Prominent Ear Surgery Research Articles

Benefits of medially based perichondrio-adipo-dermal flap in cartilage sparing prominent ear surgery

BackgroundCartilage-cutting and cartilage-sparing techniques are the two types of otoplasty procedures. Because of the significant risk of haematoma, skin necrosis, and ear deformity, cartilage-cutting techniques have been questioned. As a result; suture-based cartilage-sparing procedures such as Mustarde and Furnas suture procedures have grown in popularity. However, these techniques have a tendency for deformity recurrence due to cartilage memory and suture fatigue, as well as the possibility of suture extrusion and pinpricking sensation of the sutures. MethodsIn this study, we used a medially based adipo-dermal flap including perichondrium which is elevated from the back of the auricle to cover and support a cartilage-sparing otoplasty, thirty-four patients (14 female and 20 male) were operated using this technique. The medially based perichondrio-adipo-dermal flap is advanced anteriorly and fixed to the helical rim under cover of the distal skin flap. This procedure sought to cover the suture line preventing suture extrusion and support in the repair of the deformity preventing its recurrence. ResultsThe average operative time was 80min, ranging from 65 to 110min. The patients passed the early postoperative period uneventfully except for 2 patients; one patient (2.9%) developed haematoma, and the other patient developed a small area of necrosis on the new antihelical fold. In late the postoperative period recurrence of the deformity developed in one patient. No patients developed suture extrusion or granuloma. ConclusionThe treatment to repair prominent ears is easy and safe, with benefits such as a natural-looking antihelical fold and minimal tissue stress. The medially or proximally based adipo-dermal flap may help to lower recurrence rates and suture extrusion.

Benefits of medially based perichondrio-adipo-dermal flap in cartilage sparing prominent ear surgery

BackgroundCartilage-cutting and cartilage-sparing techniques are the two types of otoplasty procedures. Because of the significant risk of haematoma, skin necrosis, and ear deformity, cartilage-cutting techniques have been questioned. As a result; suture-based cartilage-sparing procedures such as Mustarde and Furnas suture procedures have grown in popularity. However, these techniques have a tendency for deformity recurrence due to cartilage memory and suture fatigue, as well as the possibility of suture extrusion and pinpricking sensation of the sutures. MethodsIn this study, we used a medially based adipo-dermal flap including perichondrium which is elevated from the back of the auricle to cover and support a cartilage-sparing otoplasty, thirty-four patients (14 female and 20 male) were operated using this technique. The medially based perichondrio-adipo-dermal flap is advanced anteriorly and fixed to the helical rim under cover of the distal skin flap. This procedure sought to cover the suture line preventing suture extrusion and support in the repair of the deformity preventing its recurrence. ResultsThe average operative time was 80min, ranging from 65 to 110min. The patients passed the early postoperative period uneventfully except for 2 patients; one patient (2.9%) developed haematoma, and the other patient developed a small area of necrosis on the new antihelical fold. In late the postoperative period recurrence of the deformity developed in one patient. No patients developed suture extrusion or granuloma. ConclusionThe treatment to repair prominent ears is easy and safe, with benefits such as a natural-looking antihelical fold and minimal tissue stress. The medially or proximally based adipo-dermal flap may help to lower recurrence rates and suture extrusion.

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.

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.

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.

A retrospective analysis of complications and surgical outcome of 1380 ears: Experience review of paediatric otoplasty

Aim of the studyThe psychological benefits of successful surgery for prominent ears have been emphasised. However, there are few comprehensive reports in the literature on the incidence of complications. The aim of this retrospective study is to present the postoperative outcome and possible recurrence of prominent ears after otoplasty in a University Hospital Center. MethodsA total of 705 patients were followed after otoplasty. We carried out a retrospective review of the file that included all children who had been treated for prominent ears following the same surgical technique from January 01, 1993 to December 31, 2017, and made a descriptive analysis of the data. Main resultsOur study confirmed the prevalence of females in operative treatment of PE, as well as the predominance of the bilateral form of this anomaly. Postoperative complications were recorded in 3.7% of the children (n = 26). 16 patients (2.2%) developed hypertrophic scar complications that required surgical revision in all cases, classifying them as 3b according to the Clavien-Dindo classification. Nine patients (1.3%) required surgical revision for recurrence (Clavien-Dindo 3b). Recurrence, unlike scarring complications, seems to be dependent on the surgeon's experience. A family history was noted in 20% of cases. ConclusionsThe otoplasty technique showed here is safe and has a low rate of the complications commonly described in the literature. A prospective study with a survey of complications and degree of satisfaction with the results will follow.

Postcode lottery? Do clinical commissioning groups differ in their funding of prominent ear correction surgery

SummaryIn 2013 Clinical Commissioning Groups (CCGs) were created and became responsible for the planning and commissioning of health care services in their area. The Royal College of Surgeons and the British Association of Plastic, Reconstructive and Aesthetic Surgeons created guideline for the CCGs in 2013 for the surgical treatment of prominent ears. By looking at each of the CCGs’ websites, we aim to review their equity and how well they adhere to standards to determine whether there is a regional variation for funding of this procedure.We found that 47% of the CCGs will fund this procedure only on an exceptionality basis, compared to 26% who had set criteria and would allow funding if these criteria were met. There was significant variation in the age at which funding would be considered with some CCGs allowing funding from 5 years of age and others not providing it until as old as 11 years. Only 11 policies made any reference to cartilage moulding and only 3 mentioned funding to allow correct fitting of hearing aids.Unfortunately, despite recommendations from the Royal College of Surgeons and the British Association of Plastic and Reconstructive Surgery, there is still variation in funding criteria between CCGs for correction of prominent ear surgery. This may result in patients being treated differently depending on their postcode. We would urge commissioners to apply more consistent and uniform guidelines for the funding of surgical correction of prominent ears.

A Modification of the Posterior Perichondrio-Adipo-Dermal Flap for Protruding Ear Correction: A Customized Technique.

Prominent ear deformity is a common congenital deformity of the external ear affecting 5% of the general population. Because of the deformity's displeasing nature, corrective prominent ear surgery is widely common and performed as a prophylactic surgery. More than 200 surgical techniques for the correction of prominent ear deformity have been described to improve the cosmetic outcome and decrease complication rates. The aim of the study was to present a modified post auricular flap technique that increases the control of reshaping the ear cartilages, decreases the operation time, and provides a symmetrical long-lasting cosmetic outcome.One hundred sixty-two patients (141 male and 21 female) had ear correction surgeries performed by the same surgeon using the described technique between January 2015 and January 2018. One hundred sixty patients were gone through bilateral ear correction, whereas only 2 patients had unilateral ear correction procedures. A modified posterior perichondrio-adipo-dermal flap technique for protruding ear correction was applied to all patients.The patients' ages ranged from 18 to 40 years, with a median of 28.3 years. The mean follow-up time was 22.5 months (6-36 months). Total operation time was 35 minutes on average (25-45 minutes). As more experience was gained in flap harvesting, operation time became shorter. The mean preoperative upper third ear proportion-scalp distance was 33.1 mm and the middle third ear proportion-scalp distance was 29.8 mm. At the sixth month of the surgery, the measurements were 9.8 and 11.6 mm.Measuring and adjusting flap's width provided to achieve symmetry in initial technique. Locating the postoperative scar along the posterior surface of the helical groove also provides a natural view. Different from traditional posterior fascial flap, the width of the flap was narrowed to 8 to 10 mm. In the traditional technique, the flap was dissected along the incision margins. Narrowing the width of the flap decreased the operation time. The preserved skin between the helix and the mastoid bone has the same width with perichondrio-adipo-dermal flap. That increases the control over the helix-mastoid distance and posterior auricular fold not to mention provides permanent results. The previously mentioned method can be a simple, useful, and practical technique for protruding ear deformity.

A new otoplasty procedure: combination of perichondrio-adipo-dermal flap, posterior auricular muscle transpositioning and cartilage suturing to decrease the post-operative complication rates

Prominent ear deformity is a common congenital deformity of the external ear affecting 5% of the general population. Although this is a harmless deformity, several publications demonstrate the psychological distress, emotional trauma and behavioural problems that this deformity can inflict on children. As a result of these concerns, corrective prominent ear surgery is now widely performed as a prophylactic surgery. Three different prominent ear repair techniques were combined. First, a laterally based perichondrio-adipo-dermal flap was elevated. The posterior auricular muscle was dissected and transected from its insertion. After concha-mastoid suture replacement, the posterior auricular muscle transposition and flap positioning were performed. The helix–mastoid distances and concha-mastoid angles of the patients were measured pre-operatively and at the sixth month of the surgery as the late post-operative assessment. Patients were also evaluated for suture extrusion, granuloma formation, deformity recurrence and postauricular area sensitivity. Fourteen patients with bilateral prominent ear deformities were treated between January 2016 and January 2017. None of the patients suffered from skin necrosis, suture extrusion, hematoma or wound infection at the early or late post-operative period. No recurrence was noted. The combination of these three techniques not only decreases post-operative complication rates but also provides a primary otoplasty technique. All three techniques are well-documented and reliable protruding ear correction methods. It was aimed to benefit from specific advantages of each technique while decreasing the complication rates. The primary drawback of our study is the amount of patients in our sample. Complication rates of this technique remain debatable in the 14 cases. The need for further prospective comparative studies about this subject remains. Level of Evidence: Level IV, therapeutic study.

Fascioperichondrial Flap with a Proximal Base Combined with Prominent Ear Surgery

Fascioperichondrial Flap with a Proximal Base Combined with Prominent Ear Surgery

Otoplasty for prominent ears – demographics and surgical timing in different populations

IntroductionProminent ears are seen in approximately 5% of the population. This benign condition can be treated surgically to reduce or prevent psychological and social problems, most commonly in children before the start of school. Our aim was to examine the demographic characteristics of patients undergoing prominent ear surgery in Finland, and compare findings with international data. MethodsA retrospective study of all the patients treated for prominent ears in our academic tertiary care referral center during 2007-2011 was performed to gather demographic details of operated patients.A systematic review of published series of prominent ear surgery after the year 2000 was performed to gather demographic details for international comparison. ResultsA total of 180 patients were operated in our institution for prominent ears, most of the cases (78.9%) were bilateral. Age at operation ranged between 3 and 36 years, with mean of 9.2 y and median of 7 y. The most common reason for seeking operative treatment was aesthetic complaint, followed by bullying.Review process gathered 20 publications, describing a total of 4433 patients who had been operated for prominent ears. There was wide variation the mean age at operation, ranging 7-38 y while the mean overall was 15.0y. Gender distribution of patient samples was also very variable, with percentage of females ranging from 38 to 71% (overall 52%). There was also considerable variation in the tendency to perform unilateral operations: from 0% up to 21% of the reported population. There were no statistically significant correlations linking these demographic variables, though there was a trend that females are more likely to have this operation performed at an older age. ConclusionsThe treatment culture of prominent ear surgery varies substantially in international comparison. The age at which this operation is performed showed most variation. Omitting some of the basic demographic variables while reporting the results of surgery was common in the reviewed publications.

An easy supplement in ear surgery to reduce patient’s post-operative discomfort

The goal of otoplasty surgery for prominent ears is to normalize the shape and position of both ears with maximal symmetry. The aim of the post-operative dressing is to maintain the designated shape and position, and to confer a degree of compression in order to prevent hematoma formation.

A New Way for Antihelixplasty in Prominent Ear Surgery: Modified Postauricular Fascial Flap.

Otoplasty procedures aim to reduce the concha-mastoid angle and recreate the antihelical fold. Here, we explained the modified postauricular fascial flap, described as a new way for recreating the antihelical fold, and reported the results of patients on whom this flap was used. The defined technique was used on 24 patients (10 females and 14 males; age, 6-27 years; mean, 16.7 years) between June 2009 and July 2012, a total of 48 procedures in total (bilateral). Follow-up ranged from 1 to 3 years (mean, 1.5 years). At the preoperative and postoperative time points (1 and 12 months after surgery), all patients were measured for upper and middle helix-head distance and were photographed. The records were analyzed statistically using t test and analysis of variance. The procedure resulted in ears that were natural in appearance without any significant visible evidence of surgery. The operations resulted in no complications except 1 patient who developed a small skin ulcer on the left ear because of band pressure. When we compared the preoperative and postoperative upper and middle helix-head distance, there was a high significance statistically. To introduce modified postauricular fascial flap, we used a simple and safe procedure to recreate an antihelical fold. This procedure led to several benefits, including a natural-in-appearance antihelical fold, prevention of suture extrusion and granuloma, as well as minimized risk for recurrence due to neochondrogenesis. This method may be used as a standard procedure for treating prominent ears surgically.

The Use of a Retroauricular Fascioperichondrial Flap in the Recreation of the Antihelical Fold in Prominent Ear Surgery

The surgical treatments for prominent ears are on the basis of the approach over the basics of the deformity decrease the concha-mastoid angle and create a new antihelical fold. The author describes a new retroauricular flap to be used in the recreation of the antihelical fold and critically analyzes the cosmetic results and complications. A skin ellipse is outlined on the posterior surface of the ear. After hydrodissection with anesthetic solution in the outlined area, the skin is removed as thin as possible over the superior mid ear, preserving the underlying connective tissue and perichondrium. A triangular flap is created in the superior third of the raw area and elevated in the subperichondrial plane. The fixation of the flap posteriorly allows the medialization of the upper pole, resulting in a natural antihelical fold. One hundred sixty-one otoplasties were performed in 82 patients (3 unilateral), 53 women and 29 men. Mean age was 19.2 years and mean follow-up time was 3.4 years. Loss of correction at the upper pole led to secondary correction in 12 ears (7.45%). Suture extrusion was observed in 7 ears (4.34%). Hypertrophic scarring developed in 3 ears (1.86%). The accumulated risk of reoperation was of 10.85% in 9 years. The retroauricular fascioperichondrial flap combined with other techniques may be used as a standard procedure in the surgical treatment of prominent ears.

A new validated otoplasty dressing technique

The goal of otoplasty surgery for prominent ears is to normalize the shape and position of both ears with maximal symmetry. The operation is often performed on children; thus, the importance of dressing design has been emphasized in the literature as a factor determining successful outcome. We present an audited method for otoplasty dressing accompanied by an intraoperative photographic sequence. Proflavin-soaked wool is molded into the anatomical sulci anteriorly and a combination of Vaseline gauze and dressing gauze are held in position posteriorly by tying the continuous skin suture over them. Gauze is then placed over the pinna with a thick soft piece of cotton wool covering the whole area bilaterally. Finally, a length of stockinet is used to secure the dressings in place for 10 days, ensuring support, yet without undue pressure. An audit of the cases we have done so far demonstrated no complications relating to the dressing and satisfaction from patients and staff. We have found this otoplasty dressing technique to be simple, economical, and unobtrusive to the patients, while reproducible by junior staff if examination is required prematurely. Compromise of forehead or anterior pinna skin has not been encountered.

Ear reconstruction following severe complications of otoplasty

Correction of prominent ears is one of the most common operations performed in congenital deformity. Many appropriate corrective techniques have been described. While rare, severe complications destroying ear contours can occur and their correction should follow the established principles of ear reconstruction. A retrospective review of the notes of all patients who presented to Clinique George Bizet (1981-2007) in Paris, for correction of complications after undergoing prominent ear surgery at another facility, was performed. Each patient's age, gender, diagnosis, number of previous operations and final outcome were noted as available. Patients were included in this study if they had undergone one or more operations for prominent ears, leading to severe destructive complications, prior to consultation with the senior author and then underwent surgical repair with either an auricular (conchal) cartilage graft or with autogenous costal cartilage. A total of 49 (25 female, 24 male) patients met the inclusion criteria. The mean age at presentation was 23 years (range of 10-59 years of age). The mean number of previous attempts to correct the ear deformity was 1.3 (1-12) times. Eight patients underwent reconstruction with a conchal cartilage graft and 41 with costal cartilage. While more minor contour deformities are correctable with a contralateral conchal cartilage graft, when more than a quarter of the ear or more than two planes of its complex folds are deformed, costal cartilage is recommended for surgical repair. The principles of ear reconstruction should be well understood prior to attempting a repair of severe complications after otoplasty.

Are Growth Alterations a Consequence of Surgery for Prominent Ears?

This study was undertaken to detect growth alterations after surgery for prominent ears. The cartilage excision technique was used in all 77 patients seen for follow-up. Two hundred students served as controls. Auricular measurements were done according to standardized guidelines of anthropometry. There was no significant difference between the retroauricular angle in the surgical group and in controls. The morphologic ear length in the surgical group was significantly smaller than in controls. Maximum ear length was significantly greater in men. Our measurements in the control group were significant below the reference values reported in the literature. Comparing the ear index of both groups with published data, we found a harmony between the width and the length of the ear. We could demonstrate that prominent ears were significantly larger in all other dimensions and that auricular growth does not stop following surgery for prominent ears with the cartilage excision method. We also evaluated subjective criteria such as tolerance to cold, scar formation, and patient satisfaction.

Are Growth Alterations a Consequence of Surgery for Prominent Ears?

Are Growth Alterations a Consequence of Surgery for Prominent Ears?