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Objectives: This study aims to assess possible wound complications of tympanoplasty and tympanomastoidectomy with or without postoperative mastoid dressing., Patients and Methods: A total of 37 patients (22 females, 15 males; mean age: 23.88 years; range 9 to 64 years) who underwent middle ear or mastoid operations via postauricular incision were included in this prospective, randomized, controlled study. The patients were divided into two groups as having mastoid dressing (n=17) and nonmastoid dressing (n=20). Through a close follow-up, postoperative complications were noted and distance from mastoid scalp and auricular rim was measured., Results: The mean mastoid-helix distance of non-mastoid dressing group was found 17.2 mm in operated and 16.9 mm in non-operated ears. The mean mastoid-helix distance of mastoid dressing group was 15.53 mm in operated ears and 16.47 mm in non-operated ears. Skin erythema was seen in a patient. There was no statistically significant increase in mastoid-helix distance (p>0.05)., Conclusion: Tympanoplasty with or without mastoidectomy does not cause postoperative complication or protrusion of the ear, even if no mastoid dressing is used. Our study results suggest no benefit of mastoid dressing after tympanoplasty with or without mastoidectomy.

We describe a rare case of necrotizing fasciitis of the ear in an otherwise generally healthy 39-year-old man. The ear is rarely involved in this often-fatal disease. The diagnosis was suspected on the basis of clinical examination and confirmed by computed tomography and pathology of a biopsy specimen, which revealed subcutaneous gas formation and dermal infiltration of inflammatory cells, respectively. The patient was promptly treated with surgical debridement, intravenous antibiotics, and hyperbaric oxygen. He recovered well and subsequently underwent otoplastic reconstruction with very satisfactory results. By documenting this case, we aim to heighten awareness of necrotizing fasciitis of the head and neck in an effort to improve survival rates.

Objective: We report three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging findings in a patient with relapsing polychondritis., Method: Case report., Result: A 76-year-old woman initially presented with bilateral auricular swelling together with dyspnoea. Three months later, she experienced left hearing loss and recurrent vertigo. A biopsy of the auricle was performed and relapsing polychondritis was diagnosed. The patient underwent three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging 4 hours after intravenous injection of a standard dose of gadolinium. Gadolinium enhancement was visible throughout the vestibule and the endolymphatic space could not be visualised, suggesting breakdown of the blood-labyrinth barrier., Conclusion: This is the first radiological report to demonstrate breakdown of the blood-labyrinth barrier in a case of relapsing polychondritis with inner ear impairment.

Objective: To present and critically examine the spectrum of chondrocutaneous branchial remnants or accessory pinna, including rare case of bilateral cervical lesions, and to explain the basis of the biological behavior., Material and Method: Five cases of pediatric chondrocutaneous branchial remnants or accessory pinna were included. The ratios of the longest dimensions of the external ear to that of the accessory tragus/chondrocutaneous branchial remnants were calculated., Results: The size and rate of growth of chondrocutaneous branchial remnants or accessory pinna were found to be inversely proportional to the distance between the lesions and the normal pinna., Conclusion: The current literature and norms of terminology dictate that two different terminologies for lesions that are essentially histologically identical should be avoided. Chondrocutaneous branchial remnants, accessory pinna/tragus and chondroid/ cartilaginous choristomas are identical lesions with similar pathogeneses and should be referred to as choristomas.

The authors present a male 40-year-old patient with established diagnosis of Behçet's disease which had evolved to recurrent bilateral auricular polychondritis crises. MAGIC syndrome (mouth and genital ulcers with inflamed cartilage) is rare and groups together patients with this clinical picture without necessarily fulfilling the clinical criteria for Behçet's disease or relapsing polychondritis, demonstrating an independent disorder.

Objective: To investigate the treatment of auricular keloid with dinuclear surgery and intralesional injection of compound Betamethasone., Methods: From Jan. 2008 to Jan. 2012, a total of 186 cases of ear keloid were treated by surgery only (22 cases), or intralesional injection of compound Betamethasone (34 cases), or combined dinuclear surgery with compound Betamethasone (130 cases). All the patients were followed up for one year. SPSS 16.0 software was used for statistical processing and analysis, and GraphPad inspection method for inspection., Results: The effective rate was 54.55% (12/ 22) in surgery group and 55.88% (19/34)in injection group. The recurrence was obvious in injection group during the follow-up period. The effective rate was as high as 96.92% (126/130) in combined group with recurrence in 4 cases, which was significantly higher than that in other 2 groups (P < 0. 01)., Conclusion: Combined dinuclear surgery and compound Betamethasone injection has a good therapeutic effect on auricular keloids.

We report a case of an 83-year-old previously healthy female patient presenting with a swiftly evolving erythematous violaceous, infiltrative, ulcerated onion like mass with hyperkeratotic surface on the left ear lobe. The lesion was excised and resulted as an atypical fibroxanthoma, an extremely rare neoplastic growth, being a superficial variant of pleomorphic malignant fibrous histiocytoma. A brief review of dia-gnosis, treatment and prognosis is discussed.

Background: Auricular tophi are firm deposits of monosodium urate in crystal form, which may slowly develop in subcutaneous tissue of the ear. Ear is not usual locations for gout tophi, but when this growth does occur, helix and the antihelix are common sites., Case Presentation: We present a 64-year-old man who had multiple painless nodules over bilateral helix. An excisional biopsy was performed. Hematoxylin-eosin staining of biopsy specimens revealed a proteinaceous matrix that surrounded dissolved crystals, consistent with gout tophi. Bilateral auricular tophi are not common and may resemble a number of other diseases including squamous cell carcinomas, Kaposi's sarcoma, epidermal and dermoid cysts, rheumatoid nodules. Biopsy should be performed to rule out malignancy., Conclusions: Tophi of the auricle are usually asymptomatic but can become inflamed and occasionally ulcerate through the overlying skin. Chronic tophaceous gout is treated with dietary control and medication. Surgical excision is performed under local anesthetic if symptoms progression or cosmetically deformity is concerned.

Tufted angioma is an acquired vascular proliferation with specific histological characteristics. The most common clinical features are erythematous macules. It occurs predominantly in children and young adults, especially in the chest and neck. We report the case of a male patient, 12 years old, with an increased right ear auricle associated with erythematous macules and increased local temperature, referred with a diagnosis of lepromatous leprosy; however, this diagnosis was questioned. Histopathology was consistent with tufted angioma.

Nevi, which consist of nevus cells arising from external auditory canals (EACs) and auricles, are rare and their characteristics are not thoroughly understood. The purpose of this study was to analyze the clinicopathological characteristics of melanocytic nevus (MN) in EACs and auricles. Medical records were reviewed in 35 cases with junctional, compound and intradermal nevi treated in Ajou University Hospital, Korea between 2001 and 2011. Patient demographic, location, shape, and diameter of nevi, and pathologic results were analyzed according to the location, EACs (23 cases) and auricles (12 cases). Female predominance was noted in both EAC (60.9 %, 14 cases) and auricular (75 %, 9 cases) nevi. The mean age of EAC nevi (37.1 years) was younger than that of auricular nevi (42.2 years). The chief complaint was a symptomless mass in both groups, mostly in dome-like gross appearances. The mean diameter of EAC and auricular nevi was 9.6 (3-16) mm and 12.2 (3-25) mm, respectively. Histological findings chiefly presented intradermal nevi in EACs (78.3 %) and auricles (83.3 %) which showed preference to older patients, in contrast to the compound type. All nevi including five cases with skin grafts were completely excised without any recurrence within the follow-up period (average 5.3 months). A possible dysplastic nevus was detected in only one case. All MNs in EACs or auricles reveal similar characteristics. Early and complete excision is recommended to avoid skin graft, functional problems, and the risk of malignant melanoma.

Introduction: Angiolymphoid hyperplasia with eosinophilia (HALE) is a rare, benign proliferative vascular disorder of unknown etiology which typically presents as tumor-like nodules of the skin or subcutaneous tissue. It concerns mostly young female adults. We report a case of HALE located on the ear auricle diagnosed by biopsy. The outcome was total regression., Observation: An 81-year-old male patient presented with a lesion of the whole ear auricle. A diagnosis of HALE was confirmed histologically on biopsy. The evolution was marked by spontaneous and complete regression in 2 months. There was no recurrence after 1 year of follow-up., Discussion: The etiology of this disease remains hypothetical. It poses real diagnostic problems with other types of proliferation, but its main differential diagnosis is Kimura disease. Its treatment has not been codified yet. Spontaneous regression is possible and justifies following the patient from 3 to 6 months, before a possible surgery., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

In patients with advanced-stage cancer, small biopsies including fine-needle aspirates may be the only opportunity to obtain diagnostic tissue. In the current era of precision medicine, there is an increasing emphasis on the performance of ancillary molecular tests that can provide insights into prognosis and targeted chemotherapeutic options for patient management. Cytopathologists must meet this challenge by accurately diagnosing these fine-needle aspirates and ensuring that adequate material has been obtained for anticipated molecular studies. Herein, we describe a case of a fine-needle aspiration illustrating these principles, especially focusing on the utilization of direct smears for ancillary studies.

Keloids are considered aberrations of the wound healing process, and various treatment regimens are described depending on the morphology and size of the lesion. Compression therapy using custom-made pressure clips or splints is widely used for the treatment of keloids. The most common complication of this therapy is ulceration due to excessive soft tissue pressure, resulting in delays and prolonged treatment time. This article describes the fabrication of a custom-made pressure appliance for the treatment of a keloid located at the auricle helix. The pressure appliance can be modified to fit the auricle helix and covers the area needing pressure., (© 2013 by the American College of Prosthodontists.)

Purpose: Auricular reconstruction is a challenging surgical intervention that requires perfect surgical skills, exact planning, and esthetic knowledge. It is necessary to use a suitable method of reconstruction for each patient. From 10 years of experience, the authors have developed a general concept for auricular reconstruction., Patients and Methods: Seventy-five patients (62 male, 13 female; age range, 8 to 92 yr; mean age, 65.9 yr) underwent partial to total auricular reconstruction. Tissue loss occurred from different causes: 19 cases of squamous cell carcinoma (25.3%), 18 cases of basal cell carcinoma (24%), 14 cases of Bowen disease (18.7), 11 cases of malignant melanoma (14.7%), 7 cases of trauma (9.3%), 3 different malignant tumors (4%), and 3 cases of congenital deformity (4%)., Results: Defects smaller than one fourth the vertical auricular size (15 to 20 mm) could be treated by primary closure. A larger defect closed by this method caused visible deformity. In defects larger than one to three fourths the vertical auricular size (40 to 55 mm), a reversed retroauricular flap was used successfully if there was no contraindication or rejection. This flap can be combined with other flaps, depending on the flap location, size, and tissue involved. In defects exceeding three fourths the vertical auricular size, an implant-retained prosthesis was preferred., Conclusion: The location and size of a defect, the medical condition of the patient, and the desired esthetic outcome play an important role in choosing the appropriate method. According to the authors' experience, the only contraindications for the reversed retroauricular flap are medical condition, poor prognosis, and patient refusal., (Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Cutaneous tuberculosis (TB) is less common than other forms of TB but accounts for 1.5% of all cases of extrapulmonary TB. The source of mycobacterial infection and the immune status of the host determine the presentation of any of a wide spectrum of clinical manifestations. Lupus vulgaris (LV) is a post-primary, paucibacillary form of TB caused by hematogeneous, lymphatic, or contiguous spread from elsewhere in the body., Methods: We report two recent cases of LV in women presenting with the exclusive involvement of the ear lobe. In Patient 1, clinical presentation appeared as an apparently benign chronic eczematous process. In Patient 2, it appeared as a fulminant ulceronecrotic process. Both women were immunocompetent, and neither had a personal or family history of TB., Results: Both patients were diagnosed with LV and treated with standard antitubercular therapy (ATT). In both patients, mycobacterial culture showed growth of Mycobacterium tuberculosis sensitive to streptomycin, rifampicin, and ethambutol., Conclusions: Lupus vulgaris is the most common form of cutaneous TB. It is important to diagnose LV because it can result in chronic disfigurement and because 10-20% of LV patients have active pulmonary TB or TB of the bones and joints. In addition, longstanding LV is known to lead to the development of squamous cell carcinoma, which can be avoided by early diagnosis and treatment with ATT., (© 2013 The International Society of Dermatology.)

Background: The ear is known to have variable lymphatic drainage. The purpose of this study was to define better the lymphatic drainage patterns of the ear by correlating the location of primary tumors, classified according to the embryologically derived anatomical subunits of the ear, with their mapped sentinel nodes (SNs) identified by lymphoscintigraphy (LS)., Methods: Lymphatic drainage data for patients with a primary melanoma of the ear were reviewed and correlated with the precise primary melanoma site., Results: Between 1993 and 2010, LS was performed in 111 patients with a primary melanoma on the ear, identifying 281 SNs in 195 lymph node (LN) fields. The mean numbers of SNs and LN fields identified by LS per patient were 2.65 and 1.76. SN biopsy was performed in 71 patients (64 %). The mean number of SNs removed was 2.36. The 111 ear melanomas were mostly located on the helical rim (55 %), followed by the lobule (24.3 %). The five different primary ear sites drained mainly to SNs in level CII, level CV and the preauricular region. Drainage was most often to level CII (36.4 %). Drainage to the contralateral neck was not observed., Conclusions: Lymphatic drainage of the ear has no predictable pattern and can be to SNs anywhere in the ipsilateral neck. Most commonly drainage is to cervical level II and the preauricular and postauricular LN fields. LS defines the lymphatic drainage pattern in individual melanoma patients and is essential for accurate SN identification and reliable SN biopsy.

We report a case of an unusual presentation of American Tegumentary Leishmaniasis involving a male patient with a solitary lesion on the ear lobe, persisting with minimal increase for at least six months without ulceration or related symptoms. The histological sections showed epithelial atrophy and a large number of structures consistent with Leishmania sp. amastigotes within macrophages. Treatment commenced with meglumine antimoniate resulting in regression of the condition. This report is of importance given the unusual clinical manifestation and histopathological findings in this case and the fact that there was low correlation with the extended duration of the disease.

Purpose: To describe a man with pseudocyst of the auricle, summarize the salient features of this condition, and review other sports-associated dermatoses of the ear., Background: Pseudocyst of the auricle is an intracartilaginous collection of viscous straw-colored fluid typically located in the triangular fossa of the upper half of the auricle. It is usually asymptomatic. It can result in a permanent auricular deformity., Materials and Methods: A 63-year-old man developed a pseudocyst of the auricle following a traumatic rugby-related injury to his left ear. The lesion has persisted for many years; chronic massage has slightly decreased its size., Results: The etiology of pseudocyst of the auricle has been described as either traumatic or developmental. Our patient developed his pseudocyst after a rugby-related injury. This condition is usually unilateral. Aspirate of the content is usually sterile. Histology shows an intracartilaginous cyst devoid of an epithelial lining. Treatment involves either partial removal of the cartilage or chemical irritation to enhance adhesiveness. Subsequent compression (via button bolsters) minimizes recurrence., Conclusions: Pseudocyst of the auricle is a benign cystic dilatation, which is intracartilaginous, devoid of an epithelial lining, and may be traumatic or non-traumatic in origin. A man with rugby-associated trauma to his left ear developed this condition. Auricular pseudocyst can be added to the list of sports-associated dermatoses of the ear.

Objective: The aim of this study was to investigate the association between earlobe crease (ELC) and cardio-ankle vascular index (CAVI) in asymptomatic hypertensive subjects., Materials and Methods: A total of 75 subjects with ELC and 75 age- and gender-matched patients without ELC were prospectively selected from subjects admitted to the Outpatient Cardiology Clinic. ELC was assigned to a person with a crease stretching obliquely from the outer ear canal towards the border of the earlobe of at least one ear. CAVI was assessed by a VaSera VS-1000 instrument., Results: There were statistically significant higher CAVI values in ELC subjects (9.8 ± 2.1 vs. 8.6 ± 1.6, p < 0.001). There was a significant and positive association between CAVI and age (r = 0.42, p < 0.001), ELC (r = 0.31, p < 0.001), BMI (0.20, p < 0.001) and male gender (r = 0.21, p = 0.04). Linear regression analysis demonstrated ELC (95% confidence interval, CI, 0.61-1.74, p = 0.009), age (95% CI 0.03-0.09, p < 0.001) and male gender (95% CI 0.48-1.55, p = 0.03) as independent determinants of CAVI. Also, there was a higher prevalence of ELC in subjects with subclinical atherosclerosis (CAVI ≥9) than in normal subjects (CAVI <9)., Conclusion: Patients with ELC had higher CAVI than normal subjects. This observation of ELC is simple, adds no cost and can be easily made by most physicians, and it may provide important predictive information of arterial stiffness and subclinical atherosclerosis in asymptomatic hypertensive subjects. © 2013 S. Karger AG, Basel.

Keloids form as a result of aberrations of physiologic wound healing and may arise following any insult to the deep dermis. By causing pain, pruritus, and contractures, keloids significantly affect the patient's quality of life, both physically and psychologically. Multiple studies have been conducted for decades and have led to a plethora of therapeutic strategies to prevent or attenuate keloid formation, of which no single treatment has proven to be widely effective. Also, there is a dearth of information in the prosthodontic literature regarding appropriate management of such cases, especially when located in cosmetic areas. This clinical report presents an interdisciplinary cooperative approach between maxillofacial prosthetics and dermatology in prophylactic management of postsurgical auricular keloid. A new and an innovatively designed custom prosthesis for the management of the same is presented., (© 2012 by the American College of Prosthodontists.)

Two-photon microscopy has enabled the study of individual cell behavior in live animals. Many organs and tissues cannot be studied, especially longitudinally, because they are located too deep, behind bony structures or too close to the lung and heart. Here we report a novel mouse model that allows long-term single cell imaging of many organs. A wide variety of live tissues were successfully engrafted in the pinna of the mouse ear. Many of these engrafted tissues maintained the normal tissue histology. Using the heart and thymus as models, we further demonstrated that the engrafted tissues functioned as would be expected. Combining two-photon microscopy with fluorescent tracers, we successfully visualized the engrafted tissues at the single cell level in live mice over several months. Four dimensional (three-dimensional (3D) plus time) information of individual cells was obtained from this imaging. This model makes long-term high resolution 4D imaging of multiple organs possible.

Discovery and study of condyloma acuminatum in the ear with the occurrence of clinical symptoms. Mainly for thwart protuberance, and discomfort, no pain. The pathology report showed: (The left crus of helix) squamous papilloma.

Hypothesis: Bell's palsy is highly associated with diabetes mellitus., Background: The cause of Bell's palsy in diabetes mellitus is not completely understood. Diabetic mononeuropathy or reactivation of herpes simplex virus type 1 (HSV-1) may be responsible for the facial paralysis seen in diabetic patients. We previously reported transient and ipsilateral facial paralysis in mice inoculated with HSV-1. In this study, we examined the neuropathogenesis of HSV-1 in diabetic mice to clarify the relationship between Bell's palsy and diabetes mellitus., Methods: We compared the incidence and course of facial paralysis after HSV-1 inoculation in diabetic and nondiabetic mice groups. Diabetic mice were prepared by intraperitoneal streptozotocin injection. Facial nerve damage was assessed by electrophysiologic and histopathologic examinations., Results: Compared with the nondiabetic group, the incidence of facial nerve paralysis was significantly increased in the diabetic mice. Electrophysiologic examinations and histopathologic changes also revealed that the facial nerve damage was more severe in the diabetic group., Conclusion: The aggravated course of HSV-1 infection in diabetes suggests that HSV-1 may be the main causative factor for the increased incidence of facial paralysis in diabetic patients.

We present a case of spontaneous seroma of the ear, which can be encountered in the plastic surgery clinic. We describe our management and briefly review the literature regarding this interesting condition., (Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objective: To report a case of sebaceoma of the auricle, and to discuss the differential diagnosis, histopathological features, surgical management and genetic associations of this entity., Methods: Case report and review of the medical literature., Results: A 79-year-old man presented with a slowly growing lesion of his auricle. Excision of the mass and histopathological review revealed a benign, basaloid, adnexal neoplasm consistent with sebaceoma. Due to its association with Muir-Torre syndrome and increased risk of visceral malignancy, the patient was followed closely for signs of malignancy. At 36 months post-excision, there were no signs of recurrence; thereafter, the patient continued to receive routine cancer surveillance follow up., Conclusion: Sebaceoma is a rarely encountered, benign, adnexal neoplasm which can occur in the head and neck. The treatment is surgical excision, and recurrence is rare. Sebaceoma can occur as part of Muir-Torre syndrome, and in these patients there is an increased risk of other sebaceous lesions and visceral malignancy; thus, genetic testing and surveillance should be strongly considered.

Objective: Leishmaniasis comprises a group of diseases transmitted by the bite of infected sand flies. There are three basic clinical forms of leishmaniasis: cutaneous, mucocutaneous and visceral. Leishmaniasis may mimic neoplastic lesions and other infectious diseases because of similar disease localisation, physical characteristics and histopathological findings., Case Report: A 35-year-old man was referred to our clinic with a presumed diagnosis of angiolymphoid hyperplasia of the auricle; however, this lesion proved to be cutaneous leishmaniasis. The definitive diagnosis was reached by identifying the parasites on smears obtained from the lesion., Conclusion: It should be borne in mind that cutaneous leishmaniasis presenting as isolated auricular lesions may mimic neoplasia. In the present case report, we discuss auricular cutaneous leishmaniasis and we review the relevant literature.

The aims of the article were to study the clinical characteristic of patients with pseudocysts and to compare different common modalities of treatment and introduce the concept of observation in pseudocyst management. Twenty-eight patients were diagnosed with pseudocyst of the auricle between June 2009 and June 2011 in a medical college hospital. The patients were divided into four groups each of seven patients on the basis of primary treatment offered. Four primary treatments offered were simple aspiration, aspiration with intralesional steroid, incision and drainage with removal of anterior cartilage leaflet with buttoning, and lastly, simple observation and reassurance. All 28 patients were male with involvement of right side more than left and no one had bilateral involvement. Adults in the age group of 30-40 were commonly affected. Most of the patients had history of significant trauma by security forces. Most common site of involvement was scaphoid and triangular fossa. The best form of treatment with minimum recurrence was incision and drainage with removal of anterior cartilage leaflet with buttoning. Simple observation as a treatment option was found to be as good as intralesional steroids. Pseudocyst of the pinna is a benign condition of unknown etiology affecting the pinna, commonly encountered in middle-aged men. It is a rare condition and is hardly encountered in routine ENT practice. Bilateral diseases are uncommon. Most common site of occurrence is triangular and scaphoid fossa. Many modalities of treatment have been recommended in literature with varied recurrence and failure rates. The best treatment is surgical deroofing followed by buttoning with minimum recurrences. An option of simple observation for 2-3 months should be discussed with each patient and was found to be as good as intralesional steroids.

Forensic medicine specialists take account of the projectiles remaining in the body when determining whether there are an equal number of entry and exit wounds. The absence of projectiles should suggest blank cartridges, a single exit wound despite several firings and bullet embolization, whereas the presence of more projectiles than expected may indicate tandem projectiles and multiple projectiles entering through the same hole. Radiological examination of the whole body, follow-up of the bullet trajectories, examination of the clothes, and examination of the gun and projectiles play a key role in solving difficult cases. We review such situations based on a case of tandem bullets. Two 7.65-mm bullets created lethal wounds entering through a 32-year-old victim's neck followed the same trajectory to a certain point and diverted. We discussed the possibilities in cases that show inequalities between entry and exit wounds, in light of relevant literature., (© 2012 American Academy of Forensic Sciences.)