Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Badachu Road No.33, Beijing, China.
Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Badachu Road No.33, Beijing, China.
Int J Pediatr Otorhinolaryngol. 2021 Dec;151:110965. doi: 10.1016/j.ijporl.2021.110965. Epub 2021 Oct 28.
The surgical treatment of microtia generally starts in childhood, and costal cartilage is the most widely used material for auricular reconstruction. However, multiple costal cartilage harvests lead to local cartilage defects, which may influence the growth of the hemithorax, that need close attention by doctors. In this study, morphological changes of the thorax were measured and analyzed in different follow-up groups.
Twenty-eight adolescent microtia patients underwent auricular reconstruction using 6th-8th costal cartilage. Thoracic computed tomography (CT) with three-dimensional reconstruction was performed preoperatively and during follow-up. Comparison of the hemithorax on the operated and unoperated sides was performed by measuring several thoracic parameters using Mimics software (Materialise, Belgium). The data were further analyzed by a paired-samples t-test.
In the operated hemithorax, the costochondral junction midpoints moved medially (6th-8th), posteriorly (6th-7th) and descended less (6th-9th) with significant differences as P < 0.05 compared to the unoperated hemithorax. In addition, height differences indicated local depressions in the chest wall in the areas of cartilage defects (6th-9th, P < 0.05). Following local depression of the chest wall and migration of the ribs, the operated hemithorax also had a smaller area than the unoperated hemithorax (6th-9th, P < 0.05). The differences in the hemithorax were more significant in the midterm group (5-10 y) than in the other follow-up groups, while most parameters showed no significant differences in the long-term group (10-15 y). No significant differences were found in the modified Haller index.
Multiple costal cartilage harvests caused morphological changes and asymmetry of the thorax in adolescent patients. As indicated by thoracic CT, significant changes occurred in the local area of cartilage defects, which did not affect the overall thorax. In the long term, more than 10 years after harvesting, the differences in the hemithorax between the operated and unoperated sides decreased significantly. This study provides an important reference for thoracic changes when applying auricular reconstruction in the pediatric microtia patients.
耳部再造术通常在儿童期开始，肋软骨是最常用于耳廓重建的材料。然而，多次肋软骨采集会导致局部软骨缺陷，这需要医生密切关注。本研究通过测量和分析不同随访组的胸廓形态变化来探讨这一问题。
28 例青少年小耳畸形患者采用第 6-8 肋软骨进行耳廓再造。术前及随访时行胸部 CT 三维重建。使用 Mimics 软件（比利时 Materialise 公司）测量多个胸廓参数，比较手术侧和非手术侧半胸。数据采用配对样本 t 检验进行分析。
在手术侧半胸，肋软骨结合部中点向内（第 6-8 肋）、向后（第 6-7 肋）移动，下降较少（第 6-9 肋），与非手术侧相比差异有统计学意义（P < 0.05）。此外，在软骨缺损区域（第 6-9 肋），高度差异提示胸壁局部凹陷。肋骨局部凹陷和迁移后，手术侧半胸面积也小于非手术侧（第 6-9 肋，P < 0.05）。中期（5-10 年）组的半胸差异比其他随访组更显著，而长期（10-15 年）组的大多数参数差异无统计学意义。改良 Haller 指数无明显差异。
多次肋软骨采集导致青少年患者胸廓形态和不对称。胸部 CT 提示，软骨缺损局部区域发生明显变化，但不影响整体胸廓。在长期随访中，即采集后 10 年以上，手术侧和非手术侧半胸之间的差异显著减小。本研究为小儿小耳畸形患者应用耳廓再造术时的胸廓变化提供了重要参考。
