By age 5, the cartilaginous growth of the ear is near completion, and otoplasty is often performed on children at this time. Correction of the ear deformity prior to enrollment in school can spare the child the emotional trauma which may result from teasing by peers. There are no age restrictions for adult otoplasty, though the pliability of the cartilage decreases with in-creasing age, so that surgical weakening of the cartilage may be necessary.
A careful assessment of the ear will reveal the precise anatomic features responsible for the deformity.
An excessively deep and high-walled ear cartilage bowl is frequently a major contributing factor to the presence of a lop ear. This malformation has the effect of both outwardly projecting the heclical-antihelical complex and increasing the angle that the helix is positioned relative to the mastoid process.
Another common feature of the lop ear is an insufficiently folded antihelix. The fold may be inadequate throughout its entire course or at the superior or inferior segments only. Other abnormalities must be recognized is asymmetries in the size, shape, and projection of the ears that are common.
Development of Otoplasty TechniquesThere are many surgical approaches for correction of the congenital lop-ear deformity. Many decades ago, surgeons used skin excision only with a great tension closure to reposition the ears. Studies showed that the cause of these deformities is the irregularities in cartilages. Therefore, modern otoplasty started to focus on correction of the deformed cartilages.
One of the causes of this deformity is the absence of a well-formed antihelix rather than simply an excessive angle of the ear from the head. To correct this deformity the surgeon must create a new antihelix by making a curvilinear incision on the cartilage and fold it over and then secure it with permanent sutures.
Several other techniques are available which primarily use suturing to set cartilage position and contour. These approaches provided a more natural shape and minimized the unsightly ridges accompanying incisional and excisional methods.
Mustarde TechniqueMustarde technique is a multiple transcartilaginous permanent mattress sutures to construct the antihelical fold. This method had the additional advantage of precisely setting the amount of antihelical folding by adjusting the tightness of the sutures.
Furnas TechniqueFurnas technique uses sutures extending from the conchal bowl to the mastoid periosteum and from the scaphoid fossa to the temporalis fascia. Webster technique effectively combines newer and older techniques, using skin excision, resection of excessive cartilage , and mattress sutures at the antihelical fold, to achieve natural contour and position.
The great variety of techniques attests to the complexity of ear anatomy and the difficulty in achieving superior results with consistency. Modern approach to otoplasty is largely based upon the suture techniques developed by Mustarde and Furnas.
We have found that by using a graduated approach, first setting back the ear cartilage bowl and then contouring the antihelical fold as necessary, we are able to achieve the most natural-appearing result. This technique has the advantage of enabling precise positioning of the cartilage by progressively tightening the sutures until the desired contour is achieved.
Anesthesia for Otoplasty PatientsYounger children usually require general anesthesia, while adolescents and adults may need only intravenous sedation and local infiltration.
Otoplasty PostOperationAfter surgery is completed, a compression dressing is placed over the ear. The dressing is removed the day after surgery and replaced with a new one which is worn for four more days.
In adults and older children the second dressing may not be needed. Following the removal of all dressings, a headband is worn continuously for 2 weeks, and then for another 2 weeks only at night. Children should be encouraged not to engage in rough play for 6 weeks.
Complications of Otoplasty
Early ComplicationsEarly complications of otoplasty are those occurring within hours to several days after the procedure. These include bleeding, infection, and necrosis. A simple wound infection may arise if there was a breach in sterile technique during surgery.
Late ComplicationsLate complications of otoplasty appear in the weeks to months following surgery. These include suture problems, recurrence of the deformity, hypertrophic scarring, numbness, and aesthetic problems related to the initial correction.