Otoplasty – techniques, characteristics and risks

The protruding ear as a minor ear abnormality is found in approx. 5% of the German population and may give rise to serious emotional problems in children and also in adults. In general, the procedure used for the surgical correction of protruding ears (otoplasty) is a combination of incision, scoring and suture techniques. The choice of the surgical procedure is based on the severity of the ear abnormality and the individual characteristics of the auricular cartilage. In children up to the age of ten years, a soft, elastic or easily pliable auricular cartilage is often still present. In this situation, gentle suture techniques, such as a suturing technique described by Mustardé, are frequently enough to achieve a cosmetically good and lasting result. In adults, the auricular cartilage has already become stiff. Therefore, a combination of incision, scoring and suture techniques is usually required. Apart from reducing the cephaloauricular angle to 15-20°, emphasis on the antihelical fold and a smooth rim of the helix without interruption of the contour are desirable outcomes of this operation. Occasionally, surgical fixation (lobulopexy) may be required to treat protruding lobules or, in rare cases, an additional conchal reduction may become necessary in cases of conchal hyperplasia. Since postoperative complications can often result in severe auricular deformities, as a matter of principle, each ear should be analysed individually regarding its problem areas, and the surgical approach that causes the least injury to the cartilage should be used

Evaluation and comparison of two different cartilage-sparing techniques in 356 otoplasties performed in children

Background: Prominent ear is the most common deformity of the external ear. Although hundreds of surgical otoplasty techniques have been described, none of them has proved enough advantage over others to become the gold standard in this field. In this study, we evaluated the results of a cohort of 188 patients operated with two different cartilagesparing otoplasty techniques.Patients and methods: A total of 356 otoplasties were performed in 188 patients, between January 2012 and November 2016. Two different techniques were utilized in two different groups: a modified-Mustardé otoplasty and a modified-Furnas technique. Postoperative follow-ups were performed at week 1, and at 1 and 6 months and at 1 year. Complications were recorded and compared between both techniques. The success rate was measured according to McDowells’ criteria.Results: A total of 356 ears were operated in 188 patients (85 men; 103 women; mean age 9.97; range: 6–15 years). In all, 105 patients underwent modified-Mustarde otoplasty, and 83 were operated utilizing a modified-Furnas technique. Success rates ranged from 90 to 100% depending on the technique utilized. No significative differences wereobserved in the incidence of complications and success rates.Conclusion: None of the compared otoplasty techniques showed better results than the other. Notwithstanding, otoplasty shows to be an effective treatment with high success rates (independent of the technique utilized) for patients with prominent ears.Keywords: antihelix, concha, Furnas, Mustarde, otoplasty, prominent ear

CO2 Laser-Assisted Otoplasty: A New Dermatosurgical Procedure

Otoplasty is the surgical procedure characteristically performed to improve the appearance of unpleasant, protruding auricles. An incision in the back of the ear with or without excision of cartilage is the usual approach. A novel technique performed with CO2 laser is presented. The objective of CO2 laser-assisted otoplasty is to decrease the mastoid-scapha angle up to approximately 30°; also, the conchal-scapha angle should be reduced to its usual of approximately 90°. The aims of this procedure are to restructure the scapha and the antihelix fold, to diminish the size of the concha (hinge effect), and to relocate the reshaped ear closer to the head in esthetically desired angles, not only horizontally (lateral angle), but also (and of extreme importance for most patients) vertically (superior angle)

Presentation and Management Outcome of Unilateral and Bilateral Prominent Ears with Standard Otoplasty Techniques

Objective: To determine the outcome of otoplasty in terms of a satisfactory cosmetic outcome and any postoperative complications. Methodology: This descriptive case series was carried out over a period of five years from January 2017 to December 2021 at the Burn and Trauma Center, Department of Plastic Surgery, Hayatabad Medical Complex, Peshawar. Patients of all ages and genders who presented with prominent ears and underwent corrective procedures at our institute were included. Patients who were unwilling to undergo surgery or who did not consent to inclusion in the study were excluded. Patients with constricted ears, cryptotia, shell ears, and question mark ears were also excluded. Results: Out of 45 patients, 29 (64.44%) were females and 16 (35.55%) were males. Their ages ranged between 11-30 years, with a mean of 22.28±5.49 years. The anomaly was bilateral in 84.44% (n = 38) of the patients, while 15.55% (n=7) patients had unilateral defects. 57.7% (n=26) of the patients were unmarried, whereas 42.3% (n=19) were married. All the patients had satisfactory cosmetic outcomes. Various complications encountered included extrusion of sutures (n=3; 6.66%) and superficial wound infection (n=1; 2.22%). Conclusion: Correction of the prominent ears with the standard otoplasty techniques yields satisfactory cosmetic results. Lasting results can be achieved by combining different otoplasty techniques that are stable over time

The Cartilage-Sparing Versus the Cartilage-Cutting Technique: A Retrospective Quality Control Comparison of the Francesconi and Converse Otoplasties

From a total of 281 patients with protruding ears who underwent a bilateral otoplasty between 1990 and 2001, a group of 28 (10%) was selected for a retrospective quality control study. The goal was to compare two methods of otoplasty, the Francesconi, a cartilage-sparing technique, and the Converse, a cartilage-cutting technique, in terms of objectively measurable and subjectively discernable differences in results. Objective parameters included measurement of the three cephaloauricular distances and the conchoscapal angle. An independent plastic surgeon performed the evaluation by means of a systematic evaluation system for rating cosmetic surgical procedures and a 5-point visual analog scale for rating satisfaction. The patients' subjective rate of satisfaction also was investigated using the 5-point scale. The mean medial and inferior cephaloauricular distances were significantly smaller in the Francesconi group. The concoscaphal angle was 90°, or less in all the patients of the Francesconi group, but more than 90° in eight patients (57%) of the Converse group (p = 0.041). Accordingly, the independent surgeon found adequate correction of protrusion in 86% of the Francesconi group and 50% of the Converse group (p = 0.050). His satisfaction rate was significantly in favor of the Francesconi technique (p = 0.006). Not unexpectedly, the patients' satisfaction rate was comparably high in both groups, and there was no statistical difference between them. In conclusion, the quality control led to a clear preference of the Francesconi over the Converse otoplasty. In addition, the assessment of the postoperative results with the systematic evaluation system offered an excellent information base by which to judge the results of otoplasty. Consequent use of this evaluation system will lead to progress in the surgical procedur

A review of selection criteria used by medical scheme advisers to approve or deny procedures with a cosmetic component

Objective. To review and apply statistical tests to the selection criteria used by two medical advisers to approve or deny applications for three common cosmetic or reconstructive procedures within a large group of medical schemes.Design. A retrospective descriptive study which applied multiple regression analysis, frequency analysis, comparison of means and simple correlations to the data sets for three procedures.Setting. Administrative records from the clinical files of medical advisers and the administrator's claims database.Subjects. Data were reviewed for 1 143 members who, between January and December 1996, submitted applications for breast reduction, excimer laser refractive surgery, or otoplasty.Main outcome measures. The primary outcome measure was the statistical relationship between medical advisers' selection criteria and final decision. In addition, the financial implications of these cosmetic/reconstructive procedures were assessed.Results. For the three procedures reviewed there was a statistically significant relationship behveen 5 of 13 preoperative criteria requested and the medical advisers' opinion. Excimer laser surgery was generally approved on the basis of the refractive error (myopia> -3.00; astigmatism > -1.5 dioptres); otoplasty was generally approved for children aged :≤ 12.years; and breast reduction was usually covered for women with a sternal-nipple distance > 29.0 cm and with a cup size ≥ DD. The other data submitted were similarly distributed between the approved and denied groups.Conclusions. Review of medical advisers' decisions is important in an era of protocols, guidelines and 'standard operating procedures'. Selection criteria for approval of applications for medically necesssary cosmetic/reconstructive surgery must be reviewed and revised to provide a reliable, reproducible and statistically valid process

Effect of a small change in auricle projection on sound localization

Pinnae assist in sound localization, and changes in auricle shape, position, or projection can theoretically alter the perceived position of a sound. The minimal displacement required to affect perceived sound location is undefined. This study quantified the error in horizontal sound localization when auricle projection is slightly decreased. The study was conducted at two sites by different experimenters, using different (though similar) systems, over a year apart. There were 21 normal-hearing participants: 11 at the University of Virginia (UVA) and 10 at James Madison University (JMU). Both UVA and JMU protocols involved a normal listening condition and a second condition with a headband that slightly altered pinnae projection by pushing the helixes medially against the temporal bones. Participants identified the location of a short, moderate-intensity noise burst from one of 8 speakers distributed in a horizontal array. Root mean squared error was calculated from tests of 48 trials. Localization errors in the UVA data were greater with the headband than without (t10=2.6; p=.023; Cohen’s d=.8 or ‘large’ effect size). The experiment was repeated at JMU and results replicated; localization errors were greater with than without the headband (t9=2.4; p=.034; Cohen’s d=.8). There was no effect of testing order and no consistent direction of error in either protocol. None of six anatomical measurements of pinnae correlated with the decrease in azimuth accuracy. Combined data from both experiments show a highly significant effect of the slightly medialized helix (t20=3.6, p=.002; d=.9). These data indicate the minimum pinna change required to alter sound localization is at least as small as the 15 mm average movement of the helix or 29 degree reduction in auricle projection. These data on psychoacoustic effect of altering auricle projection may be of relevance after otoplastic operations

Complications of auricular correction

The risk of complications of auricular correction is underestimated. There is around a 5% risk of early complications (haematoma, infection, fistulae caused by stitches and granulomae, allergic reactions, pressure ulcers, feelings of pain and asymmetry in side comparison) and a 20% risk of late complications (recurrences, telehone ear, excessive edge formation, auricle fitting too closely, narrowing of the auditory canal, keloids and complete collapse of the ear). Deformities are evaluated less critically by patients than by the surgeons, providing they do not concern how the ear is positioned. The causes of complications and deformities are, in the vast majority of cases, incorrect diagnosis and wrong choice of operating procedure. The choice of operating procedure must be adapted to suit the individual ear morphology. Bandaging technique and inspections and, if necessary, early revision are of great importance for the occurence and progress of early complications, in addition to operation techniques. In cases of late complications such as keloids and auricles that are too closely fitting, unfixed full-thickness skin flaps have proved to be the most successful. Large deformities can often only be corrected to a limited degree of satisfaction

Blepharoplasty and otoplasty: comparative sedation with remifentanil, propofol, and midazolam

Three different methods of sedation or sedoanalgesia using remifentanil, Propofol, or midazolam to increase intra- and postoperative comfort and to reduce neuroendocrine stress in patients who had undergone typical ambulatory cosmetic surgery under local anesthesia were studied. A sample of 90 patients who underwent upper and lower eyelid blepharoplasty to correct baggy eyelids or otoplasty to correct protruding ears was selected according to standard criteria for the study. Remifentanil provided the best tolerability profile and the most effective perioperative pain control among the substances studied, demonstrating it to be a valid drug for modern sedoanalgesia aimed at increasing the well-being of patients undergoing ambulatory cosmetic surgery

Correlation between projection of the ear, the inferior crus, and the antihelical body: Analysis based on computed tomography

This is a preprint of an article whose final and definitive form has been published in the SCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY AND HAND SURGERY © 2007 copyright Taylor & Francis; SCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY AND HAND SURGERY is available online at: http://www.informaworld.com/openurl?genre=article&PISSN=0284-4311&volume=41&issue=6&spage=288ArticleSCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY AND HAND SURGERY. 41(6): 288-292 (2007)journal articl