Stahl's Ear Research Articles

Abnormality of Auricular Muscles in Congenital Auricular Deformities

It has been suggested that there is a close association of abnormality in auricular muscles with various congenital auricular deformities. However, there has been no investigation to determine what muscles are involved and how they affect the deformity. The authors examined abnormalities of auricular muscles for patients with various auricular deformities. The authors examined 77 auricles of 62 patients with congenital auricular deformities, including cryptotia, Stahl's ear, prominent ear, lop ear, and others. The superior and posterior auricular muscles from the extrinsic auricular muscle group and the auricular oblique and transverse muscles from the auricular intrinsic muscle group were investigated. The authors found characteristic features of the abnormality of the muscle for each auricular deformity. In nearly all cases of cryptotia, abnormality was found in the superior auricular, auricular oblique, and auricular transverse muscles. Abnormal insertion was found mainly in the superior auricular muscle and was the main cause of cryptotia. In Stahl's ear, the major abnormality was abnormal insertion of the auricular transverse muscle, which creates an abnormal cartilaginous prominence in the scapha. The abnormality in cases of prominent ear was clearly limited mostly to the auricular transverse muscle and, in some cases, to the posterior auricular muscle. In lop ear, abnormality was mostly found in the auricular transverse muscle, with elongation, and in the superior auricular or auricular oblique muscle in some cases. There is a tendency for a specific muscle abnormality to be found in each deformity. It is important to identify the abnormal muscle and correct the abnormality during the operation.

Surgical correction of constricted ear combined with Stahl's ear

Constricted ear combined with Stahl's ear is a rare ear deformity, which is a kind of complex congenital auricular deformity. From 1 January 2007 to 1 January 2014, 19 patients with constricted ear combined with Stahl's ear (Spock ear) were enrolled in this study, most of which were unilaterally deformed. To correct the deformity, a double Z-shaped skin incision was made on the posterior side of the auricle, with the entire layer of cartilage cut parallel to the helix traversing the third crus to form a fan-shaped cartilage flap. The superior crura of the antihelix were shaped by the folding cartilage rim. The cartilage of the abnormal third crus was made part of the new superior crura of antihelix, and the third crus was eliminated. The postoperative aesthetic assessment of the reshaped auricle was graded by both doctors and patients (or their parents). Out of the 19 patients, the number of satisfying cases of the symmetry, helix stretch, elimination of the third crus, the cranioauricular angle, and the substructure of the reshaped ears was 14 (nine excellent and five good), 16 (six excellent and 10 good), 17 (eight excellent and nine good), 15 (five excellent and 10 good), and 13 (two excellent and 11 good), respectively. With a maximum of a 90-month follow-up, no complication was observed. The results of the study suggested that this rare deformity could be corrected by appropriate surgical treatment, with a satisfied postoperative appearance.

Stahl Ear Correction Using the Third Crus Cartilage Flap

Stahl ear is usually associated with the existence of a third crus that traverses the scapha. The absence of the superior crus of the antihelix, a broadened scapha, and unfolded, long helical rim may contribute to the formation of the deformity. The method presented in this article is a combined technique intended to recreate the absent superior crus using the third crus as a cartilage flap along with elimination of the third crus, reducing the scapha size, and correcting helical rim deformities by skin and cartilage excisions. One bilateral and three unilateral cases were operated on with this technique (five auricles). The first unilateral cases were performed without scapha reduction and helix correction which was used in the other three cases with successful results. This procedure can be used to correct Stahl ear variations in the case of an absent superior crus when a third crus is present, the scapha is of increased size, and the helix is long without a fold.

Mythological ears, a real deformity: A case of bilateral Stahl’s ears in a South African girl

Stahl’s ear is a rare congenital deformity of the pinna with a third crus resulting in an ‘elf-like’, ‘Vulcan-like’ or ‘satyr-like’ appearance with pointing of the ears. Early recognition of the condition allows successful early conservative treatment and may avoid the need for surgical correction at a later stage. We present the case of a 7-year-old South African girl with bilateral Stahl's ears, who presented with psychological distress as a result of being ridiculed at her school. The deformity was surgically corrected with a good cosmetic result and patient satisfaction.

Aetiology, pathogenesis, and specific management of Stahl's ear: role of the transverse muscle insertion

Stahl's ear is an anomaly of the external ear that is characterised by a third crux in the antihelix. Its aetiology is unknown. We report 5 patients with Stahl's ear, and describe the anatomy, particularly the musculature. We identified the position of the transverse muscle of the ear as being abnormal, and this can take 2 forms: an abnormal insertion of the entire muscle, or an abnormal insertion of the superior head of the muscle.

Identification of congenital auricular deformities during newborn hearing screening allows for non-surgical correction: A Mayo Clinic pilot study

ObjectiveTo introduce a Mayo Clinic pilot study in which newborn hearing screeners are trained to identify congenital auricular deformities, allowing for non-surgical correction with a simple splint initiated in the immediate neonatal period. MethodsNewborn hearing screeners received education on evaluation of congenital auricular deformities. Ten infants with 19 affected ears amenable to treatment with a simple splint were enrolled between June 15 and December 10, 2009. Splinting was initiated prior to the infant's discharge from the hospital. ResultsCongenital auricular deformities amenable to correction with splinting included cup ear, Stahl's ear, and prominent ear. All ears were assessed by physical examination and photographic documentation prior to splinting and at follow-up visits. All exhibited improvement from the original deformity after 1–4 weeks of splinting. There were no instances of skin irritation or breakdown. ConclusionSplinting therapy of congenital auricular deformities is very effective when initiated within the first 3 days of life while cartilage is quite malleable. Newborn hearing screening is performed within 24–48h of birth and is an ideal opportunity to identify auricular deformities. This pilot study shows that early identification of auricular deformities by properly educated newborn hearing screeners is feasible, allowing for successful initiation of splinting therapy.

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.

Ear Deformities, Otoplasty, and Ear Reconstruction

After reviewing this article, the participant should be able to: 1. Evaluate patient's ears for needed adjustments to size, shape, prominence, and symmetry. 2. Identify common ear deformities and describe methods to repair them. 3. Avoid or manage common complications associated with otoplasty and ear reconstruction. The essentials of otoplasty will be described/illustrated for the following conditions: Prominent ears, underdeveloped helical rims (shell ear), macrotia, Stahl's ear, constricted ear, cryptotia, and question mark ear.

Ear Molding in Newborn Infants with Auricular Deformities

A review of a single physician's experience in managing over 831 infant ear deformities (488 patients) is presented. The authors' methods of molding have advanced from the use of various tapes, glues, and stents, to a comprehensive yet simple system that shapes the antihelix, the triangular fossa, the helical rim, and the overly prominent conchal-mastoid angle (EarWell Infant Ear Correction System). The types of deformities managed, and their relative occurrence, are as follows: (1) prominent/cup ear, 373 ears (45 percent); (2) lidding/lop ear, 224 ears (27 percent); (3) mixed ear deformities, 83 ears (10 percent) (all had associated conchal crus); (4) Stahl's ear, 66 ears (8 percent); (5) helical rim abnormalities, 58 ears (7 percent); (6) conchal crus, 25 ears (3 percent); and (7) cryptotia, two ears (0.2 percent). Bilateral deformities were present in 340 patients (70 percent), with unilateral deformities in 148 patients (30 percent). Fifty-eight infant ears (34 patients) were treated using the final version of the EarWell Infant Ear Correction System with a success rate exceeding 90 percent (good to excellent results). The system was found to be most successful when begun in the first week of the infant's life. When molding was initiated after 3 weeks from birth, only approximately half of the infants had a good response. Congenital ear deformities are common and only approximately 30 percent self-correct. These deformities can be corrected by initiating appropriate molding in the first week of life. Neonatal molding reduces the need for surgical correction with results that often exceed what can be achieved with the surgical alternative.

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.

Non-surgical correction of deformational auricular anomalies

Less severe congenital auricular anomalies can be corrected by appropriate splinting in the early neonatal period without anaesthetic and with minimal cost. We present a series of 46 patients affected by various ear deformities (non cryptotia, non Stahl's ear, non prominent ear) that we treated by splintage during the early neonatal period. These deformational auricular anomalies were classified according to the limitation to the external ear architecture development: vertically, horizontally and focally deformed ears. This new classification guided us in splint shaping and positioning. Excellent or satisfactory results were achieved in 98% of the splinted ears. Ear splintage is an effective technique for treatment of neonates with deformational auricular anomalies.

Stahl Syndrome in Clinical Practice

Stahl syndrome, known also as "Satiro's ear", is a deformation of the auricle described in the nineteeth century by Stahl who included it in a classification of various deformities of ear:-Helix transversus spleniformis-Crus anthelicis trifurcata-Crus superior turgidumAt present Stahl's ear is included in the second group for the abnonnal cartilaginous pleat which extends from the Crus anthelix to the edge of elix deforming in this way the regular curvature of ear and amplifying the triangular hole. It's frequently associated to other aesthetic deformities of the auricle itself and above all among oriental peoples; the pathogenetic origin of this deformation has to be connected with an hereditary, familial character confirmed by the diffusion of this deformation among the members of the same family, reaching its highest expression in identical twins where its manifestation is about at seventy-five percent. Besides the hereditary-familial hypothesis, we find a second hypothesis according to which the cartilaginous deformity is connected with an altered growth of an instrinsic muscle of ear, the transverse muscle [1,4]. The solution of the problem is surgical, through the Chongcet technique [9], modified and applied in the post-operating using particular remedies.

Nonsurgical correction of congenital ear abnormalities in the newborn: Case series

To determine whether a simple, nonsurgical treatment for congenital ear abnormalities (lop-ear, Stahl's ear, protruding ear, cryptotia) improved the appearance of ear abnormalities in newborns at six weeks of age. This is a descriptive case series. All newborns with identified abnormalities were referred by their family physician to one paediatrician (WGS) in a small level 2 perinatal centre. The ears were waxed and taped in a standard manner within 10 days of birth. Pictures were taken before taping and at the end of taping (one month). All patients and pictures were assessed by one plastic surgeon (JWT) at six weeks of age and scored using a standard scoring system. A telephone survey of the nontreatment group was conducted. The total number of ears assessed was 90. Of this total, 69 ears were taped and fully evaluated in the study (77%). The refusal rate was 23%. In the treatment group, 59% had lop-ear, 19% had Stahl's ear, 17% had protruding ear and 3% had cryptotia. Overall correction (excellent/improved) for the treatment group was 90% (100% for lop-ear, 100% for Stahl's ear, 67% for protruding ear and 0% for cryptotia). In the nontreatment (refusal) group, 67% of the ears failed to correct spontaneously. No complications were recognized by the authors or parents by six weeks. The percentage of newborns in one year in the perinatal centre with recognized ear abnormalities was 6% (90 of 1600). A simple, nonsurgical treatment in a Caucasian population appeared to be very effective in correcting congenital ear abnormalities with no complications and high patient/parent satisfaction.

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.

Nonsurgical Correction of Congenital Auricular Deformities in Children Older than Early Neonates

It has been reported that nonsurgical correction of auricular deformities is not effective except in early neonates. We have succeeded in nonsurgical correction using thermoplastic splints for congenital auricular deformities on 50 ears of 45 patients without severe hypoplasia in children older than 1 year. Details of the types of ears we attempted to treat were 26 cryptotias, 5 lop ears, 5 Stahl's ears, 3 prominent ears, 3 shell ears, and 8 other miscellaneous conditions. The patients were between 1 and 14 years of age with an average age of 3.6 years. Our results were categorized as follows: excellent (the auricle was delicately corrected into a desirable form and satisfied the patient), improved (the auricle was corrected into a rough form that did not attain to a desirable shape and an irregular form still remained; however, its improvement satisfied the patient), recurrent (the auricle was initially corrected but the deformity recurred), not improved (the auricle was not corrected to the desired form and the result did not satisfy the patient), and gave up (the patient gave up before treatment could be completed). In our results, the average period of splint application was 2.1 months. In 27 of the 50 cases, the treated ears were excellent. Eleven ear cases showed improvement. Six cases showed recurrence. Three cases did not improve. Three patients gave up treatment. It is suggested that nonsurgical auricular correction is possible in almost all children, even if they are not early neonates, when corrections are made continuously and gradually.

An alternative approach for correction of Stahl's ear.

A technique of correction of Stahl's ear is presented and is compared with other techniques reported in the literature.

Otoplasty for prominent ears

Protruding ears may be a source of psychological distress in either sex and at any age. A truly gratifying psychological response to a well performed otoplasty is the rule. If the neonate with protruding ears, mildly constricted ears, Stahl's ear, or cryptotia is seen by a plastic surgeon during the baby's first days of life, the timing is auspicious. If the process of shaping the ear with molding splints and Steri-Strips is promptly initiated, correction of the problem without surgery is a realistic expectation. The urgency and the effectiveness of early nonsurgical treatment of such ears is not yet widely appreciated by those responsible for primary medical care of neonates. The plastic surgeon is in a position to increase awareness of the availability and effectiveness of this technique.