Combined technique for the correction of prominent ears: Results in 140 patients

We present our assessment of a combined technique for the correction of prominent ears in 140 patients between 1991 and 2007. We had no major complications, and minor complications including extrusion of a stitch, granuloma around a suture, hypertrophic scarring, and superficial ulceration on the anterior side of the helix developed in nine patients. Two also developed residual asymmetry. A good aesthetic result was achieved in all cases.     

Surgical correction of lop and cup ear deformities

Summary The published methods for surgical correction of lop and cup ears are numerous. Surgical techniques must restore the helix overhang, raise and lengthen the helical arch and correct the protrusion, if it exists. Some authors try to add cartilage and skin to correct the deformity. We believe that, except in the most severe cases, there is no real reduction in size at the upper third of the lop and cup ears. In moderately and severely constricted ears, expansion of the upper pole of the ear by a double, opposite directed, Z-plasty, based on Hinderer's technique, provides predictable and safe results and has proved to be easy to apply to each patient. Requests for reprints: F. J. Fregenal, C/Dr Fleming 1, 6° C, 10.001-Caceres, Spain     

Comparing Cephaloauricular and Scaphaconchal Angles in Prominent Ear Patients and Control Subjects

Approximately 5% of 1-year-old children have prominent ears. The most common findings are underdevelopment or lack of the antihelical fold, overdevelopment of the concha, a scapha-conchal angle greater than 130 degrees, and a protruding lobule. This study compared the cephaloauricular and scaphaconchal angles of 15 patients with prominent ears and 15 patients in a control group. Alginate was used to create a mold of each patient's right ear. Afterward the molds were cut transversally for measurement of the angles. The first cut was made at the middle of the ear's cephalocaudal length. The second cut was made in the superior piece midway between the first cut and the superior extremity of the ear. The cephaloauricular angle was defined as the intersection of a straight line running through the tragus insertion and the lateral portion of the mastoid region with a straight line that running through the tragus and the middle of the helix. The scaphaconchal angle was obtained in the second cut by measurement of the angles formed by these two structures molded in the posterior aspect of the ear. The Student's t test was used for statistical analysis. The average cephaloauricular angle was 47.7 degrees for the study group and 31.1 degrees for the control group. The average scaphaconchal angle was 132.6 degrees for the study group and 106.7 degrees for the control group. This study presents a new method for evaluating the angles of the ear, confirming that both measured angles (cephaloauricular and scaphaconchal) are greater in patients with prominent ears (p < 0.005).     

Aetiology,pathogenesis, and specific management of Stahl's ear: role of the transverse muscle insertion

Stahl's ear is an anomaly of the external ear that is characterised by a third crux in the antihelix. Its aetiology is unknown. We report 5 patients with Stahl's ear, and describe the anatomy, particularly the musculature. We identified the position of the transverse muscle of the ear as being abnormal, and this can take 2 forms: an abnormal insertion of the entire muscle, or an abnormal insertion of the superior head of the muscle.     

Pediatric otoplasty and informed consent: Do information handouts improve parental risk recall?

BackgroundThe elective nature of pediatric otoplasty requires that parents are well educated regarding the risks involved. Simple educational tools have been found to enhance risk recall in some surgical procedures.ObjectiveTo assess the effectiveness of information handouts in improving parental risk recall.MethodsFifty caregivers were randomly assigned to receive traditional oral dialog of the surgical risks, or to receive oral discussion and a written handout outlining the risks of otoplasty. Twelve to 14 days after the consultation, parents were contacted for assessment of risk recall.ResultsOverall risk recall was 48% (3.4 of 7 risks recalled). Bleeding (82%) was the most commonly recalled risk, while cartilage necrosis/deformation (14%) was the least recalled risk. Mean risk recall was higher in the group that received written information (3.9 of 7 risks) compared to the group that received only oral discussion (2.8 of 7 risks) (p = 0.003). No child or parental variables were significantly related to higher risk recall on multivariable analysis.ConclusionCaregiver risk recall in pediatric otoplasty was improved with the addition of written information provided during the informed consent process. As the consent process serves a vital role in pediatric otolaryngology, the use of supplementary educational materials should be further studied.     

Comparison of cartilage scoring and cartilage sparing otoplasty--A study of 203 cases.

The Edinburgh experience of different methods of otoplasty techniques in 203 patients (406 ears) over a five-year period is reviewed. MATERIALS AND METHODS: The patients were divided into three groups - Group A (anterior cartilage scoring), Group B (cartilage sparing in the fashion of posterior suturing) and Group C (posterior suturing refined with posterior fascial flap). Demographic details, operation technique, operation time, grade of the surgeon, suture materials, early and late complications, recurrence and revision rates, patients' and physicians' comments at the follow-up clinic were retrieved from the case notes. The pre- and the post-operative photographs were assessed by a blinded lay observer and a physician and scored on a visual analogue scale. Median follow-up was 11 months. RESULTS: The recurrence rate was 11.0%, 8.0% and 4.8% in Groups A, B and C, respectively (p = 0.0214). Complications were more common in Group A (8.8%) and Group B (7.9%) compared to Group C (1.2%) (p = 0.0208). The cosmetic result was judged best in Group C. In our experience, cartilage-sparing otoplasty refined with the post-auricular fascial flap results in significantly reduced complication rate and improved aesthetic outcome.     

Knifeless otoplasty: How simple can it be?

A simplified and knifeless technique for otoplasty is presented. Correction of the prominent ear is easily achieved by subcutaneous and transcartilaginous nonabsorbable permanent sutures after cartilage resilience is weakened by needle scoring. This technique was very successful in 11 consecutive cases with up to 30 months of followup.     

A new validated otoplasty dressing technique

The goal of otoplasty surgery for prominent ears is to normalize the shape and position of both ears with maximal symmetry. The operation is often performed on children; thus, the importance of dressing design has been emphasized in the literature as a factor determining successful outcome. We present an audited method for otoplasty dressing accompanied by an intraoperative photographic sequence. Proflavin-soaked wool is molded into the anatomical sulci anteriorly and a combination of Vaseline gauze and dressing gauze are held in position posteriorly by tying the continuous skin suture over them. Gauze is then placed over the pinna with a thick soft piece of cotton wool covering the whole area bilaterally. Finally, a length of stockinet is used to secure the dressings in place for 10 days, ensuring support, yet without undue pressure. An audit of the cases we have done so far demonstrated no complications relating to the dressing and satisfaction from patients and staff. We have found this otoplasty dressing technique to be simple, economical, and unobtrusive to the patients, while reproducible by junior staff if examination is required prematurely. Compromise of forehead or anterior pinna skin has not been encountered.