Question Mark Ear Deformity: A Combined Method for Correction

Abstract

Question mark ear deformity or Cosman ear is a very uncommon congenital alteration. The deformity includes a cleft between the posterior helix and the lobule, an increase in anterior projection, an abnormal superior third that modifies the superior crura and the scaphoid fossa, partial or complete absence of the antihelix, transposition of the lobule and antihelix (severe cases), and postauricular tags. The authors present a case of moderate question mark ear deformity treated using Mustarde sutures and two cartilage grafts to correct the support and the contour defect. Adequate correction of the deformity and symmetry was achieved for both ears. The technique described in this report is suitable for minimal to moderate defects.

Question Mark Ear: An Unusual Anomaly and a Novel Surgical Technique for Reconstruction

“…The variability in the destined appearance of the ear and this spectrum where 1 surgical technique does not fit all. Several approaches exist and can be classified as local cutaneous flaps with or without cartilage grafts, 6 chondrocutaneous flaps, 5 which can be combined with tissue expansion 1 …”

“…Reconstructive surgery for this deformity aims to restore the contour of the helical and lobule interface, often requiring the use of skin and cartilage. Various techniques have been described for this purpose, such as cartilage grafts, local flaps, interdigitating Z-plasty flaps, cartilage wedge resection, composite grafting, and tissue expansion 4–10 . To address the protruding superior helix, Mustarde suture techniques and cartilage scoring may be utilized.…”

“…Other modalities, such as covering the joints during radiation therapy, myofascial and visceral relaxation, and hyperbaric oxygen therapy, have been shown to improve QoL in patients with RIF. 5,6 When coronoidectomy alone is insufficient to achieve adequate oral motoric function or when trismus recurs, further surgical management may be necessary. Sivam et al 7 reported a tonsillar SCC survivor with worsening trismus and pain despite bilateral coronoidectomy and botulinum toxin injections.…”

“…Various techniques have been described for this purpose, such as cartilage grafts, local flaps, interdigitating Z-plasty flaps, cartilage wedge resection, composite grafting, and tissue expansion. [4][5][6][7][8][9][10] To address the protruding superior helix, Mustarde suture techniques and cartilage scoring may be utilized.…”

Understanding the basis of auriculocondylar syndrome: Insights from human, mouse and zebrafish genetic studies

“…Among ACS patients, there is a high degree of inter- and intra-familial phenotypic variation, including non-penetrance [Gordon et al, 2013; Ozturk et al, 2005; Rieder et al, 2012]. Isolated QME (IQME, OMIM 612798), where the range of ear dysmorphism is very similar to that in ACS, has also been reported in isolated and familial cases with an autosomal dominant mode of inheritance, and might represent a milder form of ACS [Al-Qattan, 1998; Brodovsky and Westreich, 1997; Cosman et al, 1970; Fumiiri and Hyakusoku, 1983; Pan et al, 2010; Park, 1998; Posso et al, 2011; Shkalim et al, 2008; Takato et al, 1989; Vayvada et al, 2005; Vincent et al, 1961]. …”