The ear is a fascinating and complex appendage and organ. Formation is from structures called branchial arches. Branchial (from Greek branchia gills) arches are composed of endoderm on the internal aspect, by clefts composed of ectoderm on the external side with the central mesoderm containing the muscle, cartilage, vessels and nerves that will ultimately supply and establish the surrounding anatomic structures. Molecular signaling from the ectoderm leads the mesenchyme from the mesodermal (central) layer to eventually, if it works out as planned, to obliterate the clefts and and pouches. If clefts persist, they are given names, such as Type I branchial cleft cyst. When this signaling goes wrong, there are different degrees of anomalies, from absence of specific auricle components to microtia or even anotia if there is complete failure.
The ear begins to form the otic placode and vestibulocochlear ganglia at 3 weeks of gestation. The external canal then develops from the first branchial cleft at 4 weeks. By 28 weeks there is a fully open external canal. Failure to canalize can result in membranous or bony stenosis or atresia (from Latin a = no and Greek trēsisperforation, from tetrainein to pierce). Development of the auricle (external ear) begins at 5 weeks gestation with development of the auricular hillocks numbered from 1 through 6, derived from the first (mandibular) and second (hyoid) branchial arches. So the inner ear has already formed when the external ear begins.
The ear develops in a predictable manner, with various alterations in development resulting in predictable deformities when the process is interrupted. Knowledge of auricular development as well as normal external anatomy allows for precise evaluation of the ear and assists in selecting appropriate reconstructive techniques to optimize the complex 3-dimensional anatomical outcomes.
If you have a ear question, please do not hesitate to call me for an appointment. Office number is 989-839-6201, fax is 989-839-6202. Providers can page me through the Midland hospital operator. Patients can reach me by way of the patient portal.
Let me know how I can be of help to you.
Philip Harris, MD FARS
Ear Nose Throat and Cancer of the Head and Neck
Serving Gladwin, Clare, Midland and Alpena
Call for appointment and ask to see Dr. Harris
A new report addresses many novel and intriguing aspects of the relationship between cancer, cancer stem cells, and adipocytes (fat cells).
Fat (adipose) tissue has been suggested to play a direct role in resistance to cancer treatment. Obese (body mass index or BMI > 25) patients with leukemia have shown poor survival outcomes relative to non-obese patients (see 2010 ,M.A. Lichtman Oncologist, 15, pp. 1083–110). When one has cancer, traditionally there was weight loss. This was termed cachexia,a common and historically long-recognized hallmark of advanced cancer. Breakdown of adipose tissue through the action of pro-inflammatory cytokines leading to tissue atrophy occurs as part of cancer-induced cachexia. This dramatic metabolic disturbance was assumed to benefit the tumor at the expense of the normal tissue. These changes are only beginning to be more fully explored.
A recent mouse study found that leukemia cells utilized fat to hide away from the immune system. Numerous leukemia cells were found in gonadal addipose tissue (GAT), which is the largest visceral fat depot in mice, but not in subcutaneous fat deposits. The leukemia cells were located directly adjacent to adipocytes throughout the tissue. Even more worrisome, these phenotypically defined GAT-resident leukemic stem cells gave rise to leukemia at frequencies comparable to bone-marrow-derived leukemia stem cells. This established that adipose (fat) tissue can function as a reservoir for this cancer. As the mice’s leukemia progressed, atrophy of GAT was noted before the development of full-blown cachexia (weight loss).
Adipose tissue has previously been identified as an extra-medullary reservoir for normal hematopoietic stem cells (HSCs) and may promote tumor development.
As a cancer survivor and as a surgeon who treats head and neck cancer, I encourage you to be lean and fit. Maybe it will keep that cancer at bay or from recurring? You will feel and look better while fighting to keep away a disease that 50% of the population will get, cancer.
Physical Therapist Jennifer Root, D.P.T., describes the Survivorship Training and Rehabilitation (STAR) Program at MidMichigan Health. The program is designed to assist patients heal from cancer’s debilitating side effects and symptoms. Physicians, physical and occupational therapists, speech pathologists, dietitians and mental health professionals work together to create a personalized plan to help patients increase strength and energy, alleviate pain, improve appetite and enhance quality of life. MidMichigan Health is certified in the STAR Program by the Massachusetts-based Oncology Rehab Partners, leading experts in the field of survivorship care.