Conchal Setback Research Articles

Modified Posterior Triple Scoring as a Refinement Technique in Creating Aesthetic Antihelical Fold in Otoplasty

Objective: To develop a precise and reliable technique in addressing underdevelopment of antihelical fold in patients with prominent ears. Background: Prominent ears remain to be a common presentation in aesthetic surgery. Multiple otoplasty techniques addressing the antihelical fold have been developed, but no standard technique is globally adopted. Creating a uniformly even, defined and smooth-edged antihelical fold without retropulsion of helix can be at times challenging and difficult to achieve. This study describes a modified way of refining a desirable antihelical fold by posterior triple scoring technique. Methods: A posterior approach was developed to access the posterior surface of antihelix and apply strategic triple linear scoring in conjunction with conchal repositioning. Ten patients underwent this procedure and followed up in 1-month and 1-year periods. Results: All patients were satisfied with the procedure. None of the patients developed complication or require secondary otoplasty. Conclusion: This novel technique provides a simple yet reliable and precise technique in conjunction with conchal setback or as a standalone procedure in selected patients to achieve the aesthetic curves of the external ear. We suggest this technique as an option to address the underdevelopment of antihelical fold in patients with prominent ears.

Safety Otoplasty: Novel Usage of Piezoelectric Mastoid Sculpting for Conchal Setback.

Safety Otoplasty: Novel Usage of Piezoelectric Mastoid Sculpting for Conchal Setback.

597 Reconstruction of Lop Ear Deformities After Severe Burn Injury in Pediatric Patients: An 11-year Experience

IntroductionThe ear is one of the most highly visible structures on the face. One or both ears are frequently involved in panfacial burns. Because they are bilateral structures, asymmetries are clearly visible. Reconstruction of burned ear deformity often requires replacement or modification of skin and/or cartilage. Even these are successfully replaced, scar contractile forces can cause deformation of the ear. One of these deformities is lop or cup ear, in which the helical rim is either folded over, wrinkled or tight. We describe the necessity of applying otoplasty techniques to address this problem.MethodsA retrospective chart review analysis was performed to assess demographic variables, procedural indications and procedural outcomes in pediatric patients treated at our hospital for complex ear reconstruction for ear deformities after her surgery. Inclusion criteria were pediatric patients aged 0 to 21 years admitted to Shriners Hospital for Children-Boston from January 1, 2010 to January 1, 2021 for burn injury, who subsequently required follow-up complex ear reconstruction for ear deformities after burn injury. Of these patients, those with lop ear deformities who required construction were examined. Using the Trauma Registry of the American College of Surgeons (TRACS) and Shriners Hospital for Children Information Source (SHCIS) databases, we identified 12 eligible patients. Surgical procedure data was obtained from the SHCIS electronic medical records. Surgical photographs were obtained with patient informed consent. Those patients who required Medpor or cartilage frame reconstructions were excluded.Results12 patients required an otoplasty-type procedure to obtain desired results or symmetry with the contralateral ear. This technique involved a posterior incision in the auriculomastoidmastoid sulcus, are you a year and cartilage modification with sutures to to re-create the antihelical fold an superior crus as well as conchal setback sutures.ConclusionsBecause ears are bilateral structures, symmetry is extremely poor. Because of multiple contractile forces on the external ear from secondary healing or contraction of skin grafts, the ear is often displaced anteriorly and the upper portions become folded. Treatment requires reconstruction of the natural folds of the ear and shortening of the helical rim to mastoid distance. this requires an otoplasty approach with a posterior incision,, exposure of the cartilaginous framework and modification of the cartilage with incisions and sutures. This technique however requires adequate soft tissue coverage of the ear.

Otoplasty Outcomes and Results: Does Furnas Setback Suture Affect Complication Rates?

lems, or auricular atresia or patients or their parents who were diagnosed with psychiatric problems. We evaluated 27 male and 27 female patients for the clinical outcomes, revision needs, elastic headband wearing time, and complications, such as infection and hematoma, after otoplasty for surgical correction of prominent ears when Furnas suture was used. Photographic documentation was done preoperatively and postoperatively. Surgical Techniques Otoplasty was performed under general anesthesia. The operative site was prepared with povidone-iodine solution. To reduce the bleeding, 1% lidocaine with 1:200.000 epinephrine was infiltrated with a fine needle to postauricular subcutaneous tissue. The position of the antihelix was arranged by pressing the ear backward. The key markings of folds and suture sites were plotted with a violet marker. The skin incision was made postaurically and long enough for accessing the posterior helix (Mustarde suture) and mastoid area (Furnas suture). Hemostasis was obtained with monoand bipolar cautery. Small elliptical skin with subcutaneous tissue was excised from the posterior part of the concha. Subcutaneous tissue was separated from the conchal cartilage. The formation of a new antihelical fold was created according to the Mustarde technique. A row of horizontal mattress sutures was centered along the long axis of the root and superior crus of the antihelix. Each suture brought the cartilage of the scapha near to the concha. When tightened, they created or augmented the roll of the crest of the antihelix by drawing the scaphoid fossa towards the concha. The lowermost Mustarde suture was placed from the cauda helicis to the concha, and the uppermost suture was from the concha to the triangular fossa. These sutures were performed with 4/0 white polypropylene (3). Later, if performed, conchal setback procedure was applied to the Furnas technique. The posterior edge of the incision was elevated from the mastoid fascia. The postauricular soft tissue was dissected to expose the mastoid fascia. Furnas suture was applied as a 2/0 polypropylene mattress suture. After careful hemostasis, the skin was closed with 5/0 Ethilon suture (4). A “mastoid” head wrap was wrapped to all patients postoperatively. The dressing was opened on the first postoperative day; if there was no hematoma, it would not be wrapped again. The patient was instructed to wear an on-ear elastic headband after surgery for a week. Statistical Analysis All data were analyzed using the Statistical Package for the Social Sciences (SPSS) 15.0. The following statistics were used: t-test, homogeneity of variance (Levene) test, Mann-Whitney U-test, Fisher’s chi-square test, simple correlation, and regression analysis method. Results A total of 54 patients (95 ears) were detected retrospectively after otoplasty. Twenty-seven (50%) of them were male and 27 (50%) were female. The patient age range was 5-46. Twenty-one patients (40 ears) were children and 33 (55 ears) were adults. Primary surgery was performed on 95 ears of 54 patients (41 of the patients had bilateral surgery and 13 had unilateral). Five patients (9%) needed revision surgery due to inadequate correction (Table 1). In 7 (13%) patients with an isolated absence of the antihelix, only Mustarde suture was performed (Figure 3). Both Furnas and Mustarde sutures were used in 47 (87%) of patients-41 bilaterally (Figures 4a, b). While using the Mustarde and Furnas suture, all patients underwent the same procedure described above (Table 2). The minor complication rate of our cases that did not require any additional surgical intervention was found to be 12.6% (12/95). These minor complications included minimal low-flow bleeding for 1 day despite pressure headwrap and bandages in three ears of two patients (3.9%). Four ears of four patients had a hematoma (4.2%); 50 of them did not (95.8%). All hematomas Figure 1. Furnas (setback) suture application Figure 2. Mustarde suture application Turk Arch Otolaryngol 2014; 52: 52-6 Kuscu et al. Otoplasty Outcomes 53

Using bilaterally fascioperichondrial flaps with a distal and a proximal base combined with conventional otoplasty

Prominent ears are the most common aesthetic abnormality of the external ear. Mustardè sutures and conchal setback are usually used for otoplasty, additional various cartilage-manipulation methods are also presented. One adjunctive technique that is often used involves the elevation of a fascial flap beneath which is sutured for additional cover, potentially reducing the risk of complications and recurrence. In the literature, this flap is traditionally raised with a proximal or distal base but it can be raised both distally and proximally with a number of advantages as we demonstrate. This article presents a technique to raise the fascioperichondrial flap with both a proximal and a distal base as an addition to conventional otoplasty. One hundred consecutive patients, followed up for at least 12 months, have been reviewed. One hundred ninety otoplasties were performed in 100 patients (10 unilateral), 65 women and 35 men. The mean age was 20.6 years, and the mean follow-up time was 16.3 months, respectively. No patient has developed skin necrosis or suture extrusion. In two patients (One bilateral and one unilateral for a total of three ears) a further procedure has been required to improve symmetry (1.5%). Using the retro auricular fascioperichondrial flap combined with other techniques offers good results and can be used as a standard procedure in the surgical treatment of prominent ears.

Conchal Setback without Resection in Prominent Ear Deformity

Prominent ear deformity is a congenital anomaly characterized by the absence of an adequate antihelical fold, an increased conchal-mastoid angle, and conchal hypertrophy. In order to overcome the conchal hypertrophy and increased conchal-mastoid angle, either conchal cartilage excision or conchal-mastoid suture placement or posterior auricular muscle manipulations are currently used. The authors present an assessment of a combined technique for the correction of prominent ears with conchal hypertrophy. In this technique through a cartilage incision, a setback is obtained by overlapping the cartilage segments, and the antihelix is formed by Mustarde’s sutures. The conchal setback combined with other techniques may be used as a standard procedure in the surgical treatment of prominent ears with predominance of the conchal component.

Pediatric otoplasty

Pediatric otoplasty

Biomechanical Evaluation of Surgical Correction of Prominent Ear

Mustardé sutures and conchal setback are widely used for surgical correction of prominent ear, and numerous cartilage-manipulation techniques accompanying these two methods are also available. However, it is unknown how each technique works biomechanically. The effects of otoplasty were evaluated by finite element analysis. Data of eight prominent ears were obtained with a noncontact three-dimensional digitizer, and three-dimensional auricular cartilage models were produced. These models were modified to cartilage-manipulation models: scaphal-incision, abrasion, conchal-incision, and conchal-excision models. The loads corresponding to Mustardé sutures were then applied to the no-manipulation, scaphal-incision, and abrasion models. Loads corresponding to conchal setback were applied to the no-manipulation, conchal-incision, and conchal-excision models. Stresses and deformed shapes were evaluated using finite element method. When Mustardé sutures and conchal setback were compared in the no-manipulation models, maximal stresses occurred around loads in Mustardé sutures and at the root of the helix in conchal setback. The entire ear laid down in conchal setback, whereas in Mustardé sutures, strong bending occurred at the upper third. In Mustardé sutures, maximal stresses decreased to 82 percent with scaphal incision and 95 percent with abrasion. However, the setback effect was also reduced in these two models. In conchal setback, high stresses were markedly decreased with conchal incision or excision. There was no significant difference between incision and excision. For successful otoplasty, precise understanding of biomechanical reactions is essential. This study provides improved insight into otoplasty for many surgeons.

Management of Prominent Ears with Conchal Setback, Minimal Access Anterior Scoring, and Retention Sutures: A Reliable Approach, Applicable in all Prominent Ears

Management of Prominent Ears with Conchal Setback, Minimal Access Anterior Scoring, and Retention Sutures: A Reliable Approach, Applicable in all Prominent Ears

Retrospective Analysis of the Farrior Technique for Otoplasty

To evaluate clinical outcomes and patient satisfaction following otoplasty for surgical correction of protruding or prominent ears using the Farrior technique. This was a retrospective study of patients undergoing cosmetic otoplasty with the Farrior method at a private facial plastic surgery practice in Tampa, Fla. The study population comprised 75 subjects desiring operative correction of auricular deformities by one of the authors (E.H.F.) over the past 15 years. The subjects (40 male and 35 female) ranged in age from 5 to 68 years, with a mean age of 23.9 years. Clinical follow-up ranged from 1 day to 7 years 2 months, with a mean duration of 1 year 5 days. The Farrior otoplasty is a graduated technique that combines elements of cartilage sculpting, suturing, and conchal setback procedures, and stresses a patient-specific, anatomy-directed approach. This method was first introduced in the literature in 1959 by the senior author (R.T.F.) and is continued to the present day by his son (E.H.F.). Main outcome measures included satisfactory correction of auricular deformity, incidence of postoperative complications, and degree of patient satisfaction with the procedure. These outcomes were compared with that of other otoplasty techniques and long-term studies in the literature. Of the 75 patients who underwent otoplasty via the Farrior technique over the last 15 years, bilateral otoplasties were performed in 69 (92%). Of the cases, 69 (92%) were primary procedures, with revision otoplasties constituting 6 (8%) of the total. A combination of conchal cartilage reduction, cartilage scoring, and mattress suturing was the most frequently used maneuver (47 cases [63%]). Most cases were performed using local anesthesia (n = 62 [83%]), with 18 (24%) of all cases having adjunctive procedures at the time of the otoplasty. No major complications (large hematoma, tissue necrosis, gross deformity, or significant wound infection) were documented. A total of 40 minor complications was observed in 29 patients, with suture extrusion and persistent auricular protrusion being the most common (occurring in 14 [19%] and 17 [23%] cases, respectively). Overall, 11 patients required revision surgery (9 for protrusion, 1 for hypertrophic scar, and 1 for cartilaginous callus). A majority of positive responses on an anonymous patient survey reflects a high degree of patient satisfaction with the procedure and results. The Farrior otoplasty is a graduated technique that has met with clinical success over the years. It combines elements of cartilage shaping and suturing procedures and as such is susceptible to complications such as suture extrusion and auricular protrusion that are ascribed to similar otoplasty methods described in the literature. It allows for a directed approach to correct the causative anatomic defects, while maintaining a natural appearance. While further research and long-term analyses are encouraged, this technique remains a valuable component of a facial plastic surgeon's armamentarium.

Aesthetic Otoplasty

T he prominent rim of the auricle known as the helix takes a more or less curvilinear shape, starting at the helical root anteriorly and ending approximately at the level of the intertragal notch posteriorly. Many types of malformations of the auricle exist, with the prominent ear being one of the most commonly discussed deformities in the cosmetic literature. In many of these malformations, especially in the classic lop ear deformity, a deficient lateral overhang of the helix can exist. Creating a lateral overhang of the helix, or helical curl, that will persist has so far been an elusive endeavor in cosmetic otoplasty. Most surgeons have been satisfied with the helix’s mere prominence and relationship to the antihelix. This report calls attention to this helical flattening and presents a simple approach to obtaining a more natural appearance of the helical curl. This effect is achieved by excising a composite wedge(s) from the superior helical rim in a fashion that promotes an aesthetic tubular appearance of the helix.

Cartilage-sparing otoplasty: our experience.

Prominent ears are the most frequent congenital deformity in the head and neck area. Otoplasty has undergone important developments and numerous techniques have been employed to address the anatomical defects, namely the lack of antihelix and the overdevelopment of the concha. We present a cartilage-sparing technique involving scapha--conchal sutures insertion to recreate the antihelix, conchal setback and cartilage weakening. No cartilage is excised. Prior to creating the antihelix, the medial surface of the cartilage is superficially scored. Occasionally a tangential excision of the posterior prominence of the cartilage prior to the placement of set back sutures is employed for an excessively large conchal bowl. A series of 86 consecutive patients underwent otoplasty with this technique. According to our experience the described technique gives good and predictable long-term results with a natural-appearing ear. Significant complications are rare. In case of loss of correction, revisional surgery is straightforward on the intact pinna cartilage.

New modification in otoplasty: anterior approach.

After harvesting the conchal cartilage in a large series of secondary rhinoplasties using the anterior approach, there was a marked improvement in the shape of the auricle, with unnoticeable scarring hidden under the convolution of the antihelix. In this series of 250 cases, there were no hypertrophic scars or keloid formations. Based on these favorable results, a new modification of otoplasty was developed using only the anterior approach. Between 1992 and 2000, 108 otoplasties were performed on 55 patients to correct the prominent ear using only the anterior approach. All maneuvers used in modern otoplasty, such as conchal reduction, scaphal cartilage scoring and folding, placement of horizontal mattress buried sutures, conchal setback, and the positioning of the tail and upper pole, can be easily and effectively performed using only the anterior approach as described in this article. The use of an anterior approach does not disturb the neurovascular system of the ear because it is located on the ear's posterior side. Overall, patient and physician satisfaction has continued to be very high during the 8 years that this technique has been used. Some patients experienced a few minor complications, such as postoperative pain (16.3 percent), late suture reaction (1.8 percent), hidden helix (3.6 percent), and partial relapse (3.6 percent), that were easily corrected by the application of a Kaye-type buried suture and that were not directly related to the technique.

Otoplasty for the school-aged child

Protruding ears are frequently the focus of social derision, particularly in the school-aged child. Otoplasty can be performed to correct this problem with resulting pleasure for both patients and their families. An otoplasty protocol is described, including the goals, principles, operative procedure, and postoperative patient care. Possible complications are also discussed. To maximize the goals of a normal looking ear, and ear-to-ear symmetry, a system of simple pre- and postoperative measurements, based on the Frankfort line, is explained. The “four Ds” of otoplasty, including diagnosis, documentation, determination of surgical goals, and doing the worse ear first, are emphasized. A recommended order of the operative procedure, particularly placement of the conchal set-back sutures prior to the antihelical correcting sutures, is presented and the rationale explained.

Otoplasty: Critical review of clinical results

Although it is generally believed that otoplasty provides uniformly gratifying results, thorough patient follow-up reviews are quite rare. Otoplasty surgery performed on 119 ears was retrospectively reviewed to assess the results of our cartilage-sparing technique. This method of otoplasty relies on a conchal set-back and suture transfixation technique to improve the antihelical contour. Auricular medialization averaged 10.3 mm. Over-correction is required, particularly in the superior pole, as loss of correction with healing was approximately 40% of the initial medialization. Revision surgery due to loss of correction was necessary for 6.6% of the ears initially operated on by the senior author. Patients who presented following cartilage-cutting procedures tended to have a higher rate of revision and persistent postoperative stigmata. Complications in general were few; however, mersilene suture extrusion occurred in 8% of ears. Only one of these required revision surgery for associated loss of correction. Despite these drawbacks, over 95% of patients achieved satisfactory results using cartilage-sparing otoplasty techniques.

The conchal flap: an adjunct in otoplasty.

When the protruding ear is caused in whole or in part by an enlarged or abnormally angulated concha, the conchal set-back is a recognized technique in corrective surgery. The authors describe a modification of this procedure in which a posterior flap of cartilage, based laterally adjacent to the antihelix, is elevated and sutured to the mastoid process. The maneuver serves to bring the concha closer to the scalp and thus reduces the protrusion. The residual deformity in the conchal bowl, resulting from the development of this cartilage flap, is negligible. The authors stress the need for correct analysis of the original deformity and usually employ this maneuver in conjunction with a suture technique for creating or accentuating a poorly defined antihelix.

Basic science approach to otoplasty for prominent ears.

Variations of the conchal setback operation for prominent ears have produced my best long-term otoplasty results. Additional use of the Mustarde mattress sutures combined with cartilage weakening techniques must be used when the anthelix cartilage is thick and flat or concaved, but they should never be used above the beginning of the inferior crus. Other additional techniques which can be used to supplement or replace the Mustarde sutures are radical postauricular skin excision and closure under tension, incision and suturing to sharpen the inferior crus, and mattress sutures from the periosteum to the fossa triangularsor anterior helix. Methods for correction of lobular protrusion are also discussed.

Prevention of meatal stenosis in conchal setback otoplasty.

The conchal setback is a useful technique for correcting many prominent ear deformities. A disadvantage of the technique in some cases is meatal stenosis of the external auditory canal. By excising a portion of meatal cartilage, this problem is prevented. The technique is illustrated and post-operative result is shown.