Prominent Ear Deformity Research Articles

Treatment of an Overcorrected Ear After Previously Performed Otoplasty.

No single otoplasty technique can be applied to all prominent ear deformities. The factors determining the type of operative method are based on the surgeon's preference for and confidence in the technique as well as long-term results. However, all cutting or scoring techniques include a risk of development of undesired edges, defects, or deformities on the ear being operated on. One of the patients' complaints and dissatisfactions after otoplasty is an overcorrected ear in its upper half. This condition leads to the loss of helix and prominent and conspicuous crus superior and antihelix. The article presents a simple and successful surgical procedure for correction of the condition.

Cartilage-sparing otoplasty – 288 ears in 3 years

BackgroundStandard methods of otoplasty may risk anatomical distortion. Previous work showcased a novel, cartilage-sparing technique. This study aimed to confirm the safety and effectiveness of the method in a larger cohort. MethodsThis retrospective study included patients undergoing otoplasty by a single surgeon using a single technique between January 2021 and December 2023. Eligible patients were aged above 5 years and had prominent or constricted or cup ears, forming a 2cm distance from the mastoid. Surgical techniques included novel key-point sutures. Minimum follow-up was 6 months. Data on demographics, risk factors, perioperative management, and complications were collected from patient records. ResultsA total of 288 operated ears (147 patients) were included. The mean age was 17 years and 91 (61.9%) were female. The mean duration of follow-up was 24.3 months. Postoperative complications were generally minor and included PDS suture exposure (n=16, 5.5%), manageable postoperative pain (n=8, 2.7%), self-resolving swelling (n=8, 2.7%), minor bleeding (n=7, 2.4%), and superficial skin complications (n=4, 1.3%). Infections occurred in 4 ears (1.3%) and were treated effectively with topical/oral antibiotics. Cases of partial release of the ear resolved without intervention (n=4, 1.3%). Only 4 (1.3%) ears experienced loss of correction, with options for reoperation available as needed. Analysis showed no significant age differences in postoperative complications, and a nonsignificant trend towards higher postoperative swelling in males compared to females (10.7% vs 2.2%; P=0.054). ConclusionsThe data confirms that this technique offers a safe and rapid cartilage-sparing otoplasty with minimal complications and low recurrence rates. It ensures long-lasting and aesthetically pleasing results for prominent ear deformities. Level of evidenceLevel III

Combined Mustardé and Furnas type otoplasty with minimal conchal cartilage excision

Objective: We aimed to evaluate the complication rate and satisfaction status of patients who underwent otoplasty with the combined
 Mustardé and Furnas sutures with minimal medial conchal cartilage excision.
 Materials and Methods: Forty-four ears of 22 patients, operated for prominent ear deformity were retrospectively included in the
 study. Patients were called for follow-up at various time intervals. At the sixth month, the patient and parents were asked to rate their
 satisfaction with the operation on a scale of 1-10 and noted.
 Results: The mean age of the patients was 8.09±2.72 years. The antihelix was created with Mustardé technique, minimal medial
 conchal excisions were performed, two conchamastoid sutures were placed with Furnas technique. The mean follow-up period was
 23.86±11.97 months. Complications developed in 4 of 44 ears (9%). Major complication rate was 4.5%. Two patients (4.5%) had suture
 extrusion in one ear. None of the patients scored lower than 7 in the satisfaction questionnaire.
 Conclusion: Otoplasty with a combination of cartilage-sparing techniques has low complication, revision, and high satisfaction rates.
 Minimal medial conchal cartilage excision in addition to this technique is beneficial in reducing the conchamastoid tension and does
 not increase the risk of complications.

Advantages of the Cartilage-Sparing Technique in Prominent Ear Deformity Surgery: Comparison of a New Technique.

Ear cartilage, crucial for maintaining ear shape and function, can sometimes undergo damage or deformation, requiring surgical intervention. This study aimed to compare the efficacy of a novel, less invasive cartilage-protective method with the traditional, more invasive cartilage-removal technique. Our study included 64 patients (128 ears). The first group of 32 patients (64 ears) received the new cartilage-protective technique, while the second group of an equal number of patients and ears underwent the traditional method. The newer technique endeavors to retain as much healthy cartilage as possible, addressing only the issue at hand, while the traditional technique requires the removal of a substantial portion of cartilage. The cartilage-protective method demonstrated several notable advantages over the traditional one. First, it significantly reduced the operation duration due to its less invasive nature. Second, it caused less pain to the patients by minimizing trauma to surrounding tissues. Furthermore, this technique significantly lowered the risk of complications, probably due to the minimal disturbance or removal of healthy cartilage, hence reducing the likelihood of post-operative complications such as infections or deformities. The findings of our study propose the cartilage-protective method as a superior treatment option when surgical intervention becomes necessary to repair or restore the function of ear cartilage. This technique, being less invasive, not only results in less pain for the patients but also reduces the risk of complications. It promotes quicker patient recovery without any loss of sensation in the ear. Thus, it could potentially revolutionize the approach to dealing with ear cartilage issues. Level four.

Cartilage-Sparing Otoplasty: A New Approach.

Ear protrusion is the primary indication for otoplasty. Many methods have been developed for addressing this defect, based on cartilage-scoring and excision and suture-fixation techniques. Disadvantages include irreversible distortion of the anatomy, irregularities, or overcorrection, or forward bulging of the conchal bowl. One of the most common long-term sequelae of otoplasty is an unsatisfactory result. A novel, cartilage-sparing, suture-based technique has been developed that aims to minimize the risk of complications and provide a natural-appearing aesthetic result. The method is based on two to three key sutures that shape the concha into the desired natural appearance while preventing a conchal bulge, which otherwise could appear if no cartilage is removed. Furthermore, these sutures support the neo-antihelix created by four further sutures anchored to the mastoid fascia, thus achieving the two main goals of otoplasty. The sparing of cartilaginous tissue means that the procedure is reversible if needed. In addition, permanent postoperative stigmata, pathologic scarring, and anatomical deformity can be avoided. This technique was used on 91 ears in 2020 and 2021, with only one ear (1.1%) requiring revision. Rates of complications or recurrence were low. The presented technique appears to be a rapid and safe method for treating the prominent ear deformity, providing aesthetically pleasing results.

Vertical mattress suture applied as "tension band fixation" for the antihelix creation and prominent ear treatment: 104 case reports

BackgroundProminent ears were the most common auricular deformity. Different surgical techniques, such as cartilage-cutting techniques and suturing techniques, are available for treatment. The horizontal mattress suture technique, represented by the Mustard technique, is widely accepted, while the vertical mattress suture technique is rarely discussed in otoplasty. MethodA total of 104 cases of prominent ear deformities were treated from January 2017 to December 2020. Several hypothetical "tension bands" perpendicular to the natural curvature of the antihelix were introduced for the surgical design and determination of the position of the antihelix fixation, and vertical mattress sutures were placed accordingly for the auricular cartilage fixation. ResultFollow-up ranged from 3 months to 2 years. No complications, such as hematoma, infection, or poor wound healing, were observed. Three patients had recurrence within two months post operation, and one complained about the overfolded antihelix. Three cases had suture exposure, but the shape of the auricle was not affected after suture removal. The surgical result was evaluated according to the overall shape of the auricle, including the shape of the antihelix, the improvement of the prominent, the surgical marks, and the bilateral symmetry. A total of 98 patients (94.23%) rated the results as "very satisfactory" or "satisfactory". ConclusionThe vertical mattress suture applied as "tension band fixation" could provide stable cartilage fixation with the natural appearance of the antihelix formation. In addition, the technique could fit a wide range of indications with a low risk of complication and reoccurrence.

A Novel Otoplasty Technique Using Dermabrader on Prominent Ear Deformity Patients: A Retrospective Study and a Description of Technique.

An analysis of retrospective medical records was conducted by the senior author on patients with prominent ears treated with our novel dermabrasion technique between 2018 and 2021. The demographics, clinical assessment, and outcomes of the patients were assessed. Furthermore, the article provides a detailed description of the technique. A total of 18 ears were operated on. Eight of the included patients had bilateral ear deformities, and two had unilateral deformities. The mean distance from the ear to the head at the superior helix was 29 mm (range, 25-35 mm). In our series, no complications were observed. During the most recent clinical evaluation, all patients had achieved acceptable ear positioning and excellent aesthetic results. Dermabrasion is a useful technique for otoplasty because no sutures are required and symmetry can be achieved in bilateral ears. Furthermore, this technology is safe, simple, reproducible, reliable, and versatile. We recommend that future studies be conducted in a prospective manner with larger sample sizes and longer follow-up periods to ensure the validity of the findings.

Benefits of Combined Surgical Techniques in Otoplasty.

Prominent ear deformity is one of the aesthetic problems that should be treated due to the psychosocial problems it causes. We aimed to present our results in which we used the combination of Mustarde suture to create an antihelix, conchal resection, and concomastoid suture combination to reduce conchal excess in the light of literature. A total of 28 cases in which the same otoplasty method was used in 2 separate centers between 2014 and 2020 were included in the study. Elliptic skin excision, antihelix reconstruction with Mustarde suture, and in cases with large conchal cartilage, cartilage excision and reconstruction with concomastoid suture were performed in all of our cases. After the skin was closed, a bandage was applied to the ear. In the early postoperative period, hematoma developed in 4 cases. There was superficial erosion of the skin in 4 cases. In the late period, hypertrophic scar developed in both ears and resolved with medical treatment. There was minimal asymmetry in 4 cases, but intervention was not required in cases with asymmetry. Skin necrosis, infection, and visible cartilage irregularity on the anterior side were not observed in any case. The aim of otoplasty is to create symmetrical ears with smooth contours, so combined techniques should be used instead of a single technique. In otoplasty, we used Mustarde suture to create antihelix, conchal resection, and concomastoid suture combination to reduce cavum. Our results were satisfactory.

Comparison of Transcutaneous Fixation-Assisted Method with Classical Needle-Assisted Method in Prominent Ear Surgery.

Prominent ear deformity is an autosomal dominant inherited deformity. Surgery is the most effective treatment method for prominent ear patients. Different prominent ear operations have been described in the literature. In this study, it is aimed to compare the transcutaneous fixation-assisted method that we described in prominent ear repair with the classical needle-assisted method. Patients who were operated for bilateral prominent ear deformity between January 2017 and January 2020 were included in the study. Two different approaches were used in the operations. In the first group, conventional needles were used to adjust the position of the concha-scaphal sutures. In the second group, transcutaneous suturing was used to adjust the position of the concha-scaphal sutures. The duration of the operation was recorded. Patients were called for controls in 1-3-6 and 12th months; photographs were taken. Measurements were made in the preoperative period, in the intraoperative and at the postoperative 12th month. SPSS program was used for statistical analysis. A total of 52 patients were included in the study. There were 27 patients in Group 1and 25 patients in Group 2. There was no significant difference between the groups in terms of demographic characteristics (p>0.05). While the average operation time was 80.37minutes in Group 1, the average operation time was 60.40minutes in Group 2. The operative times between the groups were statistically significant (p<0.05). There was no statistically significant difference between the groups in preoperative, intraoperative and postoperative measurements (p>0.05). As a result, transcutaneous fixation-assisted method is performed faster than the classical needle-assisted method and the results are understood right at the beginning of the operation. 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 .

Modified bilateral fasciaperichondrial flap for prominent ear correction

ObjectiveVarious techniques have been described in the literature for prominent ear correction. These cartilage-preserving or cartilage-shaping techniques have their own advantages and disadvantages. We aim to achieve aesthetic and stable results with low complication rates using combinations of these methods. Herein, we present our results of prominent ear surgery with a modified bilateral fasciaperichondrial flap in combination with concha-mastoid and concha-scaphal sutures. MethodsPatients whose surgeries included a modified bilateral fasciaperichondrial flap for prominent ear deformities were included in the study. Patients’ demographic data, pre- and postoperative Concha-Mastoid Angle (CMA) and upper-middle Helix-Mastoid Distances (HMD), follow-up time, complications, secondary operations, and postoperative Visual Analogue Scale (VAS) results were evaluated. With a postauricular fish-mouth incision, the bilateral fasciaperichondrial flap was planned into two: proximal- and distal-based. They were then elevated from the cartilage subperichondrially on the proximal side and supraperichondrially on the distal side. Concha-scaphal sutures were used to form an antihelical rim along with concha-mastoid sutures to reduce the concha-mastoid angle. Conchal cartilage resection was done if needed. Then, the bilateral fasciaperichondrial flaps were sutured together to cover the concha-mastoid and concha-scaphal sutures. ResultsBetween May 2017 and May 2021, 32 ears of 17 patients were operated on due to prominent ear deformity. No hematoma or infection was observed in any patient, and there were no instances of recurrence, suture exposure, hypertrophic scars, or keloids. The satisfaction level of all patients was 8.2 ± 0.9 points on average according to the VAS. In the anthropometric measurements, a statistically significant difference was found between preoperative and postoperative sixth month CMA and HMD values. ConclusionA combination of suture techniques and a modified bilateral fasciaperichondrial flap may be used in prominent ear cases, with low recurrence rates and high patient satisfaction. Level of evidenceIII.

Our Experience With the Correction of Prominent Ear Deformity.

The ear has a unique architecture of cartilage and skin. The incidence of the prominent ear is about 5%. Surgical correction of the prominent or protruding ear can be carried out either by anterior or posterior approach. We created antihelical fold of cartilage by utilizing a posterior incision to score the anterior cartilage of the lateral scapha with a knife. Sutures were often used to uphold the produced fold. The additional procedure of conchal reduction and concho-mastoid suture was done when required. The objective of our research is to evaluate the patient’s and surgeon’s satisfaction with our technique of prominent ear correction and identify any complication if it occurs post-operatively.This is a retrospective study over a period of eight years (2011-2018) which includes all patients presented to Liaquat National Hospital with prominent ear. A total of 47 patients were included. Patients with a previous history of otoplasty were excluded. Patients were followed up for at least six months postoperatively. The outcome was assessed via Visual Analogue Score by a patient, surgeon, and a third observer (assessor). The average score by the surgeon was 7.9, by the patient it was 8.4 and by the assessor it was 8.1. The average pre-operative concho-mastoid distance was 2.2 cm which decreases to 1.4 cm post-operatively. Correction of the prominent ear by this technique is safe and easy. We did not experience any major complication, giving reproducible and good aesthetic results.

Efficacy of Using Perichondrioadipodermal Flap With Combined Techniques in Prominent Ear Correction.

Prominent ear is 1 of the most common congenital deformities of the ear. Incidence is reported as approximately 5%. This deformity can classically be the result of antihelix insufficiency, overprojection of concha or combination of both. Less frequently, folded or overprojectile ear lobule can aggravate the deformity. Surgical techniques can be aimed at concha, antihelix formation, lobule positioning. In our study, postoperative results for the combination of suture otoplasty and perichondrioadipodermal flap techniques in prominent ear surgery is discussed in light of the recent literature. Forty-nine patients that were operated for prominent ear deformity in our clinic between 2010 and 2015 were evaluated. Anatomic structures that cause the anomaly was analyzed by photographing concha-scaphoid angle, antithetical fold absence or presence, position of the ear lobule, conchal depth, size of the auricula, and positioning Frankfort Plane parallel to the ground. The patients were photographed preoperatively, at postoperative first week and postoperative sixth month, respectively. Comparison of age, surgical technique, surgical complications, necessity for revision surgery, additional procedures, follow up time, preoperative, and postoperative helix-mastoid bone distance were evaluated. Forty-nine patients have been evaluated. Thirty-one of these patients were female, whereas 18 were male. Age of these patients ranged between 6 and 37. Operations were performed in 47 right side ears, and 44 left side ears (97% bilateral and 7% unilateral otoplasty). Preoperative helix-mastoid bone distance ranged between 21 and 33 mm (mean 26.77), whereas postoperative helix-mastoid bone distance was measured between 12 and 22 mm (mean 16.26). Compared to the preoperative values, helix-mastoid distance difference was statistically significant (P < 0.05). Asymmetry and recurrence are the most common late complications of prominent ear surgeries. Perichondrioadipodermal flap can be safely added to the combined surgical techniques protecting the cartilage support, therefore, reducing complication rates, with satisfying results.

Otoplasty: a modified Chong-Chet technique with positive long-term results.

Background:In the last few decades, many techniques have been developed to correct prominent ear deformities. Modified Chong-Chet otoplasty represents a new and improved classical Chong-Chet procedure for prominent ear surgery. This study evaluates and compares the long-term results of standard Chong-Chet otoplasty with the modified technique.Methods:A retrospective study was conducted on patients undergoing otoplasty at the Special Hospital S-tetik Banja Luka between January 17, 2017, and February 5, 2019. The total number of patients undergoing the procedure was 129. The first group (48 patients) underwent otoplasty using the Chong-Chet technique, while the second group (81 patients) underwent a modified Chong-Chet procedure. All patients were randomly selected on the condition that the antihelix was absent.The data were processed and analyzed using the Statistical Package for the Social Sciences version 24 using nonparametric tests (χ2 test, Mann–Whitney U test and Kruskal–Wallis test).Results:Every second patient was satisfied (19 patients were partially satisfied and five patients were completely satisfied) with the results of the classical Chong-Chet technique. Seven patients were neither satisfied nor dissatisfied, while 17 patients were dissatisfied (11 patients were completely dissatisfied and 6 patients were mostly dissatisfied). As for the modified method, on average, nine out of 10 patients (73 or 90.1%) were satisfied, of which 49 patients (60.5%) were completely satisfied and 24 patients (29.6%) were mostly satisfied.The statistical significance was P < .05.Research results point to the modified Chong-Chet technique being a significant improvement to the classical method.Conclusion:Modified Chong-Chet technique increases the number of positive long-term results and significantly improves the standard method.

MODIFIED MUSTARDÉ TECHNIQUE FOR CORRECTION OF PROTRUDING EAR ( BAT EAR ) IN CHILDREN

Background: The auricle constitutes an important part of the face which is a focus of attention and personal interaction. A malformed auricle especially in young school age may result in some kind of psychosocial disturbance. Congenital abnormalities of the auricle have been estimated to occur in 5% of the population. Objective: to demonstrate and evaluate the results of modified mustarde technique used for correction of prominent ear deformity in pediatric. Patients and Methods: The present study included the results of operations in 30 ears concerning 16patients because there were 14 bilateral and 2 unilateral patients with prominent ear deformities, at age between 4-14 years of sexes, (11 males and 5 females). The patients were admitted to Al-azhar University hospitals in Cairo. Results: Our results were discussed in view of one technique, modified mustarde technique for all cases. The aesthetic results were evaluated,during the first 6 months postoperatively, by inspection and continuous measurements of auriculo-mastoid distance. For that purpose, photographs and measurements data taken in the pre- and post-operative periods was compared. In addition, the opinions of the patients and their care givers were taken into consideration. Conclusion: The use of modified mustarde technique not only hides the suture material but also provides a primary otoplasty technique that supports the repair with plication and scoring which gives the opportunity for the new shape to remain consistent in the postoperative period, a natural-looking antihelical fold, no sharp edges was formed and Long-lasting permanent results were aimed We believe that the modified mustarde technique was simple, safe and easy applicable method for protruding ear correction with excellent results.

Post Auricular Fascial Flap in Otoplasty

AbstractObjective: To compare otoplasty with post-auricular fascial flap and otoplasty without the flap as regard deformities set back and hide if suture extrusion.Background: Prominent ear is considered as a frequent hereditary deformity affecting 5% of the population. It may cause psychological problems at any age. Modern prominent ear surgery attempts to return the ears to their normal position with soft margin outlines and attempts to perform a uniform correction without the interference of surgical evidence.Method: This study will include 31 patients presented with congenital prominent ear deformity in the plastic surgery department, faculty of medicine, Menoufia University in the period from February 2018 up to February 2020. All studied patients were subjected to take a full history, systemic examination, and local examination of the ear. The patients were classified into 2 groups. Group A (15 patients) underwent otoplasty with postauricular fascial flap, while group B (16 patients), otoplasty without postauricular fascial flap.Results: There was no statistically significant difference detected between patients underwent otoplasty with or without the post-auricular fascial flap as regard duration of surgery, and complications.Conclusion: The otoplasty with post-auricular fascial flap yields excellent patient and parent satisfaction with a natural harmonious look and minimal complication especially those related to sutures demonstrating its efficacy in preventing these complications, but with no difference with otoplasty without post-auricular fascial flap.

Outcomes and Complications of the Mustardé Otoplasty: A "Good-Fast-Cheap" Technique for the Prominent Ear Deformity.

Background:The Mustardé otoplasty is a commonly used procedure for the correction of the prominent ear deformity. Complication rates related to suture extrusion and long-term outcomes are variable in the literature. The study’s purpose was to examine the efficacy and safety of the Mustardé otoplasty and its resource utilization, using an “iron triangle” methodology incorporating quality, time, and cost.Methods:Retrospective data were collected on patients under 18 years who underwent primary Mustardé otoplasty between 2009 and 2018. Patient demographics, intraoperative details, complications, follow-up, and satisfaction were collected and analyzed.Results:There were 119 Mustardé otoplasties performed on 68 patients, with a median follow-up of 72 weeks (24–476 weeks). In total, 51 of the 68 patients underwent bilateral procedures. The median operative time was 95 minutes (31–133 minutes), translating to a facility case cost of $2046. A total of 24 complications were reported in 17 patients. Minor complications included the following: suture extrusion (n = 20), hematoma (n = 1), and suture abscess (n = 1). Major complications included reoperation (n = 2). The series had a revision rate of 1.7% (n = 2). No additional procedures were documented at other hospitals in the province. The majority (97%) of ear outcomes demonstrated both patient and surgeon satisfaction.Conclusions:The Mustardé otoplasty demonstrated a high efficacy in the correction of the prominent ear, with low reoperation rates and high patient and surgeon satisfaction. The procedure demonstrated intriguing results in resource utilization, with brief operative times, a “knife and fork” supply chain, and minimal overall case costs. This technique qualifies as a good, fast, and cheap outpatient otoplasty option.

Cartilage-Sparing Otoplasty: The Effects of Adipo-Perichondrial Flap-Assisted Posterior Auricular Muscle Complex Flap Technique on the Repair of Prominent Ear Deformities.

In the repair of prominent ear deformities, the main objectives are to recreate the antihelical fold, reduce projection in patients with a large concha, and normalize the distance between the ear and the cranium. This study evaluated the efficacy of the adipo-perichondrial flap-assisted posterior auricular muscle complex (PAMC) flap technique, which involves a new approach to the repair of prominent ear deformities. A medially based PAMC flap and a laterally based adipo-perichondrial flap were elevated in 22 patients with prominent ear deformities. In order to shape the ear, the PAMC flap was sutured to the transition zone between the helix and antihelix, and the adipo-perichondrial flap to the periosteum of the mastoid bone. The ear-cranium distances were measured preoperatively and at postoperative first and sixth months. Thirteen patients were female and 9 were male. The mean age of the patients was 19.4 years, and the mean follow-up period was 10.6 months. The ear-cranium distance significantly decreased in the postoperative first-month and sixth-month evaluations compared to the preoperative values (P < .05). No relapse, suture exposition, hematoma, keloid scar, or infection was observed. Posterior auricular muscle complex is a strong anatomical structure that includes the trapezius muscle, occipital muscle, extrinsic ear muscles, temporal fascia, and sternocleidomastoid fascia. By elevating this structure as a flap and combining it with an adipo-perichondrial flap, successful results can be achieved in the repair of prominent ear deformities, which prevents relapses and maintains the shape of the ear in the long term.

Comparison of Prominent Ear Recurrence in Different Age Groups.

Although many prominent ear deformity (PED) surgery techniques have been described to date, there have been few comprehensive studies evaluating the recurrence rates in different age groups. Previous studies have focused either on the young or the elderly. The present clinical study compares recurrence rates among patients of different age groups undergoing PED repair and discusses cartilage morphology. A total of 380 patients with a mean age of 24.2years underwent PED repair surgery between 2001 and 2019. The patients were divided into five subgroups according to age. Group I (5-10years) was composed of 44 patients, Group II (10-20years) was composed of 47 patients, Group III (20-30years) was composed of 166 patients, Group IV (30-40years) was composed of 90 patients, and Group V (over 40years) was composed of 33 patients. The cephaloauricular angle (CAA) and the distance between the helix (upper, middle, lower) and mastoid were measured and recorded prior to surgery. The patients were all treated with three concha-mastoid sutures to achieve concha reduction and to narrow the cephaloauricular angle. The anterior aspect of the cartilage was thinned with a rasp, and an antihelix was created using non-absorbable sutures in patients with an inadequate antihelix. The CAA and the upper pole-mastoid distance were measured immediately after surgery and at 15days, 3 and 6months after surgery. Recurrence was observed in a total of 18 patients, with PED recurring in one patient in Group I (2.3%), three patients in Group II (6.38%), 10 patients in Group III (6.8%), three patients in Group IV (3.3%) and one patient in Group V (3.03%). Although the difference in the recurrence rate among the age groups would appear to be clinically significant, the difference was not significant, statistically. Clinically, the differences among the groups could be attributed to intragroup numerical differences. In the present study, no significant relationship was identified between the patient age and recurrence rate. Although PED repair is recommended in the preschool period, prominent ear repairs can be carried out in any age group, although the degree of cartilage scoring should differ depending on the age group. 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 .

Prominent Ear Correction With Anterior Rasping

Prominent ear deformity is usually characterized by antihelical fold deficiency, concha hypertrophy and earlobe deformity. Between 2000 and 2018, 375 otoplasty patients aged 6 to 58 who underwent surgery in our clinic were included in this study. Among these 375 cases, 25 were unilateral and 350 were bilateral. As surgical techniques anterior rasping, concha-mastoid sutures and concha-scaphoid sutures were used. The average cephaloauricular angle, the upper pole-mastoid distance and the distance between the middle 1/3 of the ear and mastoid was measured preoperatively and postoperatively. Postoperative measurements were made on the 15th day, 3rd month and the 6th month after the surgery. The approximate follow-up period ranged from 6 months to 18 years. Concha-mastoid sutures can be used not only to reduce the concha but also to adjust the proportion between the width and height of the ear. Attenuation of the cartilage by rasping provides homogeneous thinning of the cartilage and prevents deformation. In all age groups, relapse and angle changes were observed in the first 6 months. After 6 months, there were no cases of recurrence or angle changes.

A New Cartilage-Sparing Procedure for Correction of the Prominent Ear Deformity: Dermal Anchor Technique.

Although the literature is replete with surgical techniques described for correction of the prominent ears, new techniques are still needed to minimize the recurrence rates and postoperative complications. Here, the author presents a new and simple otoplasty procedure, namely, the dermal anchor technique (DAT), in which a wide planar adhesion between the opposing dermal surfaces of the deepithelized antihelical groove is used as a biological anchor for long-term maintenance of the antihelical fold without any cartilage manipulation. For 12 years, this new procedure was used for correction of 76 prominent ears in 44 patients, with 17 being female and 27 being male. The ages of the patients ranged from 5 to 37 years. In 28 patients, the DAT was combined with conchal excision and/or concha-mastoid sutures as required, whereas it was used alone in the remaining 16 patients. The preoperative and postoperative distance between the ear and the head was measured at 4 points (superior helical point, superior conchal attachment, inferior conchal attachment, and lobules). All patients healed uneventfully. Except mild edema and pain, there was no postoperative problem. The mean follow-up time was 4½ years (4 months-10 years). During this time, there was no patient with surface irregularities and/or suture-related complications. Two patients required revision because of unilateral lateralization of the upper pole by time (recurrence rate, 2.63%). When the preoperative and postoperative superior helical point, superior conchal attachment, inferior conchal attachment, and lobule measurements for both ears of the patients who were operated on were compared, postoperative values were determined to be significantly decreased (P < 0.001). The DAT provides predictable and aesthetically satisfactory long-lasting results with a minimal risk of complications. Because it does not harm the cartilage tissue, it avoids the potential problems resulted from cartilage manipulations such as surface irregularities and chondritis. Covering the suture knots with a thick soft tissue layer, it eliminates the suture-related complications. Moreover, it offers a direct approach and does not require anterior dissection. Thus, it requires a shorter operative time, minimizes the risk of anterior skin necrosis and hematoma, and causes less postoperative pain, edema, and ecchymosis.