Visible Helical Rim Deformity Resulting from Excessive Resection of Postauricular Skin During Otoplasty

An unusual deformity resulting from overresection of postauricular skin during otoplasty is presented. To the author’s knowledge, this type of complication after otoplasty has not been described previously.     

“Anterior Scoring of the Upper Helical Cartilage as a Refinement in Aesthetic Otoplasty”

Background Anterior scoring with the use of simple or dedicated instruments, toothed forceps, endoscopic carpal tunnel release instruments, and needles has been described previously. The upper third of the ear easily maintains the original shape because memory and elasticity are stronger than in the middle or the lower part of the ear. This report describes a further refinement to the Chong-Chet anterior scoring technique, consisting of anterior scoring of the upper helical cartilage to correct the helical radix upper prominence.Methods A retrospective study analyzed 20 surgeries for prominent ears. All the subjects had undergone otoplasty softening the helix.Results There were no residual ear prominence/upper third prominence or cartilage irregularities at the 1-year follow-up evaluation. Anterior auricular cartilage scoring is an effective technique for controlling the degree and position of the antihelical fold. Furthermore, the upper third of the pinna seems to have a stronger memory than the middle third. To prevent this late complication the authors routinely perform anterior scoring up to the helix, weakening that cartilage usually untouched with other procedures.Conclusion This refinement, in combination with other procedures is safe, easy, and fast, giving reproducible and good aesthetic results.     

Otoplasty: Excision of conchal floor cartilage

In 10 consecutive otoplasties, conchal floor cartilage was excised to facilitate rotating prominent ears back against the head. The procedure is most effective in aural prominence due to deep conchae. Cosmetic improvement is as good as that achieved by excision of posterior wall cartilage, and recontouring of the antihelix fold is needed less often. The amount of cartilage to remove is easily determined, matching of asymmetrically prominent ears is simplified, and concha-mastoid sutures can be placed without tension. The corrections have been followed 1–2 years without recurrence of the deformity.     

Correction of protruding ears in combination with reduction surgery of hyperplastic auricles

A special technique is presented for correction of protruding ears (otoclisis) simultaneously with reduction of hyperplastic auricles (otomioplasty). This method was developed at our Clinic for Plastic Surgery in Munich more than 30 years ago and has been tested and observed since with very satisfactory results. The first part of the procedure requires that, during the postauricular removal of the prominent cartilage in a layer-by-layer fashion, the scalpel be used tangentially always following the outline of the individual crural curvature to the anthelix margin and the auricle base. As the simultaneous reduction surgery continues, the special combination technique is executed by falciform excision of the cartilage of the superior helix margin, starting from the anterior fold of the auricle peripherally toward the scapha. After an anterior skin sickle excision is made, a new helix margin is created by eversion of the still intact skin of the posterior helix wall. Only then is the operation terminated by a wedge-shaped skin-cartilage excision of the outer superior part of the helix.Presented at the 16th Annual Congress of the Austrian Society for Plastic and Reconstructive Surgery, November 10, 1978, Vienna, Austria.     

The lateral transhelical approach for correction of deformities of the external ear

Additional experience with the chondrocutaneous flap in the repair of auricular defects showed that (i) the entire medial surface of the auricle can be easily and rapidly exposed through this approach, and (ii) the transhelical scar on the lateral surface of the ear remains inconspicuous. The skin of the lateral surface of the ear is similar to that of the eyelids and forms flat, smooth scars which do not hypertrophy. Furthermore, these scars are hidden under the curl of the helix. Through this approach, correction of the protrusion can be accomplished by any method or combination of methods which call for manipulation on the medial surface of the auricle. The scar is remote from the site of manipulation of the cartilage. An additional advantage of this procedure is that it can be combined easily with a small reduction in the size of the scapha.     

Otoplasty in children younger than 5 years of age

Objective

The prominent ear is the most common congenital deformity of the auricle. It is often recommended that prominent ears be surgically repaired before children start school and most surgeons seem to perform the surgery after 5 years of age. The aim of our study is to summarize the rationale of performing otoplasty procedure in children under the age of 5, to discuss the advantages and disadvantages, and to review the patient (parent) satisfaction.

Methods

A retrospective study was performed on 10 children under the age of 5 who underwent otoplasty procedure and was followed for over a year.

Results

Ten patients (3 boys and 7 girls) between the ages of 48 months and 59 months, with a median age of 51.5 months were evaluated. Otoplasty was bilateral in 8 patients and unilateral in 2 patients. Global Aesthetic Improvement Scales of the patients were rated as “improved” or “better” at 52 weeks. The patient (parent) satisfaction was measured by a telephone survey. Parents revealed that 9 out of 10 were “very” or “completely” satisfied with the appearance and symmetry of their children's ears. We did not observe any visible disturbance or growth restriction in our patients, even in the unilateral operated group.

Conclusion

Timing of surgery is an issue of concern with regard to otoplasty in children. There may be significant psychosocial benefit to early intervention, particularly in light of changing norms for interaction with peers at ages considerably earlier than what had previously been thought of as the “school age.” Our preference is to plan the otoplasty as young as four years of age, after the child has expressed some concern about the deformity.