Correction Of Prominent Ears Research Articles

Comments on "Prominent Ear Correction: A Comprehensive Review of Fascial Flaps in Otoplasty".

Comments on "Prominent Ear Correction: A Comprehensive Review of Fascial Flaps in Otoplasty".

Comparative study between anterior and posterior scoring in otoplasty for bat ear

This study is meant to compare between anterior and posterior scoring techniques for the correction of prominent ear primarily in terms of cosmesis and patients’ satisfaction. We included 50 patients who were randomly assigned to anterior scoring (AS; 25 subjects with a total of 45 ears) or posterior score (PS; 25 subjects with a total of 47 ears). All patients were subjected to full history taking, general & local examinations and laboratory investigations. We analyzed the age, sex, surgical technique, the need for a second operation, type of anesthetics, additional procedures, follow-up, complications, and results. Both groups were comparable as regard patient characteristics, laterality of prominent ear, intra-operative and follow up measurements and complications. However, posterior scoring results in a high satisfaction rate with low morbidity. It was shown to be safe (low complication rate), simple and reliable intervention. Thus, we advocate posterior scoring during correction of prominent ears deformity.

Commentary on: Prominent Ear Correction: A Comprehensive Review of Fascial Flaps in Otoplasty.

Commentary on: Prominent Ear Correction: A Comprehensive Review of Fascial Flaps in Otoplasty.

Prominent Ear Correction: A Comprehensive Review of Fascial Flaps in Otoplasty.

Over the last 100 years, more than 200 different methods have been described to correct prominent ear deformity. These techniques revolved around various combinations of postauricular incision, cartilage scoring, and strategic suture placement to reapproximate the antihelical fold and correct angular deformity. In the last two decades, fascial flap techniques have become prominent in otoplasty. This article gives a comprehensive review of the different surgical techniques employed to construct fascial flaps and their contributions to otoplasty.

Audit of 117 otoplasties for prominent ear by one surgeon using a cartilage-cutting procedure.

The plethora of surgical procedures for prominent ear correction reflects lack of satisfaction with outcomes achieved. This paper describes a cartilage-cutting otoplasty procedure and reports an audit of its outcomes. Discharge coding was used to retrospectively identify patients who had undergone the otoplasty of interest at Middlemore Hospital, Auckland, during the 5 years from March 2010 to the end of February 2015. Hospital records were accessed. Demographic, procedure and patient satisfaction data were recorded and analysed (PASW/SPSS Statistics 18.0). Chi-square test and t-test were used to assess associations, with significance accepted at two-sided P < 0.05. Sixty-four patients underwent the specified otoplasty (54.7% females: mean age 9.5 years (standard deviation, SD: 4.2; range: 4-20)), of whom 93.8% had bilateral procedures with mean surgical time of 61 min (SD: 14; range: 34-94). This was significantly shorter (P < 0.001) than for bilateral surgeries by all other techniques and surgeons in the review period. None of the 117 procedures of interest subsequently had suture extrusion or revision surgery. Mean time from surgery to satisfaction determination was 993 days (SD: 521; range: 111-1850) for 43 (67.2%) patients. 23.3% believed that there had been aesthetically insignificant partial recurrence of prominence, typically of one ear only. This was insufficient for all but one patient to consider repeat otoplasty. Surgery outcome was rated 'very satisfactory' and 'satisfactory' by 90.7% and 9.3% of patients/parents, respectively. All would recommend the surgery to others. With infrequent complications and recurrence requiring revision, and without long-term reliance on sutures, the otoplasty reported is time-efficient, safe and generates high patient satisfaction.

Earfold Implantable Clip System for Correction of Prominent Ears: Analysis of Safety in 403 Patients.

The Earfold system, a new treatment for the correction of prominent ears, consists of 3 components: the Earfold implant, the Earfold introducer, and the Prefold positioner. This is an interim report based on an ongoing analysis of safety in a series of patients treated for prominent ears with the Earfold implant between February 2013 and September 2014. Safety was assessed based on adverse event reports and the need for implant revision; follow-up is ongoing. Seven surgeons used 1,200 Earfold implants to treat 403 patients (ages, 7-70 years; 63% male); the time since the initial implant procedure now ranges from 30 to 48 months. To date, 145 patients (36%) have returned for a follow-up visit (mean, 7.7 months [range, 1-34 months]). Adverse events requiring intervention have affected 39 of 403 (9.7%) patients; these include implant revisions (n = 17 [4.2%], most often due to implant visibility), skin erosion over the implant (n = 15 [3.7%]), and infection (n = 7 [1.7%]). Bleeding, recurrence of prominence, hematoma, deformity, or adverse scarring did not occur. This interim analysis has shown that Earfold prominent ear correction system is associated with relatively few adverse events that require intervention; a small number of patients experienced infection, implant extrusion, or implant visibility that required revision. Most adverse events were related to either patient selection or technical errors at implantation. It is expected that with continued use of Earfold by surgeons experienced in otoplasty, the adverse event incidence will decrease.

Correction of prominent ears: techniques and complications

Correction of prominent ears: techniques and complications

Modified Island Technique for Prominent Ears.

There have been several methods described for the correction of prominent ears, including techniques that excise, bend, suture, score, or cut the auricular cartilage. The Island Technique, proposed by Pitanguy, is based on the creation of a cartilage island to define the antihelix and correct the conchoscaphal angle. Visibility of sharp edges has been the main criticism of this technique. To avoid them, we advise performing an internal bevel incision to round off the edges and achieve a more natural look. Also, sometimes prominent ears are asymmetric with different conchoscaphal angles, determining a residual but protruding upper pole, thus requiring different treatment on each side. For such cases, we propose the additional excision of a cartilage strip from the lower border of the auricular scapha, with a greater conchoscaphal angle. In this way, cartilage islands of similar width and identical antihelixes for both ears are created and a symmetric result is achieved. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Case Report: Unusual Complication Post Otoplasty

Otoplasty is very commonly used for the surgical correction of prominent ears. This procedure generally does not involve major complications. Pain and itching, hematoma and bleeding and infection are the most common complications generally observed in post otoplasty patients. We present a case of a 13 years old boy who showed abnormal swelling from the pre- to the post-auricular area throughout the temporal region one day after the surgery. This case is distinct as the swelling was without the involvement of active bleeding but hematoma like complication at the site of surgery. The investigations were undertaken and the probable cause for these unusual observations were most likely related to lymphatic malformation.

Effects of Cartilage Scoring in Correction of Prominent Ear with Incisionless Otoplasty Technique in Pediatric Patients.

The aim of this study was to investigate the efficacy, complication rates, patient satisfaction, and recurrence risks of the incisionless otoplasty technique performed with or without cartilage scoring for correcting the prominent ear in pediatric patients. A total of 49 patients with prominent ears were operated with incisionless otoplasty. In Group 1, 44 ears of 24 patients were operated with incisionless otoplasty without cartilage scoring. In Group 2, 46 ears of 25 patients were operated with incisionless otoplasty with cartilage scoring. For comparison, auriculocephalic distances were measured at three different levels: preoperatively, at the end of surgery, and at 1th and 6th month post-operatively. Patient satisfaction was evaluated using a visual analog scale (VAS). The global esthetic improvement scale (GAIS) was applied by an independent, non-participating plastic surgeon at 6 months after surgery. Prior to surgery and at the end of surgery, no statistically significant difference was observed between the groups in terms of auriculocephalic distances at the three levels. At the and 6th month after surgery, auriculocephalic distances were significantly higher in Group 1. There were no significant differences in VAS results and GAIS values between the groups. The recurrence rate was 9.1% in Group 1 and 4.3% in Group 2. The suture extrusion rate was 18.2% in Group 1 and 13% in Group 2. Although there was a significant difference of 1-2 mm in auriculocephalic distances, our study showed that cartilage scoring is not mandatory to correct the prominent ear in pediatric patients with soft cartilages and to achieve patient and surgeon satisfaction.

Complications after prominent ear correction: A systematic review of the literature

There is great diversity in reported post-operative outcomes for otoplasty, with the incidence of haematoma or infection ranging from 0% to 15.6% and 0%-10%, respectively. With such variability, it is difficult to determine an overall 'average' incidence of common post-operative complications. A systematic review of the most relevant medical databases was conducted for studies available in English published between January 1, 2000, and December 31, 2015. Using the dataset, pooled estimates for the incidence of the primary and secondary outcomes were calculated for all included studies. The primary outcome was haematoma and/or bleeding incidence, and the secondary outcomes included infection, skin/wound healing problems, suture-related problems, scarring, pain and itching, and revision surgeries/recurrence. Comparable sub-group analysis of studies was also performed using calculated pooled proportions. After screening, 28 articles involving 3493 patients were included in the study. Pooled proportions revealed that haematoma and/or bleeding incidence was 2.5% (95% CI: 1.4-3.8%), infection 0.8% (95% CI: 0.4-1.3%), skin/wound healing problems 3% (95% CI: 1.4-5.1%), suture-related problems 1.8% (95% CI: 0.8-3.2%), scarring 1.6% (95% CI: 0.8-2.6%), pain and itching 13% (95% CI: 5.4-23.1%) and revision surgeries/recurrence 5% (95% CI: 2.9-7.7%). By pooling proportions of reported complications, the results of this study could be useful in the personal audit of practice and will be a point of reference for comparing novel surgical techniques in the future.

Effectiveness of Combined Technique for the Correction of Prominent Ears

Effectiveness of Combined Technique for the Correction of Prominent Ears

Technical refinement of Stenström otoplasty procedure

Surgical correction of prominent ears is a common aesthetic procedure in young children. Stenström technique is widely performed in France. We present some technical refinements that may be associated to this technique in order to allow for a simple correction of the majority of deformations. The first step of the Stenström technique is the treatment of the unfolded antihelix if necessary. Our first modification consists in introducing the rasp by an anterior approach, hidden under the upper plication of the helix, allowing for a better control. A second modification consists in a resection of the concha by a posterior approach in case of conchal hypertrophy. A third modification is the burying of the concha by suture to the mastoid periosteum after posterior auricular muscle resection in case of obtuse conchoscaphal angle. These refinements can be performed either separately or in combination according to the deformities to be corrected. The technical refinements presented may correct almost all the ear deformities. The suture-less technique allows for a natural aspect of the antihelix plication.

A retrospective study of patient outcomes and satisfaction following pinnaplasty

IntroductionUp to 5% of all children have prominent ears. Psychological distress and bullying adversely affect these children and can cause significant social exclusion. In times of austerity, cosmetic procedures such as surgical correction of prominent ears are felt to be an unnecessary cost to the health service.Materials and methodsA retrospective case note review of all patients undergoing pinnaplasty was undertaken. Postoperative outcomes were compared against the Royal College of Surgeons of England standards. The Glasgow Benefit Inventory, a validated post-intervention questionnaire, was then posted out to all patients.ResultsA total of 72 patients were identified. Average age at procedure was 13 years. Eleven patients were above the age of 19 years. Twenty-eight patients were male and forty-four female. Sixty-two cases underwent bilateral pinnaplasty. No patients developed hematoma, and there were no readmissions within 30 days of surgery. Twenty-nine patients responded to the questionnaire (40%), of whom 27 reported a positive impact on their psychosocial well-being with a mean score of 36.ConclusionPinnaplasty offers patients an opportunity to alleviate the psychological distress of bullying and harassment secondary to the appearance of prominent ears.

Correction of Prominent Ears

외이의 기형은 외이의 형성부전(anotia)부터 경도의 외이기 형까지 다양한 정도를 보인다. 외이의 기형은 상당이 흔한 편 이다. Tanzer는 외이 기형의 유병률이 5% 이상 될 것으로 추 정하였다. 경도의 외이 기형에는 돌출귀(prominent ear), 매몰 귀(cryptotia), 경도의 수축귀(constricted ear) 등이 포함된다. 외이의 기형은 형태학적인 이상 외에도 전음성 청력 감소 등 의 기능적 문제 및 사회적 위축, 따돌림과 같은 심리적인 문 제가 같이 동반된다. 이비인후과 의사의 입장에서는 전통적으로 외이도 형성부 전으로 인한 전음성 난청이 문제가 되었으며, 이의 교정을 위 해서 외이도 성형술(canaloplasty)을 시행해 왔다. 사실 이비 인후과 의사의 입장에서 외이의 기형에 의한 난청을 전통적 으로 중요시해 왔으며 그 이외 외이 기형을 교정하기 위한 수 술에 대해서는 등안시해 왔던 것이 사실이다. 하지만 외이가 손상을 받았을 때 이의 재건과 교정은 이비인후과의 역할이 었다. 한발 더 나아가 최근에는 경도의 외이 기형의 교정에 대 한 관심도 높아지고 있으며 실제로 시행되면서 좋은 결과들 을 보여주고 있다. 여기에서는 외이 기형 중에서 경도에 속하면서 가장 유병률 이 높은 돌출귀에 대해서 기술하고 이의 수술적 교정에 대해 서 이야기하고자 한다.

A Modified Closed Cartilage-Preserving Otoplasty Technique for Prominent Ear Correction

Prominent ear is a relatively common deformity of the external ear, with an incidence of approximately 5% in Caucasians [1]. The main anatomical features of prominent ear are protrusion of the upper half of the helix with a wide conchoscaphal angle that results from failure of the antihelix to fold properly, in conjunction with a wide conchomastoid angle, deep conchal bowl, or absence of the helical roll [2]. Prominent ear may cause psychological stress, emotional trauma, and behavioral disorders, particularly in children [3]. The anatomical goal of prominent ear correction is to produce a smooth, round, and well-defined antihelical fold, a conchoscaphal angle of 90°, and conchal reduction or reduction of the conchomastoid angle [4]. A range of techniques have been developed to achieve these goals. Otoplastic techniques are divided into three broad categories: cartilage-cutting techniques, cartilage-sparing techniques, and incisionless techniques. Cartilage-sparing techniques have been Tae Joon Choi, Jin Sik Burm, Yung Ki Lee

'Foamotomy' as an aid for skin graft conformity.

Discussion This technique uses the principle of release of interlocking stresses, described in relation to cartilage sculpting in prominent ear correction. The incisions allow easy conformity, without warping or ‘bubbling’. They are not intended to increase pressure over the graft. In fact, on convexities, pressure at some points may actually be decreased but the significance of this in relation to graft take is dubious. Criss-cross incisions may provide additional biaxial and spherical conformity. This technique is simple and effective, especially on complex anatomical surfaces as experienced in necrotising fasciitis and extensive burns.

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The discrete scar in prominent ear correction: a digital 3-dimensional analysis to determine the ideal incision for otoplasty.

Various postauricular incision sites can be used for prominent ear correction depending on technique and surgeon preference. No study has previously looked at the most aesthetic (least visible) location for the postauricular scar. We investigated the visibility of various scar locations on the posterior ear from a third person perspective through a "Visibility Arc"-a formal assessment of the range of degrees where a particular scar is visible. The objective was to determine the least visible incision-that is, the scar with the shortest visibility arc. Normal ears were marked with 3 different color markers to simulate postoperative scar position, namely, (1) black in auriculocephalic sulcus, (2) blue in the sulcus of the antihelical fold/groove, and (3) green between black and blue. Starting laterally from the right ear toward the left ear, each head was photographed across 180 degrees posteriorly, at 10-degree intervals to determine which colored line (corresponding to a particular scar location) was visible over what "visibility arc." Forty individual ears were analyzed. Scars located in the sulcus of the antihelical fold had the shortest average visible arc, which was a 70-degree arc. The auriculocephalic sulcus had the largest visibility arc, and was most obvious of all of the scar locations-a 100-degree arc. The scar location in between these 2 locations had an 80-degree arc. The least visible scar for pinnaplasty rests in the groove of the antihelix posteriorly, with scars slightly medial to this almost as discrete. The most visible scars when viewed from behind will be those in the "traditional" location of the auriculocephalic sulcus.

1064-nm Nd: YAG laser-assisted cartilage reshaping for treating ear protrusions.

Correction of prominent ears is a common plastic surgical procedure. The laser-assisted cartilage reshaping (LACR) technique for protruding ears was developed at the French National Institute of Health and Medical Research in Lille, France, using both the 1064- and 1540-nm wavelengths, with a view to simplifying the surgical procedure. Herein we report our results with the 1064-nm wavelength. Between 2008 and 2010, twenty-six 1064-nm LACR procedures in 14 patients were performed. Twelve patients received treatment to both ears, and 2 patients received treatment to one ear. Each procedure consisted of a single treatment session. The treatment consisted of laser irradiation of both sides of the helix with single pulses of 70 J/cm2. The beam diameter was 6 mm. Early and late complications were defined and reviewed for all patients. Satisfaction was assessed by patients using a visual analogue scale from 0 (unsatisfied) to 20 (highly satisfied). The superior and middle cephaloauricular distances were prospectively evaluated at 6 months after treatment. Complications included eight cases of localized skin burns and one case of dermatitis. The mean right/left superior and middle cephaloauricular distances were 10.5±1.5 mm/10.7±1.0 mm and 16.3±2.2 mm/16.3±2.8 mm, respectively, as compared to 17.5±2.9 mm/18.6±2.5 mm (P<0.01) and 24.5±2.6 mm/24.7±1.7 mm (P<0.01) before the operation. Mean patient satisfaction was 16.8/20±3.3. Despite promising results for cartilage reshaping, the 1064-nm LACR procedure often leads to skin burns and inflammatory tissue reaction after treatment. Moreover, LACR with the 1064-nm wavelength is painful and necessitates local anaesthesia. 4.