P < 0.001). Therefore, girls who are over 15 years should be paid more attention regarding the possibility of moderate-to-severe calcification; these patients should take CT examinations if necessary. Calcification rate of the youngest group (6-15 years) was the lowest of all groups, while other 3 groups showed no statistical significance (P > 0.05). So merely the age increasing is not the contradiction for cartilage harvesting, as long as the authors effectively evaluate the condition of rib cartilage before operation. Rib cartilages serve as the key material in auricular framework sculpting and determine the feasibility and outcomes of the surgery. So CT examinations for preoperative evaluation of rib cartilage could be a useful method for planning microtia reconstruction.
自体肋软骨移植法用于小耳畸形再造已成为目前最标准化的方法。但钙化会使软骨获取及耳支架雕刻变得困难。本研究的目的是探讨小耳畸形中肋软骨钙化的发生率、程度及模式，以指导肋软骨获取及耳廓再造的最佳时机。对320例连续接受术前胸部三维计算机断层扫描（CT）的患者的影像资料进行回顾性研究。总体而言，女性患者软骨的钙化率高于男性（P<0.05）。在6至15岁组中，男性和女性的钙化率相近，而在其他3组中女性的钙化率高于男性。此外，女性患者中重度钙化率高于男性（P<0.001）。因此，对于15岁以上的女孩，应更关注中重度钙化的可能性；必要时这些患者应进行CT检查。最年轻组（6至15岁）的钙化率在所有组中最低，而其他3组无统计学意义（P>0.05）。所以只要术者在术前有效评估肋软骨状况，单纯年龄增长并非软骨获取的禁忌。肋软骨是耳支架雕刻的关键材料，决定手术的可行性和效果。因此，术前对肋软骨进行CT检查可能是规划小耳畸形再造手术的一种有用方法。
