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| この度、念願のクリニックを新規開業する運びとなりました。 小耳症および再建外科・形成外科の専門クリニックとして、皆様のお役に立てるよう努力を重ねてまいります。 どうぞよろしくお願いいたします。秋葉病院から引き続き受診される方は、秋葉病院の診察券を忘れずに持ってきてください。 学会等で不在のこともありますので、受診前に必ず電話にて確認をされますようお願い申し上げます。 |
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| 永田小耳症形成外科クリニック 院長・医学博士 永田 悟 | |
| 住所 〒335-0035 埼玉県戸田市笹目南町２２-１ ＴＥＬ.048-449-3030 外来日 （月曜日 Pm１時〜４時）（水曜日 Pm１時〜４時）（土曜日 Am９時〜11時30分） 開 院 平成１７年11月15日より（自費診療のみ取り扱い） 平成17年12月1日より保険診療開始 |
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| ■形成外科 |
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History of Auricular Reconstruction （耳介再建の歴史）
Ever since Tanzer introduced auricular reconstruction utilizing the autogenous costal cartilages, numerous methods have been published. The methods varies in the number of stages involved and the morphological features reconstructed: Tanzer Method involves six (6) stages, Brent’s Method with four (4) stages and the Nagata Method with two (2) stages. As for the Tanzer’s and Brent’s Methods, the detailed morphological features were insufficient and the reconstructed auricle was not projected as published by Tolleth in his article. Therefore, I sought to solve these problems to reconstruct an auricle with detailed morphological features and a properly projected reconstructed auricle. I was able to develop the two (2) stage total auricular reconstruction method and performed the first surgical case with this method in 1985. As of date, I have performed over one thousand（1000）auricular reconstruction cases with the two (2) stage method.
Introduction
Total auricular reconstruction involves two stages with the first stage being the fabrication of the three-dimensional costal cartilage framework (3-D frame) and the grafting of the fabricated 3-D frame. The second stage is the projection of the reconstructed auricle.
Primary Auricular Reconstruction （耳介再建術）Primary auricular reconstructions are cases in which the patients undergo auricular reconstruction for the first time. The age of surgery is set at ten years of age and must fulfill the criterion of chest circumference of at least 60 centimeters (ample costal cartilage volume, confirmation with X-ray).
Case 1 Left Lobule Type Microtia
(a)
(b)
(c)
(a)
Pre-operative
Appearance
The pre-operative appearance of a typical left Lobule
Type Microtia prior to the first stage operation, note the sausage-shaped
remnant vestige and the absence of an external auditory canal.
(b)
(c) Post-operative Appearance
The post-operative appearance after
the second stage operation, note that the patient is now capable of wearing
glasses .
Case 2 Right Lobule Type Microtia
(a)
(b)
(c)
(d)
(a)
Pre-operative Appearance
Another pre-operative appearance of a typical right Lobule Type
Microtia prior to the first stage operation, note the sausage-shaped remnant
vestige and the absence of an external auditory canal.
(b) Post-operative Appearance After the First Stage
Operation
The post-operative
appearance at six months after the first stage operation and immediately prior
to the second stage operation, note that the morphological features of the
auricle have been reconstructed.
(c) Post-operative Appearance After the Second Stage
Operation
The post-operative appearance after the second stage
operation, note that the reconstructed morphological features of the auricle are
well maintained and that the auricle is properly projected.
(d) Post-operative Appearance After the Second Stage Operation
The close-up
appearance of the same patient, note that there appears to be a deep external
auditory canal present beneath the reconstructed tragus.
Case 3 Right Small Concha Type Microtia
(a)
(b)
(c)
(d)
(a)
Pre-operative
Appearance
The pre-operative appearance of a typical right Small Concha
Type Microtia prior to the first stage operation, note the shape of the remnant
vestige.
(b) Pre-operative Appearance After
Second Stage Operation
The close-up appearance, note that the morphological features of
the auricle have been reconstructed auricle.
(c) (d) Post-operative Appearance After
the Second Stage Operation
The lateral view of the reconstructed auricle on the left and the lateral view
of the normal auricle of the same patient on the right, note that the
reconstructed auricle is proportional reconstructed, properly projected and
located in the proper anatomical location as compared with the patient’s normal
auricle.
Case 4 Left Concha Type Microtia
(a)
(b)
(c)
(a)
Pre-operative
Appearance
The pre-operative appearance of a typical left Concha Type
Microtia prior to the first stage operation, note the shape of the remnant
vestige.
(b)
(c) Post-operative Appearance After
the Second Stage Operation
The post-operative appearance after auricular projection, note that the
morphological features of the auricle have been reconstructed and that the
reconstructed auricle is well projected and maintained.
The close-up
appearance, note that the morphological features of the auricle have been
reconstructed.
Case 5 Left Concha Type Microtia
(a)
(b)
(c)
(d)
(a)
(b) Pre-operative
Appearance
The pre-operative appearance prior to the first stage
operation of a left Concha Type Microtia according to my classification while
there are some authors who classify this case as Constricted Ear.
(c)
(d) Post-operative Apperance After
the Second Stage Operation
The post-operative appearance after auricular projection, note that the
morphological features of the auricle have been reconstructed and that the
reconstructed auricle is well projected and maintained.
The close-up
appearance, note that the morphological features of the auricle have been
reconstructed.
Case 6 Right Concha Type Microtia Further Complicated with Low Hairline
(a)
(b)
(c)
(d)
(e)
(a)
Pre-operative
The infra-operative appearance during the first stage operation
with the outline for auricular reconstruction, note that the superior portion of
the auricle to be reconstructed penetrates into the hair-bearing
skin.
(b) Infra-operative Appearance
(c)
Post-operative Appearance After the First Stage
Operation
The close-up appearance of the reconstructed auricle after the
first stage operation at six months, note that there is no hair growth in the
superior portion of the reconstructed auricle.
(d) Post-operative Appearance After the Second Stage
Operation
The post-operative
appearance after auricular projection, note that the morphological features of
the auricle have been reconstructed.
(e) Post-operative Appearance After the Second Stage
Operation
The post-operative appearance after the
second stage operation, note that the reconstructed auricle is well maintained
and properly projected
Case 7 Right Clinical Anotia Case Further Complicated with Extremely Severe Low Hairline
(a)
(b)
(c)
(a)
The pre-operative
appearance of a clinical anotia case complicated with extremely severe low
hairline. Anotia is an extremely complicated auricular reconstruction alone due
to extreme insufficiency of skin surface area to reconstruct the auricle and
this case is further complicated with a n extremely severe low
hairline.
(b) The infra-operative
appearance during the first stage operation revealing that more than half of the
surgical site is covered by hair bearing skin.
(c) The post-operative
appearance, note that there is absolutely no hair growth in the reconstructed
auricle and that auricular reconstruction even for clinical anotia cases and
those further complicated with low hairline can be reconstructed.
Secondary Auricular Reconstruction （耳介再々建術）
Secondary auricular reconstructions
are cases in which the patients request auricular reconstruction for the second
time due to unfavorable primary auricular reconstruction results. The number of
secondary auricular reconstruction has been increasing in the past
decade.
Secondary Auricular reconstruction for unfavorable results has been
and is considered as one of the most difficult reconstructive surgeries to
perform. The main reason being insufficient skin surface area due to scarring
from the primary surgery and may be further complicated with a severed
superficial temporal artery. But with careful preoperative planning, secondary
auricular reconstruction can be performed with favorable results.
Case 8 Unfavorable primary reconstruction results performed with the modified Tanzer method at a different institution for a lobule type microtia
(a) (b)
(c) (d)
(e)
(a) (b) The pre-operative close-up appearance revealing the unfavoralable color match of the grafted skin in
the conchal cavity, resorption of the cartilage framework in the upper region of the reconstructed auricle and absence of hair growth (alopecia) in the adjacent
area behind the reconstructed auricle where skin was also grafted.
(c) (d) (e) The post-operative results of secondary auricular reconstruction performed at our institution. Note
that the morphological features of the reconstructed auricle have been attained.
The post-operative angle view after the second stage operation, note that the reconstructed auricle is well maintained and project, also the absence of hair
growth behind the reconstructed auricle has been solved.
The post-operative close-up appearance of the same patient revealing that the morphological features of the auricle have been reconstructed and the results
appear as if there exists a external auditory canal behing the reconstructed tragus.
Case 9 A Hemifacial Microsomia Case Further Complicated with Low Hairline
(a)
(b)
(c)
(d)
(a)
(b) Pre-operative
Appearance
This is a hemifacial microsomia case
where the patient sought for secondary auricular reconstruction for an
unfavorable result of a primary total auricular reconstruction performed at a
different institution
Infra-operative appearance revealing the surgical
outline for the first stage operation, note that the reconstructed auricle from
the primary auricular reconstruction is not located in the proper anatomical
location, there is a mismatch in color of the grafted skin in the conchal cavity
and that this case is further complicated with low hairline penetrating into the
upper region of the auricle to be reconstructed.
(c) (d) Post-operative
Appearance
The post-operative results reveal that
the morphological features of the auricle have been reconstructed.
The
reconstructed auricle is located in the proper anatomical location, properly
projected and even the pseudo-auditory meatus (opening of the external ear
canal) is reconstructed.
Case 10 A Bilateral Hemifacial Microsomia Case Further Complicated with Low Hairline
(a)
(b)
(c)
(d)
(a)
(b) Pre-operative
Appearance
This is a bilateral hemifacial
microsomia case where the patient underwent primary total auricular
reconstruction surgeries at a different institution.
Infra-operative
appearance revealing the surgical outline for the first stage operation, note
that the reconstructed auricle from the primary auricular reconstruction is not
located in the proper anatomical location, the presence of abundant scar, mid
face and that this case is further complicated with low hairline penetrating
into the upper region of the auricle to be reconstructed.
(c) (d)
Post-operative
Appearance
The post-operative results reveal that
the morphological features of the auricle have been reconstructed.
The
reconstructed auricle is located in the proper anatomical location, properly
projected and well maintained.
(a)
(b)
(c)
(d)
(a)
(b) Pre-operative
Appearance
A pre-operative appearance of a
secondary auricular reconstruction case with a severed superficial temporal
artery (STA).
The pre-operative close-up appearance of this case revealing
mismatch in color of the skin graft harvested from the groin area during the
primary auricular reconstruction performed elsewhere. Note that there is pubic
hair growth in the upper portion and behind the reconstructed
auricle.
(c) (d) Post-operative
Appearance
The post-operative appearance after the
second stage operation, note that the reconstructed auricle is well maintained
and projected.
The post-operative results revealing that the morphological
features of the auricle have been reconstructed.
Correspondence Address
Satoru Nagata, M.D., Ph.D. 永田 悟
Department
Director
Department
of Reconstructive Plastic Surgery
AKIBA Hospital 秋葉病院
5-13-10
Negishi
Saitama-City, Saitama Prefecture 336-0024
Japan
Fax. No.: (+81)
48-862-6358
〒336-0024
埼玉県さいたま市根岸5-13-10
電話番号 048-864-0066 FAX 048-862-6358
E-mail Address:
NagataS7133@aol.com
Affiliation
Visiting Professor of Plastic and Reconstructive Surgery
University of California, School of Medicine Irvine
University of Alberta · COMPRU
University Hospital Rotterdam
The International Craniofacial Institute, Cleft Lip
Palate Treatment Center
Adjunct Professor of Surgery
University of Alberta
Professor of Plastic and Reconstructive Surgery
Hospital General de Mexico
Visiting Professor of Otorhinolaryngology (ENT)
University of Milano
Outpatient Clinic Hours （外来診察日時）
Monday（月） 14:00 - 16:30 hours
Wednesday（水） 14:00 - 16:30 hours
Saturday（土） 9:00 - 11:30 hours
Direction to AKIBA Hospital from Narita International Airport
Take the Narita Express (NEX) of the Japan Railway East (JR-East) to Tokyo Station (approximately 1 hour) then transfer to Keihin Tohoku Line (JR-East) to Minami Urawa Station (approximately 30 minutes) and upon leaving the exit turn right (there is only one exit at Minami Urawa Station). From Minami Urawa Station take a taxi to AKIBA Hospital (approximately 5 to 10 minutes).
Publication References
1 Nagata, S.: New method (procedure) for total auricular reconstruction and ear elevation in case of microtia. Plast. Surg. 1992. Vol. II, Hinderer, U. T. (Ed), pp 399-401, Experta Medica, Amsterdam, 1992
2 Nagata, S.: New method for total reconstruction of the auricle for microtia. Plast. Reconstr. Surg. 92:187-201, 1993
3 Nagata, S.: The modification stages involved in the total reconstruction of the auricle: Part I. The modification in the grafting of the three-dimensional costal cartilage framework (3-D frame) for the lobule type microtia. Plast. Reconstr. Surg. 93:221-230, 1994
4 Nagata, S.: The modification stages involved in the total reconstruction of the auricle: Part II. The modification in the grafting of the three-dimensional costal cartilage framework (3-D frame) for the concha type microtia. Plast. Reconstr. Surg. 93:231-242, 1994
5 Nagata, S.: The modification stages involved in the total reconstruction of the auricle: Part III. The modification in the grafting of the three-dimensional costal cartilage framework (3-D frame) for the small concha type microtia. Plast. Reconstr. Surg. 93:243-253, 1994
6 Nagata, S.: The modification stages involved in the total reconstruction of the auricle: Part IV. The modification in the ear elevation of the constructed auricle. Plast. Reconstr. Surg. 93:254-265, 1994
7 Nagata, S:.:Secondary auricular reconstruction for unfavorable microtia results:utilizing the temporoparietal and innominate fascia flaps. Plast,Reconstr.Surg. 94:254-265,1994
8 Nagata, S: Total auricular reconstruction with a three-dimensional costal cartilage framework. Ann. Chir. Plast. Esthet. 40:371-403, 1995
9 Nagata, S.: Recent advancements for surgical treatment of complicated auricular reconstruction. Plast. Surg. Forum, Dallas, Copyright applied for 1996 by the American Society of Plastic and Reconstructive Surgeons Inc. (65th Annual Scientific Meeting), ASPRS/PSEF/ASMS, Vol. XIX:252-254, 1996
10 Nagata, S.: Ear reconstruction utilizing three-dimensional costal cartilage framework. Salyer and Bardach’s Atlas for Craniofacial and Cleft Surgery, K.E. Salyer (Ed.), Lippincot-Raven, Vol. 2:410-415, 1999
11 Nagata, S.: Plastic Surgery: Indications, Operations, Outcomes (Textbook), B.M. Achauer and E. Eriksson (Eds.), Mosby, St. Louis, Vol.: 2, Chapter 66: Microtia (Auricular Reconstruction): 1023-1056, 2000
12 Nagata, S: The Unfavorable Result in Plastic Surgery Avoidance and Treatment (3rd Ed.), R. M. Goldwyn and M. Cohen (Eds.), Lippincott Williams and Wilkins, Philadelphia, Chapter 23: Discussion for Auricular Reconstruction:428-436, 2001
13 Nagata, S: Alternative surgical methods of treatment for the constricted ear. Clinics in Plastic Surgery 29: 1-15,2002 (In Print)
14 Nagata, S: Discussion for Balanced Auricular Reconstruction Dystopic Microtia with the Presence of the External Auditory Canal by C. Park, Plast. Reconstr. Surg. 29: 2002 (In Print)
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