eMedicine Specialties > Plastic Surgery > Head/Neck

Ear, Prominent Ear: Follow-up

Author: Samuel J Lin, MD, Attending Surgeon, Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
Coauthor(s): David W Furnas, MD, Clinical Professor Emeritus, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California at Irvine
Contributor Information and Disclosures

Updated: Apr 9, 2007

Outcome and Prognosis

A well-planned and carefully executed otoplasty in a properly selected patient achieves the goal of integrating the ears as an aesthetically pleasing part of the patient's appearance in accordance with the patient's body image. Prognosis for a permanent correction is excellent.

Despite the preponderance of techniques describing accentuation of the antihelical fold as the key component of correction of the prominent ear, the prominent ear has many and varied etiologies, but the common denominator has been hypertrophy of the concha. The degree of conchal hypertrophy does not need to be great to have a positive impact when employing chondrocutaneous resection as the cornerstone of the otoplasty technique. Recognizing this fact is imperative, and to date, it is underappreciated. With even limited resection and resuturing of the cut concha, the antihelix yields to the posterior placement of sutures with a soft, smooth, rounded shape unmarred by any sharp irregular surfaces.

Despite concerns expressed by some authors and criticism of the anterior approach to the concha as a potential source of a keloid scar, Bauer has not reported unsightly scarring in any of these cases, nor in a much larger series of conchal donor sites for composite grafts used for ear reconstruction. This approach allows for ready adaptation to treatment of less common deformities and can also be applied to correction of deformities seen in grade I and IIa constriction (where the deformity is bilateral and significant increase in ear height is not required).

While a small number of patients have demonstrated minor asymmetries in the upper pole correction or in lobule shape or prominence, the adjunctive procedures mentioned above have now been applied more regularly at the initial procedure to avoid these areas of concern. To date, all revisional procedures, even in younger children, have been accomplished with a single procedure under local anesthesia in the office setting.

Future and Controversies

Dr. Bauer's clinical caveats

  • Correct analysis of each ear deformity is the most important step in otoplasty.
  • Failure to fully appreciate all elements distorting the ear position and shape (particular the role of conchal hypertrophy) is a recipe for an unfavorable outcome.
  • Otoplasty techniques that involve scoring or abrasion of the cartilage all run the potential risk of visible cartilage irregularities and a sharp antihelical fold.
  • Placing the incision for conchal resection too high in the concha decreases control of the antihelical fold, allowing the cut edge adjacent to the antihelix to spring forward when the antihelix is shaped.
  • To assure a tension-free closure of the concha, more cartilage is typically resected than skin, particularly along the inferior concha, deep to the antitragus.
  • Excessive resection of skin or cartilage in the latter area pulls the antitragus upward and increases the prominence of the lower pole of the ear and lobe.
  • When designing the squid-shaped excision, failure to taper the skin excision in its midportion may result in a postoperative telephone ear deformity.
  • Preserving the perichondrium on both surfaces of the cartilage lessens the possibility of subsequent sutures pulling through the cartilage with resultant partial recurrence of the deformity.

 


More on Ear, Prominent Ear

Overview: Ear, Prominent Ear
Treatment: Ear, Prominent Ear
Follow-up: Ear, Prominent Ear
Multimedia: Ear, Prominent Ear
References
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References

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Further Reading

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Keywords

prominent ear, concha-mastoid sutures, C-M sutures, antihelix sutures, Mustarde sutures, antihelix incision, pinna

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Contributor Information and Disclosures

Author

Samuel J Lin, MD, Attending Surgeon, Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
Samuel J Lin, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, and Triological Society
Disclosure: Nothing to disclose.

Coauthor(s)

David W Furnas, MD, Clinical Professor Emeritus, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California at Irvine
David W Furnas, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Plastic Surgeons, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Head and Neck Society, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society for Surgery of the Hand, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Society of Transplantation, California Medical Association, Phi Beta Kappa, Plastic Surgery Research Council, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, and Society of University Surgeons
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

R Edward Newsome, MD, Associate Professor, Program Director and Chief, Department of Surgery, Section of Plastic Surgery, Tulane University Health Sciences Center
R Edward Newsome, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Plastic Surgeons, and Louisiana State Medical Society
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

Al Aly, MD, FACS, Consulting Surgeon, Iowa City Plastic Surgery
Disclosure: Ethicon  Consulting fee Consulting; QMP Royalty Book royalty; Insorb Stapler Consulting fee Consulting; Insorb Stapler Ownership interest None; Medicis Intellectual property rights None

 
 
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