Bilateral Otoplasty Research Articles

Novel Surgical Procedure of Repair for Stahl's Ear: A Case Report

A pointed-ear defect characterized by an abnormal folding of the skin and cartilage of the pinna, which produce an "elfin ear" or “elf ear” characterized by an ear-rim with a pointed upper-edge, rather than a rounded upper-edge.A 10 year old boy admitted at IGMC Hospital, Shimla during the month of April’ 2022 with the chief complaintsof bilateral abnormal growth of pinna by birth. After the general physical examination, routine blood profile and other Lab investigation, he diagnosed Bilateral Stahl’s Ear (Type I), underwent bilateral otoplasty. Prognosis is good and patient discharged post operatively after a short stay at hospital.

Complication Rates From Otoplasty at a Tertiary Facial Plastic Surgery Center: A Retrospective Analysis.

:Prominent ears are considered the most common congenital external ear deformity among Caucasians. Affecting approximately 5% of the population, it runs in families and exhibits equal sex incidence. This study aimed to determine the complication rate from otoplasty in a tertiary facial plastic surgery center. This retrospective cross-sectional study included all patients with prominent ears deformities who underwent otoplasty at King Abdul-Aziz University Hospital between January 2019 and June 2021. The records of 116 patients who underwent otoplasty during the study period were examined and only 44 matched the inclusion and exclusion criteria. The total of 85 operated ears from 44 patients were included. Of these, 17 were pediatric patients and 25 were male patients. Forty-one patients underwent bilateral otoplasty and 3 underwent unilateral otoplasty. Complications occurred in 17/85 (20%) patients and the complications included recurrence 4 (4.70%), hypertrophic scar 3 (3.52%), keloid 2 (2.35), granuloma 2 (2.35%), infection 2 (2.35%), discomfort 1 (1.17%), wound dehiscence 1 (1.17%), hematoma 1 (1.17%), and retracted ear 1 (1.17%). The overall patient satisfaction was 38/44 (86.36%). Our study is first study conducted in middle east about otoplasty complications. It showed that the complications from otoplasty surgery varied from severe to mild, with acceptable overall satisfactory results. The most common complication was recurrence. Fortunately, serious complications, such as wound dehiscence and hematoma, were rare. However, our study’s small sample size remains a major limitation.

Bilateral polyotia: case of a rare and atypical congenital malformation in a three-month-old infant.

Polyotia is an extremely rare congenital malformation of the external ear, characterised by the development of an accessory auricle. It is more often unilateral. We report the case of a Cameroonian infant whom we received at the age of three months. The infant´s mother had noticed a deformity concerning both ears since birth and did not observe any other associated symptom. On physical examination, we found an additional auricle fusing with the tragus on both sides. This unusual structure consisted of skin and cartilage. Their greater diameters measured 2.5cm and 2cm on the left and right respectively. Otoscopic evaluation and general physical examination were normal. A computerized tomography (CT)-scan of the temporal bones as well as an abdominal ultrasound scan were requested to explore other possibly associated anomalies. These imaging studies were normal. The diagnosis of isolated bilateral polyotia was made. An ear reconstructive surgery was proposed to the parents. An informed consent was obtained from the parents, pre-operative work-up was requested and the procedure was planned. A bilateral otoplasty was done under general anaesthesia. The procedure was simple, consisting of excision of the excess tissue to give a natural aesthetic result. Post-operative evolution was favourable, with good scarring on day 10, as illustrated in the figure. Nine months following the procedure, the parents seemed satisfied with the aesthetic result. Polytia is a rare congenital malformation. Management requires adequate and comprehensive investigations to exclude enchondroma or associated malformations, prior to ear reconstructive surgery.

Measuring attentional bias in children with prominent ears: A prospective eye-tracking study

When observing new faces, most people focus their attention on the central triangle of the face containing the eyes, nose and mouth. When viewing faces with prominent ears, observers may divert their attention from the central triangle. The objective of this study was to determine whether there was an objective attentional bias to prominent ears in comparison to non-prominent ears. A total of 24 naïve participants (13 female; mean age 22.88 years) viewed 15 photographs of children with bilateral prominent ears, unilateral prominent ears and non-prominent ears. Both pre- and post-otoplasty photographs of two patients were included. The eye movements of participants were recorded using the EyeLink 1000, a table-mounted eye-tracking device. Overall, the participants spent more time looking at the ear regions for faces with prominent ears in comparison to faces without prominent ears (p=0.007, Z=-2.688). The attentional bias to the ear region of the patient who underwent bilateral otoplasty was significantly reduced in the post-operative photograph (p=0.011, Z=-2.534). The patient who underwent unilateral otoplasty had no significant change in fixation times towards the ear region (p=0.594, Z=-0.533). This study presents objective data to support the notion that observers show attentional bias to the ear region when viewing faces of children with prominent ears. The scope of this finding requires further research in both extent and impact.

Results of otoplasty by scoring anterior surface of auricular cartilage

A prominent ear, so called a protruding or 'lop' ear, is the most common congenital deformity of the external ear. This deformity persists when the mastoid-helix angle (MHA) is higher than 30 degrees. It is relatively common among the population with the incidence of about 5%. The aim of this study is to present surgical procedure and our results using otoplasty with scoring anterior surface of the auricular cartilage. To analyze objective and subjective surgical procedure effects. Between 2011 and 2014 we treated 28 patients. We found statistically high significance p<0.01 in value mastoid-helix angle (MHA) preoperative and postoperative. In patients with bilateral otoplasty the difference between left and right MHAs after surgical procedure is less than 4 degrees. The difference of head-helix distance (HHD) preoperative and postoperative is statistically important with high significance p<0.05. Preoperative satisfaction by personal appearance was better after surgical procedure p<0.05. Complications occurred in 9 cases (32.4%). Otoplasty by scoring anterior surface of auricular cartilage is safe procedure for correction of prominent ear with excellent results on patient satisfaction by personal appearance. Effect of reducing the MHA and HHD is long lasting.

Sensibility of the Ear After Otoplasty

Changes in skin sensibility occur in various postoperative plastic surgeries, especially when they involve major skin and subcutaneous dissection. There were no studies so far that objectively compared changes of ear sensibility. This prospective study was conducted to compare ear sensibility before and after otoplasty. Patients with prominent ears (n = 15) underwent bilateral otoplasty. Ear tactile sensibility was tested preoperatively and 6 and 12 months after surgery by Pressure Specified Sensory Device, an apparatus that quantifies cutaneous pressure sensation (g/mm(2)). Comparison between preoperative and 6-months postoperative results indicated an increment on mean skin pressure thresholds; however, mean thresholds between pre- and 12 months postoperative period were similar. Vibratory and hot/cold sensibility did not present any difference during this period. This is the first comparative assessment of ear tactile sensibility using quantitative methods. After otoplasty, initially there was reduction in an ear tactile sensibility, followed by a return to levels similar to preoperative sensibility.

Y-to-V Setback for Prominent Lobule Correction in Otoplasty

Prominent ears may be very distressing for the patient and they need to be corrected. The situation is especially important for school children or the teenagers as it may cause peer criticism and psychological issues. Various techniques have been suggested, and it is possible to obtain a successful result with one of these techniques chosen according to the patient's specific needs and the surgeon's preference. However, there are not many publications regarding the finer details of this operation such as the correction of the prominent lobule. There are few techniques available with limited success. In this study, we humbly present our Y-to-V setback technique for correction of the prominent lobule, as an individual operation or as an adjunct to a successful otoplasty. A total of 22 cases in which prominent lobule correction had to be performed during otoplasty were included in our study. Mean age of the patients was 21.3 years. Of the 22 patients, 14 were female and 8 were male. All cases underwent bilateral lobule transposition together with bilateral otoplasty. All cases have been followed up for at least 12 months. Mean follow-up was 20 months. The lobule incisions were inconspicuous, and they were well hidden in the postauricular sulcus. Hypertrophic scars or keloid were not seen in any cases. No relapse of lobule prominence was seen during the follow-up period. All patients were satisfied with their results. One of the reasons the ears may look unnatural or "operated" after an otoplasty is the disharmony of the lobule with the corrected parts. Even normal lobules may become relatively prominent after medialization of the helix. It is suggested that the use of a "v"-shaped advancement flap elevated from the posterior surface of the lobule may be a very useful technique to set the lobule back to the desired extent.

Separating the Helix From the Antihelix: A New Concept in Prominent Ear Correction

For over a century, various otoplasty techniques for correction of the prominent ear have been attempted. Nevertheless, cartilage memory strength, mainly in the thick cartilage (and consequently the recurrence of the prominence), still remains a problem. An additional difficulty relates to the antihelix irregularities caused by attempts to weaken the cartilage spring, which are time-consuming and in some cases lead to an unnatural-looking result. The technique reported in this article represents a new approach to otoplasty that deconstructs the auricular pavilion with a single full incision in the antihelix. This approach makes it easier to rebuild the antihelical fold with dissolving sutures and allows repositioning of the helix and earlobe with a posterior bielliptical incision and a narrow bridge skin resection. Between 1999 and 2009, the author performed otoplasty for correction of the prominent ear in 60 patients, including 32 men (53.3%) and 28 women (46.7%). A single incision was made in the superior and lateral borders of the antihelix from the triangular fossa down to the tail of the helix, to completely separate the antihelix from the helix. Three postauricular sutures were applied with nonpermanent side-to-side mattress sutures, with a fourth suture placed to reposition the tail of the helix. A posterior bielliptical incision with a narrow bridge skin resection was performed. Complications occurred in six of the 60 patients (10%) who underwent bilateral otoplasty. A discrete recurrence occurred in the superior pole in six patients (10%) and was unilateral in all cases. Follow-up ranged from three months to 10 years. There were no major recurrences in this series. The satisfaction rate was 98.3%. The antihelix looked smooth, without marks or irregularities; the helix seemed straight and well placed. The posterior scar was inconspicuous. The present technique introduces a new concept in otoplasty that avoids handling the antihelix cartilage. A single incision of the antihelix breaks the cartilage spring memory completely and allows rebuilding of the antihelical fold without resorting to techniques such as rasping, drilling, excision, or complete incision, all of which are time-consuming and may result in irregularities. Sutures are placed to create the new antihelix in the desired shape easily and without tension. The helix and earlobe are repositioned with a specific posterior skin resection and with the tail of the helix's replacement.

Traumatic neuroma: a late complication of otoplasty

We report on the development of traumatic ear lobe neuromas as a late complication of bilateral otoplasty performed 16 years previously. To our knowledge, this is the first and only described case of traumatic neuromas arising as a late complication of otoplasty in the English literature. Traumatic neuroma should be considered in the differential diagnosis of any nodular lesions that develop within the external ear in patients who have had otoplasty or any other form of external ear surgery or trauma.

Comparative Efficacy of Ropivacaine and Bupivacaine Infiltrative Analgesia in Otoplasty

A prospective double-blind study was conducted to compare the anesthetic efficacy of ropivacaine and bupivacaine in a bilaterally symmetrical otoplasty model. Because ropivacaine has a significantly lower toxic potential than bupivacaine, it may be established as the anesthetic agent of choice for low-dose infiltration anesthesia in routine aesthetic facial operations. Each of the 24 adult patients undergoing bilateral otoplasty received infiltration with ropivacaine in 1 auricle and an equal volume of bupivacaine in the other. Patients were requested to assess their pain separately in each side at the times of infiltration, during cartilage scoring, and 2, 6, and 10 hours postoperatively on a visual analog scale. Intraoperative success rates were similar, and overall analgesia achieved at 2 hours, 6 hours, and 10 hours postoperatively was not found to be statistically different between ropivacaine and bupivacaine. The authors conclude that ropivacaine can be used as an effective alternative to bupivacaine in otoplasty.

Molding the ears after anterior scoring and concha repositioning: a combined approach for protruding ear correction.

The goal of otoplasty for correction of prominent ears is normalization of shape and position of both pinnas with a certain symmetry. Recreating the antihelical fold and lowering the auriculocephalic angle are the basic processes for achieving a normal-looking ear. Various methods have been described to recreate the antihelical fold. In addition to anterior scoring or abrasion, many involve placement of permanent or absorbable sutures to reform the cartilage to proper shape to correct the deformity. In this study the use of a custom-made silicone mold was described after anterior scoring to recreate the antihelical fold, without using any suture material. Silicone molds provide good shaping of the antihelical fold, scapha, and helical rim while the tissue is healing. Fourteen patients underwent bilateral otoplasty for prominent ears in our clinic over a four-year period. The anthelical fold was created by anterior scoring and the concha-mastoid angle lowered and sutured. After completing the surgical procedure for both ears, custom-made silicone molds were worn by the patient for the first two weeks to maintain proper position. The third week, the patient wore the mold half a day. A head dressing was used for two days and the ears were subsequently supported using a headband. Follow-up ranged from fourteen months to four years. One patient developed a postoperative hematoma in one ear that resorbed spontaneously. Patient satisfaction with the procedure was generally high. Using a shape mold after a combination of anterior scoring and concha repositioning gives predictable results with a natural-looking ear.

How long should ears be bandaged after otoplasty?

A firm head dressing is usually applied after otoplasty. Some surgeons recommend that the patient should wear the bandage for up to 10 days after surgery. However, these bandages are frequently displaced or come off. Patients complain of reduced hearing, itch and the smell of old blood in the bandages. A case series of 52 patients undergoing bilateral otoplasty who had a head bandage on for only 24 hours was audited prospectively. Minor complications occurred in two patients. A head bandage does not need to remain on for more than 24 hours after otoplasty.

Otoplasty using the postauricular skin flap technique.

To evaluate the efficacy of the postauricular skin flap technique in otoplasty. We conducted a case series study of 25 patients who underwent bilateral otoplasty for prominent ears over a 4-year period. Follow-up ranged from 6 months to 4 years. Academic tertiary care referral center. Twenty-five patients with congenitally prominent bilateral ears, aged 5 to 38 years of age. Cartilage-sparing otoplasties were performed with access using the postauricular skin flap technique. The specifics of cartilage correction were determined by the surgeon based on the patients' anatomic deformity. Clinically noted aesthetic results, complications, and patient satisfaction. No complications, such as hypertrophic scarring, keloid formation, scar migration, ear deformity, or obliteration of the postauricular sulcus, were noted. Patient satisfaction with the procedure was generally high. We conclude that the postauricular skin flap approach to otoplasty is safe, provides excellent exposure, is amenable to most cartilage surgical techniques, and is a valuable addition to otoplasty techniques.

Bilateral otoplasty. (Spanish)

Bilateral otoplasty. (Spanish)