eMedicine Specialties > Plastic Surgery > Head/Neck

Ear, Prominent Ear: Multimedia

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

Multimedia

Mustarde sutures. Left top and bottom: Preoperati...
(Enlarge Image)
Media file 1: Mustarde sutures. Left top and bottom: Preoperative views of 10-year-old patient with absent antihelix root and superior crus, which caused prominence of each ear. Repositioning with Mustarde sutures corrected prominence and mild overhang of rim of helix. Right top and bottom: postoperative views.
[ CLOSE WINDOW ]
Mustarde sutures. Left top and bottom: Preoperati...

Mustarde sutures. Left top and bottom: Preoperative views of 10-year-old patient with absent antihelix root and superior crus, which caused prominence of each ear. Repositioning with Mustarde sutures corrected prominence and mild overhang of rim of helix. Right top and bottom: postoperative views.

Concha-mastoid sutures. Left: preoperative view o...
(Enlarge Image)
Media file 2: Concha-mastoid sutures. Left: preoperative view of 10-year-old boy in whom auricular prominence was caused by excessively deep conchal cups. Treatment was bilateral concha-mastoid sutures. Right: postoperative view.
[ CLOSE WINDOW ]
Concha-mastoid sutures. Left: preoperative view o...

Concha-mastoid sutures. Left: preoperative view of 10-year-old boy in whom auricular prominence was caused by excessively deep conchal cups. Treatment was bilateral concha-mastoid sutures. Right: postoperative view.

Surface anatomy of auricle (top, middle) and area...
(Enlarge Image)
Media file 3: Surface anatomy of auricle (top, middle) and areas of skin undermining (bottom).
[ CLOSE WINDOW ]
Surface anatomy of auricle (top, middle) and area...

Surface anatomy of auricle (top, middle) and areas of skin undermining (bottom).

Anatomy of auricular cartilage, anterior (lateral...
(Enlarge Image)
Media file 4: Anatomy of auricular cartilage, anterior (lateral) and posterior (medial) surfaces. Although anterior landmarks are most familiar, posterior auricular landmarks are of special importance in otoplasty.
[ CLOSE WINDOW ]
Anatomy of auricular cartilage, anterior (lateral...

Anatomy of auricular cartilage, anterior (lateral) and posterior (medial) surfaces. Although anterior landmarks are most familiar, posterior auricular landmarks are of special importance in otoplasty.

Anatomy of auricular vessels, nerves, and muscles.
(Enlarge Image)
Media file 5: Anatomy of auricular vessels, nerves, and muscles.
[ CLOSE WINDOW ]
Anatomy of auricular vessels, nerves, and muscles.

Anatomy of auricular vessels, nerves, and muscles.

Stiff, heavy cartilage. If cartilage is not limbe...
(Enlarge Image)
Media file 6: Stiff, heavy cartilage. If cartilage is not limber and is resistant to force of sutures, the surgeon can choose from among additional steps that provide compliance. To reduce deep concha, cartilage may be excised from either a posterior (partial thickness or full thickness) approach or an anterior approach. Folding of the antihelix is enhanced by Stenstrom scoring; convexity of cartilage is produced by scoring one side of the cartilage, which releases interlocked stresses that curl cartilage in the opposite direction.
[ CLOSE WINDOW ]
Stiff, heavy cartilage. If cartilage is not limbe...

Stiff, heavy cartilage. If cartilage is not limber and is resistant to force of sutures, the surgeon can choose from among additional steps that provide compliance. To reduce deep concha, cartilage may be excised from either a posterior (partial thickness or full thickness) approach or an anterior approach. Folding of the antihelix is enhanced by Stenstrom scoring; convexity of cartilage is produced by scoring one side of the cartilage, which releases interlocked stresses that curl cartilage in the opposite direction.

Left: Stenstrom scoring has been performed with N...
(Enlarge Image)
Media file 7: Left: Stenstrom scoring has been performed with No. 15 blade (in line with arrows) to augment camber of underdeveloped antihelix. Abrasion of antihelix is performed with unmounted, hand-held diamond burr (Midas B3D or B3D) via subcutaneous tunnel. Right: acrylic ear model.
[ CLOSE WINDOW ]
Left: Stenstrom scoring has been performed with N...

Left: Stenstrom scoring has been performed with No. 15 blade (in line with arrows) to augment camber of underdeveloped antihelix. Abrasion of antihelix is performed with unmounted, hand-held diamond burr (Midas B3D or B3D) via subcutaneous tunnel. Right: acrylic ear model.

Fossa-fascia sutures reduce prominence of upper p...
(Enlarge Image)
Media file 8: Fossa-fascia sutures reduce prominence of upper pole of auricle. Deep temporal fascia is exposed by spreading the fibers of the auricularis superior and the superficial temporal fascia. Sutures pass from the deep temporal fascia to the cartilage of the scaphoid fossa or triangular fossa.
[ CLOSE WINDOW ]
Fossa-fascia sutures reduce prominence of upper p...

Fossa-fascia sutures reduce prominence of upper pole of auricle. Deep temporal fascia is exposed by spreading the fibers of the auricularis superior and the superficial temporal fascia. Sutures pass from the deep temporal fascia to the cartilage of the scaphoid fossa or triangular fossa.

Mustarde (scapha-concha) sutures produce or incre...
(Enlarge Image)
Media file 9: Mustarde (scapha-concha) sutures produce or increase the antihelix fold when the fold is absent or underdeveloped. Sutures bowstring from the scaphoid fossa or triangular fossa to the posterior conchal wall. In Kaye's modification, sutures are placed from the anterior approach through tiny incisions.
[ CLOSE WINDOW ]
Mustarde (scapha-concha) sutures produce or incre...

Mustarde (scapha-concha) sutures produce or increase the antihelix fold when the fold is absent or underdeveloped. Sutures bowstring from the scaphoid fossa or triangular fossa to the posterior conchal wall. In Kaye's modification, sutures are placed from the anterior approach through tiny incisions.

Concha-mastoid sutures and conchal nest. Sutures ...
(Enlarge Image)
Media file 10: Concha-mastoid sutures and conchal nest. Sutures reduce excessive conchal projection, passing from the conchal cartilage to the mastoid fascia and to the aponeurotic fibers of the origin of the sternocleidomastoid muscle. Sutures flatten the conchal bowl against the mastoid process. Displacement or removal of excess soft tissues provides easier identification of the mastoid fascia and contributes to reduction of conchal projection.
[ CLOSE WINDOW ]
Concha-mastoid sutures and conchal nest. Sutures ...

Concha-mastoid sutures and conchal nest. Sutures reduce excessive conchal projection, passing from the conchal cartilage to the mastoid fascia and to the aponeurotic fibers of the origin of the sternocleidomastoid muscle. Sutures flatten the conchal bowl against the mastoid process. Displacement or removal of excess soft tissues provides easier identification of the mastoid fascia and contributes to reduction of conchal projection.

Lobe sutures diminish prominence of projecting ea...
(Enlarge Image)
Media file 11: Lobe sutures diminish prominence of projecting earlobe.
[ CLOSE WINDOW ]
Lobe sutures diminish prominence of projecting ea...

Lobe sutures diminish prominence of projecting earlobe.

More on Ear, Prominent Ear

Overview: Ear, Prominent Ear
Treatment: Ear, Prominent Ear
Follow-up: Ear, Prominent Ear
Multimedia: Ear, Prominent Ear
References
[ CLOSE WINDOW ]

References

  1. Antia NH, Buch VI. Chondrocutaneous advancement flap for the marginal defect of the ear. Plast Reconstr Surg. May 1967;39(5):472-7. [Medline].

  2. Baker DC, Converse JM. Correction of protruding ears: A 20-year retrospective. Aesthetic Plast Surg. 1979;3:29-39.

  3. Davis J. Prominent ears. Clin Plast Surg. Jul 1978;5(3):471-7. [Medline].

  4. Davis J. Aesthetic Reconstructive Otoplasty. New York, NY:. Springer-Verlag;1986.

  5. Elliott RA Jr. Complications in the treatment of prominent ears. Clin Plast Surg. Jul 1978;5(3):479-90. [Medline].

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

  7. Ely ET. An operation for prominence of the auricles. Arch Otolaryngol. 1881;10:97.

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

  9. Farkas LG. Anthropometry of the Head and Face in Medicine. St Louis, Mo:. Elsevier Science;1981.

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

  11. Furnas DW. Suture otoplasty update. Perspect Plast Surg. 1990;4:136-45.

  12. Gault DT, Grippaudo FR, Tyler M. Ear reduction. Br J Plast Surg. Jan 1995;48(1):30-4. [Medline].

  13. Gibson T, Davis WB. The distortion of autogenous cartilage grafts: Its cause and prevention. Brit J Plast Surg. 1958;10:257-74.

  14. Gosain AK. Correction of prominent ears in children less than age four years: What should we tell the families?. Plast Surg Forum. 2000;23:267-269.

  15. Kaye BL. A simplified method for correcting the prominent ear. Plast Reconstr Surg. Jul 1967;40(1):44-8. [Medline].

  16. Luckett WH. A new operation for prominent ears based on the anatomy of the deformity. Surg Gynecol Obstet. 1910;10:635-7.

  17. Macgregor FC. Ear deformities: social and psychological implications. Clin Plast Surg. Jul 1978;5(3):347-50. [Medline].

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

  19. Morestin H. De la reposition et du plissement cosmetiques de pavillon de l'oreille. Revue Orthopedie. 1903;14:289-303.

  20. Mustarde JC. The correction of prominent ears using simple mattress sutures. Brit J Plast Surg. 1963;16:172-6.

  21. Mustarde JC. Correction of prominent ears using buried mattress sutures. Clin Plast Surg. Jul 1978;5(3):459-64. [Medline].

  22. Nordzell B. Open otoplasty. Plast Reconstr Surg. Dec 2000;106(7):1466-72. [Medline].

  23. Owens N, Delgado DD. The management of outstanding ears. South Med J. 1963;58:32-3.

  24. Pacik PT. Delayed onset of prominent ears. Plast Reconstr Surg. Mar 1983;71(3):444. [Medline].

  25. Peacock EE. Wound Repair. 3rd ed. 1984.

  26. Pierce GW. Reconstruction of the external ear. Surg Gynecol Obstet. 1930;50:601-5.

  27. Rogers BO. Microtic, lop, cup and protruding ears: four directly inheritable deformities?. Plast Reconstr Surg. Mar 1968;41(3):208-31. [Medline].

  28. Rogers BO. The role of physical anthropology in plastic surgery today. Clin Plast Surg. Jul 1974;1(3):439-98. [Medline].

  29. Romo T, Sclafani AP, Shapiro AL. Otoplasty using the postauricular skin flap technique. Arch Otolaryngol Head Neck Surg. Oct 1994;120(10):1146-50. [Medline].

  30. Smith D, Takashima H. Ear muscles and ear form. In: Birth Defects: Original Article Series. 1980;16:299-302.

  31. Spira M. Reduction otoplasty. In: Goldwyn R. The Unfavorable Result in Plastic Surgery - Avoidance and Treatment. 1984:307-21.

  32. Spira M, et al. Analysis and treatment of the protruding ear. Transactions of the Fourth International Congress of Plastic Surgery. 1967:1090-5.

  33. Stark RB. Plastic Surgery. 1962.

  34. Stenstrom SJ, Heftner J. The Stenstrom otoplasty. Clin Plast Surg. Jul 1978;5(3):465-70. [Medline].

  35. Tan ST, Abramson DL, MacDonald DM, Mulliken JB. Molding therapy for infants with deformational auricular anomalies. Ann Plast Surg. Mar 1997;38(3):263-8. [Medline].

  36. Tanzer RC. Congential deformities. In: Converse JM, ed. Reconstructive Plastic Surgery. 2nd ed. 1977:1705-10.

  37. Tolleth H. A hierarchy of values in the design and construction of the ear. Clin Plast Surg. Apr 1990;17(2):193-207. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

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

[ CLOSE WINDOW ]

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

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.