Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital.
George Washington University School of Medicine, Washington, DC.
J Craniofac Surg. 2020 Sep;31(6):1588-1592. doi: 10.1097/SCS.0000000000006473.
Ear molding can improve the majority congenital ear deformities when employed early after birth. However, the best time to initiate treatment remains debated. In describing one surgeon's experience over the past near decade, this study aims to highlight differences conferred by treatment timing. The authors hypothesize that auricular outcomes are superior when deformities are molded beginning in the first 3 weeks of life. A retrospective review (2010-2018) of 272 cases was performed to compare early initiation of molding (<3 weeks of birth) and delayed initiation (>3 weeks). The mean patient age was 20.4 days and the mean follow-up was 0.5 months. The overall treatment was approximately 31 days. The number of devices required was similar (2.3 versus 2.5) between early and delayed molding cases, but fall-outs (1.0 versus 0.7, P = 0.02) and replacements (0.9 versus 0.6, P = 0.004) were more common after delayed molding. Skin complications developed in 13.6% (37) of ears overall and did not differ by treatment timing. Follow-up surgery was reported in 2 (0.7%) ears. The 85% of families reported subjective satisfaction with the final outcome; satisfaction was significantly higher for early cases (97% versus 79%, P = 0.03). Ear molding of congenital ear deformities should begin within 3 weeks of birth. From our experience, setting realistic expectations helps limit discrepancies between expectation and outcome.
耳模成形术可以改善大多数先天性耳畸形，尤其是在出生后早期使用。然而，最佳的治疗时机仍存在争议。本研究通过描述一位外科医生过去近十年的经验，旨在突出治疗时机不同所带来的差异。作者假设，当畸形在出生后 3 周内开始塑形时，耳廓的结果会更好。对 272 例患者进行回顾性分析（2010-2018 年），比较早期（<3 周）和延迟（>3 周）开始塑形的效果。患者的平均年龄为 20.4 天，平均随访时间为 0.5 个月。总体治疗时间约为 31 天。早期和延迟塑形组所需的器械数量相似（2.3 与 2.5），但延迟塑形组的脱落（1.0 与 0.7，P=0.02）和更换（0.9 与 0.6，P=0.004）更为常见。总共 13.6%（37 个）的耳朵出现皮肤并发症，与治疗时机无关。报告有 2 例（0.7%）耳朵需要进行随访手术。85%的家庭对最终结果表示主观满意；早期病例的满意度明显更高（97%比 79%，P=0.03）。先天性耳畸形的耳模成形术应在出生后 3 周内开始。根据我们的经验，设定现实的期望有助于缩小期望与结果之间的差距。
