Laser-Assisted Cartilage Reshaping (LACR) for Treating Ear Protrusions: A Clinical Study in 24 Patients

Abstract

Protruding ears are the most common congenital ear deformity, with a frequency of 13.5%. Since 1845 and the first works of Dieffenbach, over 170 classical surgical methods have been proposed to correct it. We introduced laser-assisted cartilage reshaping (LACR) in 2004 as an alternative to invasive surgical otoplasty. Between January 2008 and June 2008, 24 patients underwent LACR for treatment of bilateral ear protrusion. Fourteen adults and ten children were treated (mean age = 16.0 years, range = 6-45 years). No anesthesia was used. Both sides of the entire helix and the concha were irradiated using a 1540-nm laser connected to a 4-mm spot handpiece with integrated cooling. Fluences varying from 70 up to 84 J/cm(2) were applied. Immediately after the irradiation, silicone elastomer was inserted inside the helix to give it the desired shape. After 3 minutes a solid mold was obtained. Patients were asked to keep this mold in place at all times with a bandage wrapped around the head for the first 3 weeks and then for an additional 3 weeks only during the night. A non-steroidal anti-inflammatory drug (NSAID) was prescribed to the patients for 3 days. At 1, 30, 60, and 90 days after the procedure, ears were checked and photographs were taken. Clinical follow-up at 1 year was obtained via direct patient contact or over the telephone. The treatment was well tolerated. No hematomas or skin necrosis occurred. Contact dermatitis was observed in four children and two adults as a result of inappropriate mold design. These patients stopped wearing the mold and the shape of their ear did not improve. For the remaining 18 patients (6 children and 9 adults), the expected ear reshaping was obtained (fluence was 84 J/cm(2)). For three other adults, incomplete reshaping of the ears was observed and can be correlated to a lower fluence (70 J/cm(2)). LACR, performed without any anesthesia, is a safe and less morbid approach to surgical otoplasty.