eMedicine Specialties > Plastic Surgery > Head/Neck

Ear, Congenital Deformities: Follow-up

Author: Carl H Manstein, MD, Private Practice, Manstein Plastic Surgical Association
Contributor Information and Disclosures

Updated: Jul 25, 2008

Outcome and Prognosis

As the ear withstands trauma well, patients typically do well after surgery. For set-back otoplasty, outcome depends upon expectation. If the patient is well informed, he or she has a better outcome because it matches expectations.

Future and Controversies

Future treatment of congenital ear deformities probably lies in 2 arenas. Diagnosis and surgery in utero have already been investigated with cleft lip and palate and neural tube abnormalities. Soon, other abnormalities of the head and neck, such as ear atresia, will probably at least be recognized before birth. With early diagnosis comes the hope of in utero correction.

As discussed, nonsurgical techniques emerging from Japan have been used to treat auricular deformities with nothing more than tape and head bands.4 Whether this will become the standard of care for the protruding ear in the 21st century is difficult to predict. As physicians advance toward minimally invasive surgery, the assumption is that parents who become aware of this nonsurgical option will choose this procedure. Patient and parent compliance is an entirely different issue.

The second area, and one that is currently occurring, is the advent of osseous integrated implants for reconstruction. As these devices become the criterion standard for dental reconstruction, their use in craniofacial reconstruction has grown. Devices and prostheses are available for surgically resected ears in the treatment of cancers. Similar implantation devices are likely to replace the vastly complex and multistaged operations currently considered state-of-the-art for the congenitally absent ear.

Lastly, advances are being made in gene therapy and tissue generation. In these fields, the reconstructive surgeon is limited only by his or her imagination. Cartilage frameworks someday may be grown in a laboratory and then implanted into an undermined skin pocket to recreate an atretic ear.

Medicolegal pitfalls

Medicolegal pitfalls associated with congenital ear deformities are similar to those found in other areas of surgery. Of particular concern to the plastic surgeon is patient satisfaction. A well-informed patient with realistic expectations of the end result is less likely to be dissatisfied with the outcome. Always address the issue of scarring with the patient, as well as the possible success or failure of cartilage grafts that may be used during surgery.

 


More on Ear, Congenital Deformities

Overview: Ear, Congenital Deformities
Workup: Ear, Congenital Deformities
Treatment: Ear, Congenital Deformities
Follow-up: Ear, Congenital Deformities
Multimedia: Ear, Congenital Deformities
References
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References

  1. Elliott RA Jr. Otoplasty: a combined approach. Clin Plast Surg. Apr 1990;17(2):373-81. [Medline].

  2. Gosain AK, Recinos RF. Otoplasty in children less than four years of age: surgical technique. J Craniofac Surg. Jul 2002;13(4):505-9. [Medline].

  3. Furnas DW. Complications of surgery of the external ear. Clin Plast Surg. Apr 1990;17(2):305-18. [Medline].

  4. Matsuo K, Hayashi R, Kiyono M, et al. Nonsurgical correction of congenital auricular deformities. Clin Plast Surg. Apr 1990;17(2):383-95. [Medline].

  5. Rubino C, Farace F, Figus A, et al. Anterior scoring of the upper helical cartilage as a refinement in aesthetic otoplasty. Aesthetic Plast Surg. Mar-Apr 2005;29(2):88-93; discussion 94. [Medline].

  6. Erol OO. New modification in otoplasty: anterior approach. Plast Reconstr Surg. Jan 2001;107(1):193-202; discussion 203-5. [Medline].

  7. Furnas DW. Correction of prominent ears with multiple sutures. Clin Plast Surg. Jul 1978;5(3):491-5. [Medline].

  8. Bauer BS, Song DH, Aitken ME. Combined otoplasty technique: chondrocutaneous conchal resection as the cornerstone to correction of the prominent ear. Plast Reconstr Surg. Sep 15 2002;110(4):1033-40; discussion 1041. [Medline].

  9. Blessing JD. Physician Assistant's Drug Handbook. Springhouse, Pa: Springhouse Pub Co; 1999.

  10. Davis J. Part II: Aesthetic surgery. In: Aesthetic and Reconstructive Surgery. 1987:129-87.

  11. Medical Economics Staff. Physician's Desk Reference. 53rd ed. Medical Economics Co; 2000.

  12. Wilkes GH, Wolfaardt JF. Craniofacial osseointegrated prosthetic reconstruction. In: Habal MB, ed. Advances in Plastic and Reconstructive Surgery. Vol 15. 1999:51-82.

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Further Reading

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Keywords

ear deformity, congenital ear deformity, protruding ear, ear microtia, setback otoplasty, set-back otoplasty, protruding ears, prominent ears, lop-ear, constricted ear, external ear microtia

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Contributor Information and Disclosures

Author

Carl H Manstein, MD, Private Practice, Manstein Plastic Surgical Association
Carl H Manstein, MD is a member of the following medical societies: American Society of Plastic Surgeons, Pennsylvania Medical Society, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Lawrence Ketch, MD, FAAP, FACS, Head, Program Director, Associate Professor, Department of Surgery, Division of Plastic Surgery, University of Colorado Health Sciences Center; Chief, Pediatric Plastic, The Children's Hospital of Denver
Lawrence Ketch, MD, FAAP, FACS is a member of the following medical societies: American Academy of Pediatrics, American Association for Hand Surgery, American Association of Plastic Surgeons, American Burn Association, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Society for Surgery of the Hand, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Plastic Surgery Research Council
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jaime R Garza, MD, DDS, FACS, Consulting Staff, Private Practice
Jaime R Garza, MD, DDS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Practice Director, Colorado Plastic Surgery Center at Swedish Medical Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Deepak Narayan, MD, FRCS, Associate Professor of Surgery (Plastic), Yale University School of Medicine; Chief of Plastic Surgery, West Haven Veterans Affairs Medical Center
Deepak Narayan, MD, FRCS is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Indian Medical Association, Plastic Surgery Research Council, Royal College of Surgeons of Edinburgh, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

 
 
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