Current progress of laser-assisted cartilage reshaping for prominent ear_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GUO Fengfeng , YU Xiaobo ,  JIANG Haiyue

The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100144, P.R.China;

Corresponding author：

JIANG Haiyue, Email: jianghaiyue_psh@163.com

Keywords：

Prominent ear; laser-assisted cartilage reshaping; laser parameters; mechanism

DOI：

10.7507/1002-1892.201712074

Video：

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Objective To summarize the current progress of laser-assisted cartilage reshaping (LACR) for prominent ear. Methods The domestic and abroad article concerning the LACR in treatment of prominent ear was reviewed and analyzed. Results As a new technique, there were three types of LACR therapies that been used for prominent ear. LACR with the 1 064 nm Nd/YAG laser is painful and the penetration depth of the 1 064 nm Nd/YAG laser is greater than that of the 1540 nm Er/Glass laser which is caused more tissue injury. LACR with the 1 540 nm Er/Glass laser has high absorption by the ear cartilage and produce less injury to the surrounding tissue. Use of the CO₂ laser permitted cartilage reshaping combined with both vaporization and incisions, which complicates the technique, although, with low recurrence rate and definite effect. Insisting on wearing ear mold is the key to get satisfactory effectiveness for postoperative patients. The complications of LACR for prominent ear, such as the dermatitis, perforation of the skin, hematoma, or infection, should be noticed. Conclusion Application of LACR for prominent ear just has a short period of time, limited number of cases, and few relevant literature reports. Its effectiveness needs to be further studied and clarified.

Citation： GUO Fengfeng, YU Xiaobo, JIANG Haiyue. Current progress of laser-assisted cartilage reshaping for prominent ear. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(6): 769-772. doi: 10.7507/1002-1892.201712074 Copy

1.	Adamson PA, Strecker HD. Otoplasty techniques. Facial Plast Surg, 1995, 11(4): 284-300.
2.	Farkas LG. Anthropometry of normal and anomalous ears. Clin Plast Surg, 1978, 5(3): 401-412.
3.	Kemaloğlu CA, Kılıç F, Doğan F. Effectiveness of combined technique for the correction of prominent ears. Turk J Plast Surg, 2016, 24(3): 113-117.
4.	Mordon S, Wang T, Fleurisse L, et al. Laser cartilage reshaping in an in vivo rabbit model using a 1.54 microm Er:Glass laser. Lasers Surg Med, 2004, 34(4): 315-322.
5.	Sobol E, Sviridov A, Omeltchenko A, et al. Laser reshaping of cartilage. Biotechnol Genet Eng Rev, 2000, 17: 553-578.
6.	Protsenko DE, Zemek A, Wong BJ. Temperature dependent change in equilibrium elastic modulus after thermally induced stress relaxation in porcine septal cartilage. Lasers Surg Med, 2008, 40(3): 202-210.
7.	Keefe MW, Rasouli A, Telenkov SA, et al. Radiofrequency cartilage reshaping: efficacy, biophysical measurements, and tissue viability. Arch Facial Plast Surg, 2003, 5(1): 46-52.
8.	Ho KH, Diaz Valdes SH, Protsenko DE, et al. Electromechanical reshaping of septal cartilage. Laryngoscope, 2003, 113(11): 1916-1921.
9.	Manuel CT, Foulad A, Protsenko DE, et al. Needle electrode-based electromechanical reshaping of cartilage. Ann Biomed Eng, 2010, 38(11): 3389-3397.
10.	Wu EC, Protsenko DE, Khan AZ, et al. Needle electrode-based electromechanical reshaping of rabbit septal cartilage: a systematic evaluation. IEEE Trans Biomed Eng, 2011, 58(8): 2378-2383.
11.	Holden PK, Chlebicki C, Wong BJ. Minimally invasive ear reshaping with a 1450-nm diode laser using cryogen spray cooling in New Zealand white rabbits. Arch Facial Plast Surg, 2009, 11(6): 399-404.
12.	Leclère FM, Petropoulos I, Mordon S. Laser-assisted cartilage reshaping (LACR) for treating ear protrusions: a clinical study in 24 patients. Aesthetic Plast Surg, 2010, 34(2): 141-146.
13.	Ragab A. Carbon dioxide laser-assisted cartilage reshaping otoplasty: a new technique for prominent ears. Laryngoscope, 2010, 120(7): 1312-1318.
14.	Helidonis E, Sobol E, Kavvalos G, et al. Laser shaping of composite cartilage grafts. Am J Otolaryngol, 1993, 14(6): 410-412.
15.	Trelles MA, Mordon SR. Correction of ear malformations by laser-assisted cartilage reshaping (LACR). Lasers Surg Med, 2006, 38(7): 659-662.
16.	Wong BJ, Milner TE, Kim HH, et al. Stress relaxation of porcine septal cartilage during Nd:YAG (λ=1.32 mm) laser irradiation: mechanical, optical, and thermal responses. J Biomedical Optics, 1998, 3(4): 409-414.
17.	Hajiioannou JK, Nikolidakis A, Naumidi I, et al. In vitro enzymatic treatment and carbon dioxide laser beam irradiation or morphologic cartilage specimens. Arch Otolaryngol Head Neck Surg, 2006, 132(2): 1363-1370.
18.	Sviridov A, Sobol E, Jones N, et al. The effect of holmium laser radiation on stress, temperature and structure of cartilage. Lasers Med Sci, 1998, 13(1): 73-77.
19.	Bagratashvili VN, Bagratashvili NV, Sviridov AP, et al. Kinetics of water transfer and stress relaxation in cartilage heated with 1.56-μm fiber laser. Laser-Tissue Interaction Ⅺ: Photochemical, Photothermal, and Photomechanical, 2000, 3914(1): 102-107.
20.	Leclère FM, Trelles M, Mordon SR. Cartilage reshaping for protruding ears: a prospective long-term follow-up of 32 procedures. Lasers Surg Med, 2011, 43(9): 875-880.
21.	Leclère FM, Mordon S, Alcolea J, et al. 1064-nm Nd:YAG laser-assisted cartilage reshaping for treating ear protrusions. Laryngoscope, 2015, 125(11): 2461-2467.
22.	Li C, Protsenko DE, Zemek A, et al. Analysis of Nd:YAG laser-mediated thermal damage in rabbit nasal septal cartilage. Lasers Surg Med, 2007, 39(5): 451-457.
23.	Pawar SS, Koch CA, Murakami C. Treatment of prominent ears and otoplasty: a contemporary review. JAMA Facial Plast Surg, 2015, 17(6): 449-454.
24.	Kajosaari L, Pennanen J, Klockars T. Otoplasty for prominent ears-demographics and surgical timing in different populations. International Journal of Pediatric Otorhinolaryngology, 2017, 100: 52-56.
25.	Calder JC, Naasan A. Morbidity of otoplasty: a review of 562 consecutive cases. Br J Plast Surg, 1994, 47(3): 170-174.
26.	Caouette-Laberge L, Guay N, Bortoluzzi P, et al. Otoplasty: anterior scoring technique and results in 500 cases. Plast Reconstr Surg, 2000, 105(2): 504-515.
27.	Chang CJ, Cheng SMH, Chiu LL, et al. Minimizing superficial thermal injury using bilateral cryogen spray cooling during laser reshaping of composite cartilage grafts. Lasers Surg Med, 2008, 40(7): 477-482.

1. Adamson PA, Strecker HD. Otoplasty techniques. Facial Plast Surg, 1995, 11(4): 284-300.
2. Farkas LG. Anthropometry of normal and anomalous ears. Clin Plast Surg, 1978, 5(3): 401-412.
3. Kemaloğlu CA, Kılıç F, Doğan F. Effectiveness of combined technique for the correction of prominent ears. Turk J Plast Surg, 2016, 24(3): 113-117.
4. Mordon S, Wang T, Fleurisse L, et al. Laser cartilage reshaping in an in vivo rabbit model using a 1.54 microm Er:Glass laser. Lasers Surg Med, 2004, 34(4): 315-322.
5. Sobol E, Sviridov A, Omeltchenko A, et al. Laser reshaping of cartilage. Biotechnol Genet Eng Rev, 2000, 17: 553-578.
6. Protsenko DE, Zemek A, Wong BJ. Temperature dependent change in equilibrium elastic modulus after thermally induced stress relaxation in porcine septal cartilage. Lasers Surg Med, 2008, 40(3): 202-210.
7. Keefe MW, Rasouli A, Telenkov SA, et al. Radiofrequency cartilage reshaping: efficacy, biophysical measurements, and tissue viability. Arch Facial Plast Surg, 2003, 5(1): 46-52.
8. Ho KH, Diaz Valdes SH, Protsenko DE, et al. Electromechanical reshaping of septal cartilage. Laryngoscope, 2003, 113(11): 1916-1921.
9. Manuel CT, Foulad A, Protsenko DE, et al. Needle electrode-based electromechanical reshaping of cartilage. Ann Biomed Eng, 2010, 38(11): 3389-3397.
10. Wu EC, Protsenko DE, Khan AZ, et al. Needle electrode-based electromechanical reshaping of rabbit septal cartilage: a systematic evaluation. IEEE Trans Biomed Eng, 2011, 58(8): 2378-2383.
11. Holden PK, Chlebicki C, Wong BJ. Minimally invasive ear reshaping with a 1450-nm diode laser using cryogen spray cooling in New Zealand white rabbits. Arch Facial Plast Surg, 2009, 11(6): 399-404.
12. Leclère FM, Petropoulos I, Mordon S. Laser-assisted cartilage reshaping (LACR) for treating ear protrusions: a clinical study in 24 patients. Aesthetic Plast Surg, 2010, 34(2): 141-146.
13. Ragab A. Carbon dioxide laser-assisted cartilage reshaping otoplasty: a new technique for prominent ears. Laryngoscope, 2010, 120(7): 1312-1318.
14. Helidonis E, Sobol E, Kavvalos G, et al. Laser shaping of composite cartilage grafts. Am J Otolaryngol, 1993, 14(6): 410-412.
15. Trelles MA, Mordon SR. Correction of ear malformations by laser-assisted cartilage reshaping (LACR). Lasers Surg Med, 2006, 38(7): 659-662.
16. Wong BJ, Milner TE, Kim HH, et al. Stress relaxation of porcine septal cartilage during Nd:YAG (λ=1.32 mm) laser irradiation: mechanical, optical, and thermal responses. J Biomedical Optics, 1998, 3(4): 409-414.
17. Hajiioannou JK, Nikolidakis A, Naumidi I, et al. In vitro enzymatic treatment and carbon dioxide laser beam irradiation or morphologic cartilage specimens. Arch Otolaryngol Head Neck Surg, 2006, 132(2): 1363-1370.
18. Sviridov A, Sobol E, Jones N, et al. The effect of holmium laser radiation on stress, temperature and structure of cartilage. Lasers Med Sci, 1998, 13(1): 73-77.
19. Bagratashvili VN, Bagratashvili NV, Sviridov AP, et al. Kinetics of water transfer and stress relaxation in cartilage heated with 1.56-μm fiber laser. Laser-Tissue Interaction Ⅺ: Photochemical, Photothermal, and Photomechanical, 2000, 3914(1): 102-107.
20. Leclère FM, Trelles M, Mordon SR. Cartilage reshaping for protruding ears: a prospective long-term follow-up of 32 procedures. Lasers Surg Med, 2011, 43(9): 875-880.
21. Leclère FM, Mordon S, Alcolea J, et al. 1064-nm Nd:YAG laser-assisted cartilage reshaping for treating ear protrusions. Laryngoscope, 2015, 125(11): 2461-2467.
22. Li C, Protsenko DE, Zemek A, et al. Analysis of Nd:YAG laser-mediated thermal damage in rabbit nasal septal cartilage. Lasers Surg Med, 2007, 39(5): 451-457.
23. Pawar SS, Koch CA, Murakami C. Treatment of prominent ears and otoplasty: a contemporary review. JAMA Facial Plast Surg, 2015, 17(6): 449-454.
24. Kajosaari L, Pennanen J, Klockars T. Otoplasty for prominent ears-demographics and surgical timing in different populations. International Journal of Pediatric Otorhinolaryngology, 2017, 100: 52-56.
25. Calder JC, Naasan A. Morbidity of otoplasty: a review of 562 consecutive cases. Br J Plast Surg, 1994, 47(3): 170-174.
26. Caouette-Laberge L, Guay N, Bortoluzzi P, et al. Otoplasty: anterior scoring technique and results in 500 cases. Plast Reconstr Surg, 2000, 105(2): 504-515.
27. Chang CJ, Cheng SMH, Chiu LL, et al. Minimizing superficial thermal injury using bilateral cryogen spray cooling during laser reshaping of composite cartilage grafts. Lasers Surg Med, 2008, 40(7): 477-482.

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