Accepted Manuscript Title: Letter to the Editor regarding “A long-term analysis of auricular position in pediatric patients who underwent post-auricular approaches” Author: Dong-Hee Lee PII: DOI: Reference:
S0165-5876(14)00271-7 http://dx.doi.org/doi:10.1016/j.ijporl.2014.05.003 PEDOT 7122
To appear in:
International Journal of Pediatric Otorhinolaryngology
Received date: Accepted date:
15-4-2014 3-5-2014
Please cite this article as: Dong-Hee Lee, Letter to the Editor regarding “A long-term analysis of auricular position in pediatric patients who underwent post-auricular approaches”, International Journal of Pediatric Otorhinolaryngology http://dx.doi.org/10.1016/j.ijporl.2014.05.003 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Letter to the Editor
“A long-term analysis of auricular position in pediatric patients who underwent postauricular approaches”
cr
ip t
Dong-Hee Lee, MD, PhD.
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic
us
University of Korea, Seoul, Korea
an
Correspondence to:
M
Dong-Hee Lee, MD, PhD.
Department of Otolaryngology-Head and Neck Surgery,
d
Uijeongbu St. Mary’s Hospital, The Catholic University of Korea,
Ac ce pt e
271 Cheonbo street, Uijeongbu city, Gyeonggi-do, 480-717, Korea. Telephone : +82-31-820-3564 / Fax : +82-31-847-0038
Dear Editor:
I read with great interest the article titled ‘‘A long-term analysis of auricular position in pediatric patients who underwent post-auricular approaches’’ by Hong et al.[1] They found that there was no statistically significant long-term postoperative change in any of three measurements regardless of patient variables. In conclusion, they stated that post-auricular approach did not alter the position of the external ear. Though this article gave valuable information to otologic surgeons and patients, I have one comment. I think that it is may be more important to measure anterior-posterior position as well as vertical position of the auricle before and after the surgery. Because authors focused
Page 1 of 3
on postoperative protrusion of the auricles, they measured only lateral protrusion of the ear. They admitted that this may be potential limitation of their study. In addition, previous study reported low-set ear after the mastoidectomy, which means inferior displacement of the auricles.[2]
ip t
Authors’ surgical procedure composed of three-layered approximation of periosteal layer,
cr
subcutaneous layer and skin layer. To prevent anterior displacement of the auricles, I sutured in a four-layered fashion: 1) periosteal layer, 2) superficial mastoid fascial layer, 3)
us
subcutaneous layer and 4) skin layer. Superficial mastoid fascia is a thick fascial layer caudally in the mastoid area, which cranial portion is known as the superficial temporal fascia.
an
It contains the posterior auricular muscle and the branches of the posterior auricular artery.
over the auricle.[3,4]
M
This superficial mastoid fascia over the mastoid connects to the extrinsic post-auricular fascia
d
Therefore, tight suture of these two layers is very important to secure the auricular
Ac ce pt e
cartilage in its original position. Because the auricular cartilage is lifted from its base during post-auricular approach and only subcutaneous suture cannot stick the auricular cartilage to the base, displacement of the auricle can occur after three-layered approximation and its direction can be anterior or inferior. Approximation of superficial mastoid fascial layer is very important, especially after canal wall down mastoidectomy and meatoplasty, in which postoperative wound contracture may be enough strong for the auricular position to be changed. This is why I recommend a four-layered approximation of periosteal layer, superficial mastoid fascial layer, subcutaneous layer and skin layer for postauricular approach. I suggest that change of anterior-posterior and vertical position of the auricle is more important than lateral protrusion after post-auricular approach. I hope that my comments will be helpful for authors’ future study and for the readers to understand this article correctly.
Page 2 of 3
Conflicts of Interest None Declared References 1.
Hong P, Arseneault T, Makki F. A long-term analysis of auricular position in pediatric
ip t
patients who underwent post-auricular approaches. International journal of pediatric
2.
cr
otorhinolaryngology. 78 (2014) 471-473.
Ali MS. Unilateral secondary (acquired) postmastoidectomy low-set ear:
Otolaryngol Head Neck Surg. 38 (2009) 240-245.
Datta G, Carlucci S. Reconstruction of the retroauricular fold by 'nonpedicled'
an
3.
us
postoperative complication with potential functional and cosmetic implications. J
M
superficial mastoid fascia: details of anatomy and surgical technique. J Plast Reconstr Aesthet Surg. 61 Suppl 1 (2008) S92-97.
d
Shokrollahi K, Taylor JP, Le Roux CM, et al. The Postauricular Fascia: Classification, Anatomy, and Potential Surgical Applications. Ann Plast Surg. (2013)
Ac ce pt e
4.
Page 3 of 3
S0165-5876(14)00271-7 http://dx.doi.org/doi:10.1016/j.ijporl.2014.05.003 PEDOT 7122
To appear in:
International Journal of Pediatric Otorhinolaryngology
Received date: Accepted date:
15-4-2014 3-5-2014
Please cite this article as: Dong-Hee Lee, Letter to the Editor regarding “A long-term analysis of auricular position in pediatric patients who underwent post-auricular approaches”, International Journal of Pediatric Otorhinolaryngology http://dx.doi.org/10.1016/j.ijporl.2014.05.003 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Letter to the Editor
“A long-term analysis of auricular position in pediatric patients who underwent postauricular approaches”
cr
ip t
Dong-Hee Lee, MD, PhD.
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic
us
University of Korea, Seoul, Korea
an
Correspondence to:
M
Dong-Hee Lee, MD, PhD.
Department of Otolaryngology-Head and Neck Surgery,
d
Uijeongbu St. Mary’s Hospital, The Catholic University of Korea,
Ac ce pt e
271 Cheonbo street, Uijeongbu city, Gyeonggi-do, 480-717, Korea. Telephone : +82-31-820-3564 / Fax : +82-31-847-0038
Dear Editor:
I read with great interest the article titled ‘‘A long-term analysis of auricular position in pediatric patients who underwent post-auricular approaches’’ by Hong et al.[1] They found that there was no statistically significant long-term postoperative change in any of three measurements regardless of patient variables. In conclusion, they stated that post-auricular approach did not alter the position of the external ear. Though this article gave valuable information to otologic surgeons and patients, I have one comment. I think that it is may be more important to measure anterior-posterior position as well as vertical position of the auricle before and after the surgery. Because authors focused
Page 1 of 3
on postoperative protrusion of the auricles, they measured only lateral protrusion of the ear. They admitted that this may be potential limitation of their study. In addition, previous study reported low-set ear after the mastoidectomy, which means inferior displacement of the auricles.[2]
ip t
Authors’ surgical procedure composed of three-layered approximation of periosteal layer,
cr
subcutaneous layer and skin layer. To prevent anterior displacement of the auricles, I sutured in a four-layered fashion: 1) periosteal layer, 2) superficial mastoid fascial layer, 3)
us
subcutaneous layer and 4) skin layer. Superficial mastoid fascia is a thick fascial layer caudally in the mastoid area, which cranial portion is known as the superficial temporal fascia.
an
It contains the posterior auricular muscle and the branches of the posterior auricular artery.
over the auricle.[3,4]
M
This superficial mastoid fascia over the mastoid connects to the extrinsic post-auricular fascia
d
Therefore, tight suture of these two layers is very important to secure the auricular
Ac ce pt e
cartilage in its original position. Because the auricular cartilage is lifted from its base during post-auricular approach and only subcutaneous suture cannot stick the auricular cartilage to the base, displacement of the auricle can occur after three-layered approximation and its direction can be anterior or inferior. Approximation of superficial mastoid fascial layer is very important, especially after canal wall down mastoidectomy and meatoplasty, in which postoperative wound contracture may be enough strong for the auricular position to be changed. This is why I recommend a four-layered approximation of periosteal layer, superficial mastoid fascial layer, subcutaneous layer and skin layer for postauricular approach. I suggest that change of anterior-posterior and vertical position of the auricle is more important than lateral protrusion after post-auricular approach. I hope that my comments will be helpful for authors’ future study and for the readers to understand this article correctly.
Page 2 of 3
Conflicts of Interest None Declared References 1.
Hong P, Arseneault T, Makki F. A long-term analysis of auricular position in pediatric
ip t
patients who underwent post-auricular approaches. International journal of pediatric
2.
cr
otorhinolaryngology. 78 (2014) 471-473.
Ali MS. Unilateral secondary (acquired) postmastoidectomy low-set ear:
Otolaryngol Head Neck Surg. 38 (2009) 240-245.
Datta G, Carlucci S. Reconstruction of the retroauricular fold by 'nonpedicled'
an
3.
us
postoperative complication with potential functional and cosmetic implications. J
M
superficial mastoid fascia: details of anatomy and surgical technique. J Plast Reconstr Aesthet Surg. 61 Suppl 1 (2008) S92-97.
d
Shokrollahi K, Taylor JP, Le Roux CM, et al. The Postauricular Fascia: Classification, Anatomy, and Potential Surgical Applications. Ann Plast Surg. (2013)
Ac ce pt e
4.
Page 3 of 3
