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Microtia

R1 Roco Prez Heredia


DEFINICION

NO FORMACION ADECUADA DEL PABELLON AURICULAR ESTE DEFECTO


PUEDE SER COMPLETO , UNILATERAL O PARCIAL .
Preauricular pits and sinuses, and a combination of pits,
preauricular appendages, cupping deformity, and deafness,
are all hereditarily dominant.1,47 Both dominant and recessive
characteristics have been revealed in deafness associated with
several auricular abnormalities.48 Ear deformities frequently
recur in families of mandibulofacial dysostosis (Treacher
Collins syndrome).
HISTORIA
EPIDEMIOLOGIA

Ocurre en 7,000 a 8,000 infantes.


Ocurre frecuentemente en el oido derecho.
Frecuente en varones.
Frecuente en hispanos y asiaticos que en blancos y negros.
Antecedentes familares 15%.
Asociado a otras malformaciones congenitas.

NELIGAN PLASTIC SURGERY


MICROTIA
INCIDENCIA

CONWAY Y WAGNER (1965) 1:12.500 Nacimientos


GRABB (1965) 1:6.000
KASEFF (1967) 1:6.000

Sexo Masculino Doble en Relacin al Femenino


Relacin Derecho : Izquierdo : Bilateral - 5 : 3 : 1

DU PERTIUS-MUSGRAVE, 1959
OGINO, 1964
EDAD PARA OPERAR

Despus de los 3 aos de edad, 85% de la oreja ya se


desarroll (ADAMSON, 1965).

El odo alcanza aproximadamente el 85 % del


tamao adulto a la edad de 6 aos.

Para fines prcticos, el odo normal est desarrollado


completamente a la edad de 6-7 aos.
CONDICIONES ESCENCIALES PARA BUENOS
RESULTADOS

PIEL DE BUENA CALIDAD


CARTILAGO COSTAL SUFICIENTEMENTE ANCHO Y GRUESO
EMBRIOLOGA
I Arco branquial, originar: el trago II Arco branquial: Helix, Antehlix,
y la porcin inicial del hlix Antitrago. Lbulo, Concha
EMBRIOLOGIA

Prominencias Auriculares Fusin y desarrollo


rodean el extremo dorsal de progresivo de las
prominencias hasta
la primera hendidura
formar el pabelln de
farngea las oreja.

NELIGAN PLASTIC SURGERY


Irrigacin:
Dos redes arteriales intercomunicadas, derivadas de la
Cartida Externa, por medio de la Auricular Posterior.

La red de la fosa triangular de Escafa recibe afluentes de la


Auricular Anterior y Auricular Superior, rama de la Temporal
Superficial y de ramas de la auricular posterior, las cuales
llegan a travs del lbulo auricular y la fosa triangular y suben
por el margen del hlix.

Ramas de la Arteria Occipital, que irrigan la zona posterior


Inervacin:

Sensitiva:
Dan sensibilidad a la parte posterior del pabelln auricular y al
lbulo los Nervios Cervicales (auricular mayor, C2 a C3 ) y el
nervio occipital menor.

Los Nervios Occipitales Menores se encuentran inervando


predominantemente la regin superior de la oreja y la regin
mastoidea, mientras que la regin inferior y la regin
preauricular son inervadas por el Nervio Auricular Mayor.
La superficie anterior y el trago son inervados por el
Trigmino (nervio auriculotemporal).

La rama auricular del Nervio Vago (nervio de Arnold)


provee sensibilidad al meato auditivo externo.

Motora:

Nervio Facial, por el auricular anterior y auricular


posterior
UBICACIN: entre dos lneas
horizontales: superior, a nivel de
las cejas ; inferior a la altura de
la base de la nariz

Incidencia 1/20,000 Unilateral,


80%.Se asocia con anomalas
congnitas como: Microsoma
hemifacial. Sind de Goldenhard,
Treacher Collins, Klippel-Feil
ANATOMIA
ANATOMA: Eje mayor de la oreja forma un ngulo de 20-30 con el eje vertical de
la cabeza. Angulo cfalo-conchal: 30-45
- Msculo mayor del
hlix
-Msculo menor del
hlix
-Msculo de trago y
Msculo del antitrago
-Cola del hlix
- Cavidad de la concha
FISIOLOGIA (ANTROPOMETRIA)
Hereditary factors
In a study conducted by Rogers,46 morphologic, anatomic,
and genetic interrelationships were shown to exist between
microtia, constricted, and protruding ears. In this thorough
investigation, Rogers demonstrated that these deformities are
interrelated and can be hereditary.
Preauricular pits and sinuses, and a combination of pits,
preauricular appendages, cupping deformity, and deafness,
are all hereditarily dominant.1,47 Both dominant and recessive
characteristics have been revealed in deafness associated with
several auricular abnormalities.48 Ear deformities frequently
recur in families of mandibulofacial dysostosis (Treacher
Collins syndrome).
These are frequently constricted ear deformities, an abnormality that is known to be
hereditary.12,5052 Hanhart found a severe form of microtia associatedwith a cleft or high palate in
10% of family members studied,51and Tanzer53 found that approximately 25% of his 43
microtiapatients had relatives with evidence of the first and secondb bronchial arch syndrome
(craniofacial microsomia); microtia was present in four instances.

In 4.9% of the authors first 1000 microtia patients, family histories revealed that major auricular
deformities occurred within the immediate family, i.e., parents, siblings, aunts, uncles, or
grandparents.23 When distant relatives were included, the percentage jumped up to 10.3%. In 6%
of patients, preauricular skin tags or minor auricular defects.
Hereditary factors In a study conducted by Rogers,46 morphologic, anatomic, and genetic
interrelationships were shown to exist between microtia, constricted, and protruding ears. In this
thorough investigation, Rogers demonstrated that these deformities are interrelated and can be
hereditary.

Preauricular pits and sinuses, and a combination of pits, preauricular appendages, cupping deformity,
and deafness, are all hereditarily dominant.1,47 Both dominant and recessive characteristics have
been revealed in deafness associated with several auricular abnormalities.48 Ear deformities
frequently recur in families of mandibulofacial dysostosis (Treacher Collins syndrome).
were observed in the immediate family. This number also rose
to 10.3% when all relatives were included. Immediate family
members with normal auricles but underdeveloped jaws or
facial nerves were seen in 1.2% of patients.23
In a thorough, intensive survey of 96 families of their 171
microtic patients, Takahashi and Maeda54 ruled out chromosomal
aberrations and concluded that inheritance must be
multifactorial and that the recurrence risk is 5.7%. In previous
studies, others have found multifactorial inheritance between
3 and 8% in first-degree relatives. If a couple has two children
with microtia, the risk of recurrence in future offspring is
thought to be as high as 15%.

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