Stahl Ear Deformity Research Articles

Titanium Mesh for Correction of Stahl's Ear Deformity

Abstract Background: Stahl's bar is a rare auricular malformation that can bring social stigma to the patient. Stahl's deformity is congenital anomaly, characterized by an accessory third crus in the ear cartilage, giving rise to an irregular helical rim and paradoxically bent scaphoid fossa along its two axes [1]. Correction of such ear deformity can be a challenging task for the surgeons. There are no standard techniques for correcting this deformity [2]. Several different techniques are described in literature which yield unpredictable results. The conventional techniques of correcting this deformity include either excision of the cartilage, repositioning of the cartilage, or scoring techniques, also correction using internal sutures [3]. We studied a new technique for correction of this deformity using titanium mesh. The technical details of the surgery are described along with a review of literature on correcting similar anomalies. Aim of Study: Our aim is to evaluate and discuss the efficacy and safety of using titanium mesh to correct Stahl's ear deformity. Subjects and Methods: A prospective randomized study conducted from June 2017 to March 2019. In all, 7 patients having the Stahl's bar deformity, two bilateral and five unilat-eral (9 ears) included. All patients have been presented and managed at the Department of Otolaryngology, Hearing and Speech Institute. Patients have been managed surgically to correct the deformity. Surgery was by implanting a piece of titanium mesh which has been shaped and tailored to reverse the paradoxically bent scaphoid fossa. The titanium mesh with its new curve was put inside a small sub-perichondrial pocket along the long axis of the deformed bar. Regular follow-up visits were done every month for at least 6 months. Results: The operative time ranged from, 45 to 70 minutes with a mean of 62 minutes. Surgery was easy straight forward, Blood loss was minimal. As regards the final outcome, the affected auricles regained its normal appearance with fine scaphoid fossa and helical rim intraoperatively. The ears that were operated were of normal size and shape. All patients and their families were satisfied with the final result. There were no complications.Summary: Correction of Stahl's bar deformity can be accomplished easily and safely by implanting a pre shaped titanium mesh forcing the abnormally curved cartilage to regain its normal curvature.

The Double-reverse Wedge Excision Technique: A Novel Approach to Reconstruction of Stahl’s Ear Deformity

Stahl's ear deformity presents with an abnormal third crus of the antihelix and varying degrees of severity. This paper aims to describe a novel technique for reconstruction of Stahl's ear involving a double-reverse wedge excision of the third crus cartilage and skin, as well as use of Mustardé sutures to recreate the superior crus and Furnas sutures to complete the auricular setback. This novel technique for correction of Stahl's ear deformity produces a more stable aesthetic result versus classic otoplasty with desired auricular setback, minimal reduction in the size of the ear, and limited scarring on the anterior auricular surface. Reconstruction of Stahl's ear deformity can be accomplished using this double-reverse wedge excision technique of the third crus cartilage and skin with Mustardé and Furnas sutures to recreate the superior crus and complete auricular setback, effectively restoring anatomic harmony to the ear.

“Intra Scaphal Opposing Sutures” for Stahl’s ear correction

Stahl’s ear deformity is a rare congenital abnormality and is characterized with the presence of an abnormal third crus in the upper pole of the auricle. Although various techniques are advised, there is no standard surgical correction option. In this study, we have tried to show a new suture method to able to correct Stahl’s ear deformity as a more practical and less invasive way. This study includes 4 patients and 4 ears having Stahl ear deformity that was corrected by “Intra Scaphal Opposing Sutures”. The patients were followed up for 12 months with clinical examination and photography. Patient satisfaction was good with favorable results. Suturing techniques are common procedure for Stahl’s ear correction. They can be used alone or in combination with excision, scoring and/or reshaping techniques. The main advantages of our technique are: using a smaller posterior incision, limited dissection and less destruction without performing any excision. Stahl’s ear correction with Intra Scaphal Opposing Sutures may offer a practical and stable solution in selected cases, especially with minor presence of aberrant third crus.

Stahl’s Ear Correction

Stahl ear deformity is characterized by a third auricular crus with a horizontal orientation. A diminutive superior crus and prominence of the upper pole of the ear are also generally present. Many acknowledge that Stahl ear is a challenging deformity to correct. In the present report, an effective technique is introduced that uses 3 different, yet synergistic, maneuvers to oblate the third crus, enhance the superior crus, and normalize superior pole projection. The maneuvers are posterior abrading of the third crus, strategic placement of a posterior Mustarde suture, and placement of an anterior anticonvexity suture. Postoperative care involves the use of a custom scaphoid fossa splint and headband.

Correction of Stahl Ear Deformity Using a Suture Technique

Correction of partial ear deformities can be a challenging task for the plastic surgeon. There are no standard techniques for correcting many of these deformities, and several different techniques are described in literature. Stahl ear is one such anomaly, characterized by an accessory third crus in the ear cartilage, giving rise to an irregular helical rim. The conventional techniques of correcting this deformity include either excision of the cartilage, repositioning of the cartilage, or scoring techniques. We recently encountered a case of Stahl ear deformity and undertook correction using internal sutures with very good results. The technical details of the surgery are described along with a review of literature on correcting similar anomalies.

Stahl Ear Deformity Associated with Finiay-Marks Syndrome

Stahl Ear Deformity Associated with Finiay-Marks Syndrome

A new method to correct Stahl’s ear

Stahl's ear is a rare congenital auricular malformation in which an abnormal 'third crus' traverses the upper pole of the scapha. A number of different treatment options have been published to correct Stahl's ear deformity; however, none of them corrects all the variations perfectly. In this article, we describe our new method to correct this deformity. To correct Stahl's ear and acquire a natural-looking appearance, a technique of cartilage scoring and a folding cartilage flap was used. The entire layer of the cartilage was cut through and the anterior skin covering the cartilage was dissected to the external border of the desired superior crus and antehelix to form a fan-shape flap. After scoring of the posterior surface of the cartilage, the cartilage flap was folded and sutured to the cartilage below to build the superior crus. Seventeen patients ranging in age from 9 to 46 years were operated upon using this technique. The ears that were created were of normal size and shape. All patients and their families were satisfied with the final result. There were no complications. We have developed a new method to correct Stahl's ear deformity. Outcomes of this technique on 17 patients suggest that our method is simple, effective and successful.

Posterior Z-plasty and J-Y antihelixplasty for correction of Stahl's ear deformity

The bifurcated Y-shaped antihelix characterises the normal human ear and gives it an aesthetically pleasing appearance. In Stahl's ear congenital anomaly an aberrant crus usually replaces the superior crus, crossing the scaphoid fossa from the site of the normal bifurcation of the antihelix posteriorly towards the helix, giving the antihelix an abnormal J-shape. A technique is described to correct Stahl's ear deformity adding a simple Z-plasty to the incision to lengthen the skin on the posterior surface, together with making use of the aberrant crus to reconstruct the superior crus without reducing the ear size using a modified Mustardé technique. This is achieved by posterior scoring and suturing without any cartilaginous excisions converting the 'J' antihelix into a 'Y'. Out of a series of eight cases examined, four unilateral and one bilateral cases were operated on (six ears). The first two unilateral cases were performed without Z-plasty, which was used in the third case on with very satisfactory results in different types and severities of Stahl's ear deformity. I believe that the technique detailed in this paper fulfils the main principles necessary for correction of Stahl's ear deformity and may be used in cases where the aberrant crus is reducible regardless of its shape.

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.

Simple surgical correction of Stahl's ear

We describe a simple method of correction of the Stahl's ear deformity. The deformed portion of the auricular cartilage is cut into tiny pieces and put back into the abnormal area. The helix and the scapha are then moulded into a normal ear shape and maintained in position with a tie-over bolster. A gutta-percha splint is used for a further month. Over a 3-year period, 6 Stahl's ear deformities in 5 patients were treated with this procedure. All patients were followed up for at least 1 year. We believe that this procedure can be applied to other partial auricular deformities as well.