Abstract: Cryptotia Correction Using Double Opposing Interpositional Advancement Flaps

Abstract

INTRODUCTION: Cryptotia is a congenital deformity of the ear where the upper third of the auricle is buried beneath the temporal skin with subsequent defacement of the cartilaginous framework. Patients present with distress over the appearance of their ear and difficulty wearing glasses. When diagnosed in the neonatal period, splinting is effective, but when diagnosed later in life surgical therapy is often most effective. Various surgical techniques have been described, but there has been no consensus for the best treatment. Almost all necessitate a skin graft. We present a novel technique utilizing 2 adjacent flaps from temporal and post auricular skin to release and cover the auricular soft tissue defect without skin grafting. METHODS: 3 ears (2 patients) were treated at the University of California San Francisco with cryptotia and repaired under general anesthesia as an ambulatory procedure. Both patients presented as teenage boys. An inverted V-Y flap is designed above the buried portion of the helical rim at 12 o’clock in the temporal and postauricular skin. A second inferiorly-based flap is designed adjacent to the posterior limb of the V. Both flaps are elevated above the temporalis fascia. The buried portion of the auricle is then released from the helical rim to the base of the concha. After release, the helical rim and antihelix are re-shaped with conchal-scaphal sutures if needed. The V flap is then inset to the posterior surface of the ear, with straight-line donor site closure. The inferior flap is then advanced to close the residual soft tissue defect. The ears are dressed with a Glasscock ear cup dressing. RESULTS: All patients returned for follow up 1–2 weeks after their procedure and healed without complications. There were no problems with tissue loss or wound healing. At 4 months postoperative, our results were durable with good cosmesis and satisfaction. CONCLUSION: We present a novel technique that is reliable and effective for reconstructing the soft tissue deficiency without skin grafting in cryptotia after helical release. The procedure is well-tolerated and the scars are hidden by the ear and temporal skin.