Leren He

Global Burden of Disease (GBD) analyses of orofacial clefts often treat modeled disability-adjusted life-year (DALY) rates or quality-of-care indices as representing untreated disease or care quality. We tested whether an incidence-adjusted residual of GBD 2023 cleft estimates can support the reading for the craniofacial program targeting. Age-standardized estimates for 204 locations (1990–2023) were linked to World Bank indicators. The residual was the ordinary least squares remainder from a quadratic in year and World Bank region, fitted to log DALY rate on log incidence, using 6800 country-years (200 countries). The residual is not a validated measure of health-system or surgical access. A country-level age-matched residual could not be computed from the GBD country extract. Adding log incidence raised R ² from 0.491 to 0.551 (incremental R ² =0.060). The incidence coefficient was 0.723 (country-clustered 0.408–1.038; P =0.084 versus 1). In 2023, the SD of log incidence was 0.355 against 0.821 for log DALY rate, and 2.472 for log years of life lost (YLL) against 0.466 for log years lived with disability (YLD). Country order changed with grouping (Pearson r =0.62): Türkiye’s residual was 0.96 under World Bank Europe and Central Asia, versus −0.22 under GBD North Africa and the Middle East. The 2023 equal-country and population-weighted GDP gaps were 0.445 and 0.103 ( P =0.312). India held 49.1% of the poorest GDP quartile’s population. GBD-derived residuals should not be used as treatment-gap or surgical-access measures.

Postburn auricular reconstruction presents significant challenges due to scar contracture and compromised vascularity of the surrounding tissue. This study introduces and evaluates a specialized 3-stage surgical protocol that integrates expanded scarred skin with residual cartilage and a custom-shaped autologous costal cartilage framework. A retrospective case series was conducted on 21 patients with postburn ear defects treated between January 2021 and 2024. The surgical approach involved 3 stages: (1) subcutaneous implantation of a tissue expander to release scar contractures and expand residual tissue; (2) formation of a composite flap using the expanded scarred skin and mobilized residual cartilage to envelop a custom-sculpted framework carved from selected costal cartilages; and (3) refinement of anatomic subunits. Aesthetic outcomes were assessed by independent plastic surgeons using a 4-point Likert scale, and patient-reported satisfaction and quality of life were evaluated with the EAR-Q questionnaire. The mean follow-up duration was 21.93±16.01 months. Aesthetic evaluations yielded high satisfaction, with most cases rated as “Excellent” (n=7, 33.3%) or “Good” (n=13, 61.9%). Patient-reported outcomes through the EAR-Q demonstrated high mean scores in the “Psychological” (63.00, IQR=55.50–89.00) and “Social” (64.00, IQR=6.00–85.50) domains. A strong positive correlation was observed between psychological adjustment and social functioning (τ=0.670, P <0.001). No patients reported dissatisfaction or major complications. By integrating residual cartilage into the expanded flap, this technique effectively addresses the challenges of compromised vascularity and scar contracture, resulting in improved auricular symmetry and projection, as well as significant psychosocial benefits for patients.

To evaluate the surgical efficacy and patient satisfaction of the repositioned inverted free cartilage graft technique for correcting cryptotia. The retrospective analysis was conducted on 12 pediatric patients treated with this technique from September 2022 to September 2024. The key surgical step involved complete transection of the overfolded auricular cartilage to form a free cartilage graft, which was then horizontally rotated 180° and vertically rotated approximately 120° and was reattached to the auricular cartilage stump. Postoperative complications were recorded, and both plastic surgeon and guardians assessed ear morphology using Likert scale. Patient satisfaction was evaluated via the Visual Analog Scale (VAS). A total of 12 patients with cryptotia were included (9 males and 3 females, aged 2-12 years), with a follow-up period ranging from 6 to 15 months. No significant complications or recurrence of deformity occurred. The upper auriculocephalic sulcus was significantly deepened, enabling the patients to wear masks and glasses. Postoperative Likert scores improved to 4.25 ± 0.19 (plastic surgeon) and 4.06 ± 0.21 (guardians), while the VAS score reached 8.15 ± 0.45. The repositioned inverted free cartilage graft technique achieved satisfactory outcomes with minimal complications and high patient satisfaction, demonstrating its clinical value for cryptotia correction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background: Auricular cartilage defects, whether congenital or acquired, present a significant reconstructive challenge. Autologous chondrocytes implantation remains the clinical gold standard but is limited by donor-site morbidity, limited cell availability, and dedifferentiation during expansion. Cartilage stem/progenitor cells (CSPCs) have emerged as a promising alternative, yet their comparative properties remain underexplored. Methods: A comprehensive literature review was conducted across PubMed, MEDLINE, Cochrane, and Web of Science databases up to 2026, utilizing keywords such as chondrocytes, chondroprogenitors, Cartilage stem/progenitor cells, CSPCs, auricular cartilage, ear reconstruction and tissue engineering. Results: Chondrocytes exhibit robust matrix synthesis but suffer from dedifferentiation and limited proliferation. CSPCs demonstrate superior self-renewal and immunomodulatory properties, yet face challenges of hypertrophic differentiation and inferior tissue elasticity. Co-culture and scaffold-based strategies have been employed to enhance the functionality of both cell types in engineered constructs. Conclusion: Both chondrocytes and CSPCs present distinct advantages and limitations for auricular cartilage repair. Future strategies should aim to combine their strengths, such as the functional specificity of chondrocytes and the expandability of CSPCs, to develop more effective and clinically feasible tissue-engineered constructs for ear reconstruction.

Chest pain is one of the most common complaints after costal cartilage harvest.The present study aimed to compare the effectiveness of intraoperative area local injection after costal cartilage harvest when mixed drugs or ropivacaine plus analgesic pump is used, as measured by visual analogue scale (VAS) scores, rescue analgesic consumption, postoperative movement steps, and related complications. Eligible microtia patients who underwent costal cartilage harvest during ear reconstruction were randomly assigned to either a mixed drugs injection group (mixed drugs group) or ropivacaine plus analgesic pump group (analgesic pump group).The VAS scores in the mixed drugs group were significantly lower than those in the analgesic pump group at rest (p < 0.05) and the VAS scores in the mixed drugs group were significantly lower than those in the analgesic pump group during coughing (p < 0.05) before 96h after surgery. Rescue analgesic consumption and rate of complications were significantly lower in the mixed drugs group compared with the analgesic pump group (all p<0.05). Postoperative mobility of patients was significantly higher in the mixed drugs group compared with the analgesic pump group(p < 0.05).In conclusion, compared with ropivacaine plus analgesic pump, local injection of mixed drugs reduced chest pain after costal cartilage harvest for microtia ear reconstruction with less rescue analgesic consumption and complications, improved the postoperative movement steps of patients.