Wedge Reconstruction of Partial Auriculectomy Defects

DEFINITION

Partial ear defects can result following trauma or more commonly following resection of cutaneous malignancies.
Wedge resection and closure techniques are appropriate for defects up to one-third of the outer circumference of the ear occurring in the upper two-thirds of the ear.
Reconstruction of such defects aims to restore the natural anatomic structures and landmarks of the ear and ideally should maintain balance and symmetry with the contralateral ear.¹,²,³

ANATOMY

The ear is an important component both in the aesthetic balance of the face and in auditory function (it funnels sound into the external auditory canal and selectively amplifies sounds in the frequency range of human speech).
The anatomic landmarks of the ear are defined by the underlying cartilaginous framework, which create the contours that should be restored as best as possible during wedge reconstruction of the ear.
The outer rim or helix creates the outer curvature of the ear and originates from the face at the root of the helix (FIG 1).
- Concentrically within the helix is the antihelix, which separates into two separate crura in the upper third of the ear that define the triangular fossa.
- The scapha is the concave rim that separates the helix and antihelix.
- The concha lies within the antihelix and is the structure that leads to the external auditory meatus.
- The anterior border of the external auditory meatus is defined by the tragus. In the lower third of the ear lies the lobule or ear lobe, which does not contain cartilage.³,⁴,⁵
The ideal proportions of the external ear are variable based on age and gender.
- The length of the ear should be approximately twice the width and should project 1.5 to 2 cm from the head.⁴
- The superior most part of the ear should be level with the position of the brow or just cephalad to the orbits, which are typically situated in the middle of the face.
- The ear lobe should lie roughly even at the level of the nasal ala, which is typically half the distance between the eyes and mentum.

FIG 1 • Anatomy of the auricle. Landmarks need to be precisely realigned in ear wedge resection and reconstruction.

PATIENT HISTORY AND PHYSICAL FINDINGS

A thorough history and physical should be obtained prior to any operation paying close attention to significant comorbidities including smoking history, prior surgeries including scars in the area that may impact the design of the wedge resection, and medications that may predispose the patient to bleeding.
Patients who wear glasses should also be educated in postoperative care and management of incisions.
- They may need to remove the earpiece of the glasses on the reconstructed side until adequate healing has occurred before replacing the earpiece.
Defects resulting from oncologic resection should consider documentation for clear margins or Mohs excision prior to definitive reconstruction.

IMAGING

Patients who have undergone resection for cutaneous malignancies such as melanoma and squamous cell carcinoma may require imaging studies for staging and to rule out potential for metastatic disease.

SURGICAL MANAGEMENT