Auricular Reconstruction Nagata Method
Auricular Reconstruction Nagata Method
History of Auricular Reconstruction
Ever since the introduction of autogenous auricular reconstruction by RC Tanzer of the United States, numerous developments, refinements, modifications for auricular reconstruction have been reported. The major auricular reconstruction methods known are the Tanzer method, Brent's method and the Nagata method,the Nagata method was developed and introduced in the mid 1980's.
One of the major differences among these 3 auricular reconstruction methods is in the number of surgeries required to reconstruct the auricle. The Tanzer method requires 6b surgeries, Brent’s method requires 4 surgeries and 2 surgeries for my method. The analyses of an ideal auricle reported by Hale Tolleth, MD, a prominent plastic surgeon in the United States, described in detail the anatomical features, proper anatomical location of the auricle, proportional and dimensional analyses of what an auricle must have to be an ear. When the reconstructed auricles by Tanzer and Brent were comparatively analyzed to what Tolleth had described in his analyses, there were numerous discrepancies noted to that of an ideal auricle. The Nagata method solved these discrepancies and as to the results, the proportional and dimensional analyses of the reconstructed auricle with my method ware within 1 to 2 percent deviation from what Tolleth had described as an ideal auricle.The projection of the reconstructed auricle which was not possible to attain with conventional auricular projection methods can now be attained with the method I developed.
Presently, the Nagata method is described in numerous American medical textbooks of Plastic Surgery and now accepted worldwide as one of the “Gold Standards” for total and subtotal auricular reconstruction.
Representative Auricular Reconstruction Cases-Primary Auricular Reconstruction
The representative cases for primary auricular reconstruction, patient who underwent auricular reconstruction for the first time are presented. The patients are generally children and the criteria established for the first stage operation are: minimum age of 10 years and chest circumference of at least 60 cm at the xiphoid process with both arms at the patient’s sides, X-ray confirmation of costal cartilage volume is required.
The classification of microtia is categorized into the following 4 types in reference to the severity of the microtic condition.
- Lobule Type
- Concha Type
- Small Concha Type
- Anotia
Other than the above mentioned 4 types of microtia (non-complicated type), primary auricular reconstruction can be further complicated with conditions like low hairline. This condition is considered as a difficult auricular reconstruction case since if the auricle is reconstructed in the proper anatomical location the outcome result will be an auricle with hair growth (hairy auricle). With the conventional methods, the surgeon reconstructs a hairy auricle or will reconstruct the auricle in an abnormal anatomical location (usually in a lower anatomical location) to avoid the low hairline.
With the Nagata method, all these problems have been solved and it is possible to reconstruct the auricle in its proper anatomical location and without hair growth.
- Representative Cases for Primary Auricular Reconstruction:
- Case 1 Case 2 Case 3 Case 4 Case 5 Case 6 Case 7 Case 8 Case 9 Case 10 Case 11
Preoperative Appecfance
Post-operative Appearance
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- Typical lobule type microtia with the sausage-shaped vestige and there is no acoustic meatus and auditory canal.
- The patient is able to wear glasses after the second stage operation for auricular projection.
Preoperative Appecfance
Post-operative Appearance
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- The same microtia classification as Case 1 but of the right side with the sausage-shaped vestige and there is no acoustic meatus and auditory canal.
- Appearance at 6 months after the first stage operation and immediately prior to the second stage operation for auricular projection. Note that the morphological features of the auricle have been reconstructed.
- Appearance after the second stage operation, the reconstructed auricle is projected.
- Follow-up appearance of the same patient after auricular projection. The projected auricle is well maintained and there appears as if there is an acoustic meatus beneath the constructed tragus.
- The same microtia classification as Case 1 but of the right side with the sausage-shaped vestige and there is no acoustic meatus and auditory canal.
Preoperative Appecfance
Post-operative Appearance
- The preoperative appearance of a typical small concha type microtia.
- Appearance after the second stage operation for auricular projection where one can note that all the detailed morphological features have been reconstructed.
- The left and right auricles of the patient revealing that that the reconstructed auricle has been symmetrically reconstructed.
- Appearance after the second stage operation for auricular projection where one can note that all the detailed morphological features have been reconstructed.
Preoperative Appecfance
Post-operative Appearance
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- The pre- and post- surgical appearances of a typical concha type microtia.
Preoperative Appecfance
Post-operative Appearance
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- Another concha type microtia case where at some institution this case may be classified as a constricted ear instead of a microtia case.
- Appearance after the second stage operation for auricular projection revealing that all the detailed feature of the auricle have been reconstructed.
- Another concha type microtia case where at some institution this case may be classified as a constricted ear instead of a microtia case.
Preoperative Appecfance
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- Pre- and intra- operative appearances of the first stage operation where the outline for the first stage operation confirms that the helical rim penetrates into the hair bearing skin
- The appearance at 6 months after the first stage operation revealing that there is no hair growth at the helical rim region of the reconstructed auricle.
- Appearance after the second stage operation for auricular projection revealing that all the features of the reconstructed auricle are well maintained, projected and without hair growth
- Pre- and intra- operative appearances of the first stage operation where the outline for the first stage operation confirms that the helical rim penetrates into the hair bearing skin
Preoperative Appecfance
Post-operative Appearance
- The preoperative appearance of an anotia case further complicated with severe low hairline. Generally the vast majority of the anotia cases are associated with low hairline thus making auricular reconstruction complicated and difficult.
- The operative outline for the first stage operation reveals that 75% of the auricular reconstruction site penetrates into the hair bearing skin and that the remnant vestige is located at a distance to far to be utilized for auricular reconstruction.
- Appearance after the second stage operation for auricular projection revealing that it is possible to properly reconstruct and project the auricle even in anotia cases complicated with severe low hairline.
- The operative outline for the first stage operation reveals that 75% of the auricular reconstruction site penetrates into the hair bearing skin and that the remnant vestige is located at a distance to far to be utilized for auricular reconstruction.
Representative Auricular Reconstruction Cases - Secondary Auricular Reconstruction
Secondary auricular reconstruction is described as auricular reconstruction for unfavorable primary auricular reconstruction results where such cases have been rapidly been increasing in the last 10 years.
Briefly, secondary auricular reconstruction is sought by patients who have had auricular reconstruction previously at a different institution that resulted in unfavorable outcomes. It is necessary to remove the cartilage framework from the primary auricular reconstruction, fabricate an new 3-D frame and graft it to its proper anatomical location. This surgery can be meticulous and complicated at times since there are numerous problems that must be concurrently solved like mismatch in color of the skin due to grafting, excessive scarring, etc. from the primary auricular reconstruction. But with my method of reconstruction for secondary auricular reconstruction, favorable and satisfactory results are attained.
Preoperative Appecfance
Post-operative Appearance
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- Preoperative appearance revealing the mismatch in color of skin grafted to the conchal vault, resorption of the helical rim region of the cartilage framework, deformation of the framework in general, the mismatch of color of the grafted skin in the outer margin of the auricular reconstruction and its width is too wide and the hairline appears to abnormal.
- The re-reconstructed auricle with the Nagata method is properly projected with the hairline of the mastoid surface is corrected and well maintained. In the close-up photograph, it appears as if there exists an acoustic meatus beneath the constructed tragus and the color match of the conchal vault and the auricle in general is excellent.
- Preoperative appearance revealing the mismatch in color of skin grafted to the conchal vault, resorption of the helical rim region of the cartilage framework, deformation of the framework in general, the mismatch of color of the grafted skin in the outer margin of the auricular reconstruction and its width is too wide and the hairline appears to abnormal.
Preoperative Appecfance
Post-operative Appearance
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- Preoperative appearance of a hemifacial microsomia case where the primary auricular reconstruction was performed at a different institution resulted in the patient requesting for a secondary auricular reconstruction with the Nagata Method.
- The intra-operative appearance with the outline for the first stage operation revealing that the reconstructed auricle is located in an improper anatomical location due to avoidance of hair-bearing skin. It is located anterior to the normal anatomical location and the auricle to be reconstructed penetrates into the hair-bearing skin.
- The postoperative appearance after the second stage auricular projection revealed that the re-reconstructed auricle is in the normal anatomical location, there is no hair growth, a pseudo acoustic meatus has been created and the color match of the skin cover is excellent.
Preoperative Appecfance
Post-operative Appearance
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- Preoperative appearance of a hemifacial microsomia case where the primary auricular reconstruction was performed at a different institution
- Intra-operative appearance revealing that auricle reconstructed from the primary reconstruction is located at a great distance from the normal anatomical location (cheek) as confirmed from the surgical outline. In addition to the fact that this case is further complicated with low hairline.
- The appearance of the re-reconstructed auricle with the Nagata method revealing that the all the features of the auricle can be reconstructed and that the auricle can be reconstructed in its normal anatomical location in addition to the projection of the re-reconstructed auricle.
Preoperative Appecfance
Post-operative Appearance
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- Preoperative appearance for an unfavorable primary auricular reconstruction with mismatch in color of skin grafted from the thigh and groin region. Note that pubic hair growth is confirmed in the superior region of the auricle.
- The appearance of the re-reconstructed auricle with the Nagata method revealing that the projection of the re-reconstructed auricle has been attained and that there is no mismatch in skin color and that there is no unwanted hair growth.
- Preoperative appearance for an unfavorable primary auricular reconstruction with mismatch in color of skin grafted from the thigh and groin region. Note that pubic hair growth is confirmed in the superior region of the auricle.
