OBTAINING AURICULAR CARTILAGE F O R RECONSTRUCTIVE

SURGERY
H E N R Y I. BAYLIS, M . D . , NACHUM ROSEN, M . D . ,
AND R U S S E L L W . NEUHAUS, M . D .
Los Angeles, California

The cartilage in the scaphoid fossa between the helix laterally and the
antihelix medially provides excellent underlying support for soft-tissue
eyelid and nasal reconstruction. After subcutaneous infiltration anesthesia is administered through both the anterior and posterior auricular
skin, an incision is made along the posterior rim of the helix. A
dissection plane between the perichondrium and skin exposes the
cartilage. The cartilage is removed without incising the anterior skin
surface. This technique is particularly useful in cicatricial entropion,
upper or lower eyelid retraction, eyelid reconstruction, and socket
reconstruction.
Fresh cartilage used as a free autograft
provides excellent underlying support for
soft-tissue eyelid and nasal reconstruction. Because many ophthalmologists
are unfamiliar with auricular anatomy,
the use of fresh ear cartilage in ophthalmic plastic surgery is uncommon. Indications for additional posterior lamellar
support or augmentation commonly occur
in cicatricial entropion, upper or lower
eyelid retraction in dysthyroid ophthalmopathy, eyelid reconstruction, and
socket reconstruction. Ophthalmologists
have used a variety of tissues in these
procedures, usually a free tarsal autograft, a preserved scleral homograft, or
a preserved rib cartilage homograft, and
occasionally a free chondromucosal graft
from the nasal septum. Fresh, autogenous tissue has many advantages over
preserved homografts that are frequently
1,2

absorbed and shrink postoperatively. The

disadvantages of free tarsal grafts are
limitations in size and surgical invasion of
normal adjacent eyelid tissue.
Although we have modified several
standard reconstructive operations, the
ophthalmic surgeon can substitute ear
cartilage in any procedures using preserved sclera or tarsus that require underlying support for soft-tissue reconstruction.
MATERIAL AND METHODS

The ear is easily included in the same

surgical field as the eyelids during surgical preparation and draping. Subcutaneous infiltration anesthesia with 2% lidocaine with epinephrine should be
injected through both the anterior and
the posterior auricular skin. I f penetration of the cartilage is avoided during
injection, this infiltration will aid in the
later dissection of tissue planes. The flattest
area of cartilage and the one best
Accepted for publication Dec. 21, 1981; revised
suited for reconstructive surgery is in the
figures received April 1, 1982.
From the UCLA Center for the Health Sciences, scaphoid fossa, between the helix laterJules Stein Eye Institute, Los Angeles, California.
ally and the antihelix medially (Fig. 1).
Reprint requests to Henry I. Baylis, M.D., 5400
Balboa Blvd., Suite 127, Encino, CA 91316.
The helix is grasped with a towel clamp
3

4,5

AMERICAN JOURNAL OF OPHTHALMOLOGY 93:709-712, 1982

709

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and the posterior aspect of the ear is

exposed with anterior traction. The skin
is marked with an ink pen and then
incised along the posterior rim of the
helix (Fig. 2). A tissue plane is easily
created between the cartilage and the
overlying perichondrium and skin, until
the desired amount of cartilage is exposed. A knife blade is used to make a
small scratch-down incision through cartilage only. The anterior skin surface
should not be incised. Not making the
cartilage incision directly beneath the
skin incision adds an additional 2 mm of
cartilage to support the helix (Fig. 3).
Scissors are then used to extend the carti-

JUNE, 1982

lage incision. The cartilage is elevated

away from the skin and perichondrium of
the anterior auricular surface by blunt
and sharp dissection with scissors
(Fig. 4). Bleeding should be minimal if
epinephrine has been used in the local
anesthetic. Once the desired amount of
cartilage has been dissected free, it is
removed from the donor bed with scissors (Fig. 5).
When the towel clamp is released, the
ear returns to its former configuration.
Closing the cartilage incision causes severe deformity of the ear and should not
be done. Skin closure with a running 6-0
polypropylene suture should be delayed

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Fig. 3 (Baylis, Rosen, and Neuhaus). Incision of ear cartilage from

the posterior surface.

Fig. 4 (Baylis, Rosen, and Neuhaus). Dissection of the cartilage

away from the anterior skin surface
of the ear.

Fig. 5 (Baylis, Rosen, and Neuhaus). Removal of cartilage from the

donor site.

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until the conclusion of the reconstructive

surgery to allow small areas of bleeding to
stop spontaneously. Postoperative subcutaneous hematoma formation usually resolves, leaving no significant cosmetic
deformity. In two of our cases, however,
the helix was slightly more lateral.
Because the perichondrium is elevated
from the cartilage during the dissection,
it remains in the donor bed to reform
cartilage, giving added support to the
helix. Thus, the cartilagenous defect
present immediately after surgery gradually disappears with time.
The free cartilage graft can be used in

JUNE, 1982

its native state or can be thinned or

carved into any desired shape.
REFERENCES
1. Millard, D. R.: Eyelid repairs with a chondromucosal graft. Plast. Reconstr. Surg. 30:267, 1962.
2. Juri, J . , Juri, C , and Elias, J. C : Ear cartilage graft to the nose. Plast. Reconstr. Surg. 63:377,
1979.
3. Bayliss, H. I., and Hamako, C : Tarsal grafting
for correction of cicatricial entropion. Ophthalmic
Surg. 10:42, 1979.
4. Waller, R. R.: Lower eyelid retraction. Management. Ophthalmic Surg. 9:41, 1978.
5. Helveston, E. M.: Human black scleral patch.
Arch. Ophthalmol. 82:83, 1969.
6. Fox, S. A.: Use of preserved cartilage in plastic
surgery of the eye. Arch. Ophthalmol. 38:182, 1947.