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Estabishment of Auricular Database of Newborns and Analysis of the Factors Correlated with Auricular Deformities

Author: WuShengLin
Tutor: QiXiangDong
School: Southern Medical University,
Course: Plastic Surgery
Keywords: Auricular Measurement Epidemiological Investigation Database Auricular Deformities Related Factors
CLC: R722.1
Type: Master's thesis
Year: 2013
Downloads: 22
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Abstract


Background:Ear exposed are called the auricle. The appearance of auricle directly affect the face. Congenital auricular deformities from either pathological or clinical manifestations are varied. For the convenience of the choice of treatment, in China congenital auricular deformities are divided into four categories:full-auricular deformities, upper auricular deformities, lower auricular deformities and other. Full-auricular deformities is the entire auricular malformation characterized by absence, such as microtia syndrome, the performance for the entire auricular malformation associated with the external auditory canal and jaw deformities. The upper auricular deformities focus on the upper auricle, but can also be associated with other auricular deformities, flaring ear, cup ear, satyr ear, microtia, shell ear, etal. The lower auricular deformities are mainly about the lower auricle, but can also be accompanied by the upper auricular deformities such as cleft ear malformation, earlobe malformation. Others include accessory ear and preauricular fistula. Congenital auricular deformities are divided into two categories in foreign literature: malformation and deformation. Cryptotia, no ears and microtia are ear malformations, while flaring ear, cup ear are ear deformations. Malformations are characterized by a partial absence of the skin or cartilage resulting in a constricted or underdeveloped pinna,whereas deformations are characterized by a misshaped but fully developed pinna.Clinical Epidemiology put the basic principle and method of the epidemiology in clinical practice. The patients and their group are objects. The main task is to study disease etiology and a variety of possible risk factors. The purpose is to identify the nature of the diseases, and to provide the basis for the prevention and control. The clinical epidemiological study on neonatal auricular deformities are scarce, and the related reports are also rare. In China, due to different cognitive knowledge and lack of relevant knowledge, besides plastic surgeons, fewer pediatrician and obstetric medical workers can clearly diagnose neonatal auricular deformities. Most medical workers only attach importance to the dysfunction, and often ignore morphological deformities,when they analyse the existing birth defect or reproductive census results. Ear is an organ with complex three-dimensional structures, congenital auricular deformities are not single and simple deformities,but the general term that contains various classifications of deformities. Although clinical epidemiological studies about microtia have been reported, the information collected is limited,unilateraland and can not represent the clinical epidemiological studies of congenital auricular deformities. In addition to microtia, for the other types of congenital auricular deformities, the domestic and abroad research mostly focused on the choice of surgery scheme, more in-depth and meticulous epidemiological studies haven’t been carried out. Although the etiology of congenital malformations is complex, congenital genetic factors, biological factors, chemical factors and physical factors that cause human congenital malformations have been recognized. To sum up, all these factors can be divided into three categories,genetic factors, environmental factors,and the interaction of genetic and environmental factors. Among them, genetic factors account for about25%, environmental factors about10%, the interaction of genetic and environmental factors and unknown reasons about65%. Congenital auricular deformities are not a single process, but the results of multiple factors working together. The traditional treatment of congenital auricular deformities is surgery. Different auricular deformities have different treatments. Physically,3-year-old children’s auricle has reached85%of the adult’s. In childhood, pinna grows rapidly but slowly in adulthood. After the age of10, the growth of the width of the pinna almost stop,and the distance from helix to the mastoid remain unchanged in the future. From the consideration on the costal cartilage development, it is generally believed that the costal cartilage of6-year-old children can be carved into ear scaffold. Tanzer and Brent who are influential foreign ear reconstruction experts reckon that the surgery is suitable at the age of6.Non-surgical treatment to correct congenital auricular deformities was first proposed by the Japanese scholar Matsuo K in1984. After that, scholars in Japan, Europe and the United States rushed to carry out the research of non-surgical treatment of congenital auricular deformities. Studies have shown that auricular morphology is changing with age, the incidence of some congenital auricular deformities increases,while some congenital auricular deformities can be self-correct,and reduce its incidence.Ear molding is best suited for deformations,but is useful in cases of less severe malformation.Newborns wear ear molding in5to7days after birth,at least6weeks. In China, preschool surgery is still be choosed to correct congenital auricular deformities. However, surgical treatment exist cartilage deformation, high recurrence rate, large trauma and other complications with high risk. Due to the existence of regional, ethnic differences in neonatal ear morphology, foreign ear molding is not suitable for Chinese and the price is expensive. So we are inclined to learn from the experience of the United States,creat our own ear molding through measuring neonatal ear morphology and obtaining ear morphological data.Purpose and SignificancePurpose:1. To obtain the incidence of neonatal auricular deformities and abnormal anatomical site in Dongguan.2. To identify and confirm related factors of neonatal auricular deformities through the statistical data. 3. To make an early diagnosis of neonatal auricular deformities.Significance:1. Estabishment of auricular database of newborns is convenient for doctors to manage and use clinic data,and helpful for doctors in making a comprehensive, objective, and intuitive diagnostic analysis.lt also brings convenience to the clinical, teaching, and enhances the communication between doctors and patients.2. Accurate and objective measurement of the normal neonatal ear morphology, contributes to the diagnosis of congenital auricular deformities, provide the data support for the timing of repair and reconstruction and cartilage engraving size, but is also conducive to the preoperative and postoperative evaluation, and has anthropological significance.3. Through the statistical data, we can identify and confirm the factors which lead to congenital auricular deformities, and thus achieve the purpose of reducing the incidence through comprehensive intervention.4. The early diagnosis of congenital auricular deformities should be paid attention to, so that timely treatment is expected to improve the prognosis and population quality.Materials and Methods:1. Research ObjectSelect newborns at the age of1-7days in Dongguan Houjie Hospital from April2012to July, whose parents agree with ear measurement,the epidemiological investigation, and sign the informed consent.A total of321cases of newborns participate in research.2. Instruments and EquipmentElectronic Baby Scale:Model EBSA-20, Shenzhen Le Er Chuang CompanyTape:Model seca201,Seca Company in GermanyAngle Square:Model FYBM-1,Beijing Zhongqiao Technology CompanyBending Angle Gauge:Model FYBM-3, Beijing Zhongqiao Technology Company Protractor:Model FYBM-2attached type protractor, Beijing Zhongqiao Technology CompanyDigital Camera:Canon IXUS55(SD450),5,000,000pixelsHearing Screening Instrument:Model AccuScreen TEOAE, Denmark MADSENCompanyComputer:PC computer, Intel core2T6670,1G Discrete Graphics,2G Memory,320GB. Operating system:Windows XPSoftware:My Patients system, Guangzhou Bitst Software Company3. Research methods(1) Measurement of neonatal ear morphology(2) Epidemiological Investigation(3) We establish the database on the basis of My Patients System.(4) Data Processing and Statistical AnalysisContentAccess to the relevant literature and information, We formulate the informed consent and the epidemiological questionnaire of neonatal ear morphology. After parents sign the informed consent, We measure neonatal ear morphology and conduct an epidemiological investigation on their parents.Measurement include:Weight, Length, Head Circumference, Maximum Head Length, Maximum Head Width, Physiognomic Facial Height,Morphological Facial Height, Physiognomic Ear Length, Physiognomic Ear Breadth,Morphological Ear Length, Morphological Ear Breadth, Vertical Distance of Cephalo-auricular, Cephalo Otic Angle.The contents include:Φ Basic Information:general demographic data of newborns and their parents, such as gender, gestational age, delivery mode,position of foetus,Apgar score,and their parents’ age, native place, nationality, occupation, education level,et al.(?) Family History and Parents’ lifestyle:family history, genetic history, smoking and drinking history.(?)Mother’s situation:special previous medical history, pregnancy history, history of anemia,medication history during pregnancy, pregnancy complication, uterine disease, abnormal pregnancy and perineal laceration in labour.On the basis of digital information management system "My Patients" built by ACCESS and Microsoft SQL Serve, through the establishment of the custom table, we establish a database that accord with the morphological characteristics of neonatal ears, conserve and manage basic information, digital photos and diagnostic information of patients,and export the data for statistical analysis.We export the data from the database to Excel, assign and organize the related factors of possible influence.We open the data in the form of Excel in SPSS13.0software,and conduct statistical analysis.We choose chi-square test for count data, t test or Wilcoxon rank sum test for measurement data,and conduct univariate analysis for all variables, statistical test standarda=0.05.We select Logistic regression for multi-factor analysis.There is statistical significance when P<0.05.Results1. In321(642ears) newborns, There are136(42.37%) newborns whose both ear are normal136cases, the remaining185(57.63%) abnormal. Among them, there are left auricular deformities in37, right auricular deformities in54, both auricular deformities in94. Calculated in one ear, there are24cases of prominent ear (3.74%),14cases of cup ear (2.18%),36cases of lop ear (5.61%),16cases of Stahl’s ear (2.49%),86cases of Constricted ear (13.40%),39cases of Conchal crus (6.07%),38cases of Absent or flattened helical rim (5.92%),26cases of complex malformations(4.05%).2. Univariate analysis show.there are statistical significance of the rate of auricular deformities within groups of father smoking and drinking history, mother hepatitis, abnormal pregnancy, abnormal delivery, delivery mode, premature rupture of membrane,perineal laceration and neonatal weight.3. Multi-factor analysis show:cesarean delivery, normal pregnancy, normal delivery,and mother without a history of hepatitis are protective factors of congenital auricular deformities.ConclusionsDatabase established is the neonatal ear morphology specialist database. Via researching and analyzing the neonatal ear morphology clinical features and medical records, database field is defined as comprehensive as possible covering neonatal clinical data, fully reflecting the neonatal ear form feature. The development and application of the database is in line with China’s national conditions. The establishment of a local neonatal ear morphology data management center, including medical records management, data management, information retrieval, statistical analysis and automation provides the informatization and digitization basis for the future realization of data accumulation, data mining, decision and support. The establishment of the database is very important for the research and development of ear molding used in neonatal auricular deformities. Therefore, this database has important practical value and broad prospects for development in the application of medical information management and data quality control and is worthy of promotion.Neonatal auricular deformities has higher incidence,and different types of auricular deformities has distinct incidence. Auricular deformities are caused by the mutual interaction of a number of factors. Therefore, the prevention of congenital auricular deformities should take the protective factors into first consideration, in order to achieve a multiplier effect. Cesarean delivery, normal pregnancy, normal delivery,and mother without a history of hepatitis are protective factors of congenital auricular deformities. Through integrated intervention we hope to reduce birth defect rate and improve the quality of the population.

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CLC: > Medicine, health > Pediatrics > Newborns, premature children disease > Neonatal disease
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