No abstract

The reconstruction of the ear pavilion includes at least two stages, usually three, and in many cases more. Complete reconstruction must begin with the plastic surgeon, who sculpts the cartilaginous skeleton, assembles parts of three ribs, and inserts the finished framework under the expanded skin of the mastoid area. During the second stage, the otologist intervenes, performing the cophosurgery, carving an external auditory canal, and completing the ossicular chain in the middle ear. The plastic surgeon harvests the skin for lining the external auditory canal and for the retroauricular fold and forms the lobule with a part of the microtic vestige. The third stage is dedicated to refinements. Cophosurgery may also be performed during the third stage or in an interval between two stages of pavilion construction. Twenty-one cases are discussed.

During the course of 1974, 16 tympanoplasties were performed on patients who suffered from serious congenital heart defects. 50 % of the cases had recurrence of the perforation. It was not possible to deny the evidence of other failing factors such as the poor hemodynamic condition. Indications for performing a tympanoplasty were motivated by the necessity to eliminate a focus of dangerous infection to the patient before undergoing a major cardiac intervention. These indications have been modified to the following: (a) chronic cholesteatomatous otitis remains a valid surgical indication and (b) simple chronic otitis could be controlled by local medical treatment. The tympanoplasty could be postponed after the cardiac intervention when the hemodynamic condition had been corrected.