Surgical Correction Of Prominent Ears Research Articles

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.

Case Report: Unusual Complication Post Otoplasty

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

Technical refinement of Stenström otoplasty procedure

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

A retrospective study of patient outcomes and satisfaction following pinnaplasty

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

Surgical correction of prominent ears: association of the Furnas and Mustardé techniques

Surgical correction of prominent ears: association of the Furnas and Mustardé techniques

Otoplasty Outcomes and Results: Does Furnas Setback Suture Affect Complication Rates?

lems, or auricular atresia or patients or their parents who were diagnosed with psychiatric problems. We evaluated 27 male and 27 female patients for the clinical outcomes, revision needs, elastic headband wearing time, and complications, such as infection and hematoma, after otoplasty for surgical correction of prominent ears when Furnas suture was used. Photographic documentation was done preoperatively and postoperatively. Surgical Techniques Otoplasty was performed under general anesthesia. The operative site was prepared with povidone-iodine solution. To reduce the bleeding, 1% lidocaine with 1:200.000 epinephrine was infiltrated with a fine needle to postauricular subcutaneous tissue. The position of the antihelix was arranged by pressing the ear backward. The key markings of folds and suture sites were plotted with a violet marker. The skin incision was made postaurically and long enough for accessing the posterior helix (Mustarde suture) and mastoid area (Furnas suture). Hemostasis was obtained with monoand bipolar cautery. Small elliptical skin with subcutaneous tissue was excised from the posterior part of the concha. Subcutaneous tissue was separated from the conchal cartilage. The formation of a new antihelical fold was created according to the Mustarde technique. A row of horizontal mattress sutures was centered along the long axis of the root and superior crus of the antihelix. Each suture brought the cartilage of the scapha near to the concha. When tightened, they created or augmented the roll of the crest of the antihelix by drawing the scaphoid fossa towards the concha. The lowermost Mustarde suture was placed from the cauda helicis to the concha, and the uppermost suture was from the concha to the triangular fossa. These sutures were performed with 4/0 white polypropylene (3). Later, if performed, conchal setback procedure was applied to the Furnas technique. The posterior edge of the incision was elevated from the mastoid fascia. The postauricular soft tissue was dissected to expose the mastoid fascia. Furnas suture was applied as a 2/0 polypropylene mattress suture. After careful hemostasis, the skin was closed with 5/0 Ethilon suture (4). A “mastoid” head wrap was wrapped to all patients postoperatively. The dressing was opened on the first postoperative day; if there was no hematoma, it would not be wrapped again. The patient was instructed to wear an on-ear elastic headband after surgery for a week. Statistical Analysis All data were analyzed using the Statistical Package for the Social Sciences (SPSS) 15.0. The following statistics were used: t-test, homogeneity of variance (Levene) test, Mann-Whitney U-test, Fisher’s chi-square test, simple correlation, and regression analysis method. Results A total of 54 patients (95 ears) were detected retrospectively after otoplasty. Twenty-seven (50%) of them were male and 27 (50%) were female. The patient age range was 5-46. Twenty-one patients (40 ears) were children and 33 (55 ears) were adults. Primary surgery was performed on 95 ears of 54 patients (41 of the patients had bilateral surgery and 13 had unilateral). Five patients (9%) needed revision surgery due to inadequate correction (Table 1). In 7 (13%) patients with an isolated absence of the antihelix, only Mustarde suture was performed (Figure 3). Both Furnas and Mustarde sutures were used in 47 (87%) of patients-41 bilaterally (Figures 4a, b). While using the Mustarde and Furnas suture, all patients underwent the same procedure described above (Table 2). The minor complication rate of our cases that did not require any additional surgical intervention was found to be 12.6% (12/95). These minor complications included minimal low-flow bleeding for 1 day despite pressure headwrap and bandages in three ears of two patients (3.9%). Four ears of four patients had a hematoma (4.2%); 50 of them did not (95.8%). All hematomas Figure 1. Furnas (setback) suture application Figure 2. Mustarde suture application Turk Arch Otolaryngol 2014; 52: 52-6 Kuscu et al. Otoplasty Outcomes 53

Twenty-four hours or 10 days? A prospective randomised controlled trial in children comparing head bandages following pinnaplasty

The perceived benefits of bandaging for 10 days following pinnaplasty have been questioned by previous studies. The problems arising from these dressings are many [Powell BWEM. The value of head dressings in the postoperative management of the prominent ear. Br J Plast Surg 1989;42:692-4. Bartley J. How long should ears be bandaged after otoplasty? J Laryngol Otol 1998;112:531-2. Wong MC, Sylaidis P. Head dressings for pinnaplasty: a tradition not supported by evidence. Br J Plast Surg 2001;54:81-2], including their slippage [Powell BWEM. The value of head dressings in the postoperative management of the prominent ear. Br J Plast Surg 1989;42:692-4. Bradbury ET, Hewison J, Timmons MJ. Psychological and social outcome of prominent ear correction in children. Br J Plast Surg 1992;45:97-100. Jeffery SLA. Complications following correction of prominent ears: an audit review of 122 cases. Br J Plast Surg 1999;52:588-90]. Eighty children were recruited into a prospective randomised controlled trial comparing the use of a head bandage for only 24 h with a standard practise of a 10-day head bandage. A preoperative measurement of the lateral ear projection (LEP) was made. The outcome measures recorded during the two planned postoperative visits at 10 days (visit 1) and 2 months (visit 2) were: patient satisfaction score, LEP, complications and any unscheduled hospital visits associated with the surgery. There was no significant difference in LEP and patient satisfaction between the two groups at both the scheduled postoperative visits. Differences between the groups in the number of unscheduled visits (p=0.21) did not reach statistical significance. The findings indicate that it is safe and effective to use head bandage for only 24 h following surgical correction of prominent ears. This study shows no benefit from the application of a formal head bandage for any longer than 1 day.

Appropriate Timing of Otoplasty for Prominent Ears

Plastic Surgery| January 01 2005 Appropriate Timing of Otoplasty for Prominent Ears AAP Grand Rounds (2005) 13 (1): 10–11. https://doi.org/10.1542/gr.13-1-10 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Appropriate Timing of Otoplasty for Prominent Ears. AAP Grand Rounds January 2005; 13 (1): 10–11. https://doi.org/10.1542/gr.13-1-10 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: ear, prominent, otoplasty Source: Gosain AK, Kumar A, Huang G. Prominent ears in children younger than 4 years of age: what is the appropriate timing for otoplasty? Plast Reconstr Surg. 2004;114:1042–1054. This study from the Medical College of Wisconsin was performed to determine whether reconstructive otoplasty for prominent ears performed before 4 years of age results in an acceptable long-term outcome. The study consisted of 2 parts: 1) a survey mailed to 481 plastic surgeons asking their opinion on the timing of otoplasty; and 2) a consecutive prospective series of 12 patients who had otoplasty performed before 4 years of age. One hundred seventy-four plastic surgeons responded to the questionnaire (37%). The majority of respondents (57%) routinely delayed otoplasty until their patients were 5 years of age or older. Respondents cited a number of reasons for delaying otoplasty until at least 5 years of age, including decreased anesthetic risk, increased patient cooperation, near adult size of the auricle, and increased awareness of self-image and peer ridicule. Respondents estimated an 8% recurrence rate of the deformity in patients operated on at 5 years of age or older. The second part of the study examined the lead author’s experience with 12 patients operated on before 4 years of age (mean 23 months, range 9 months to 3 years). Bilateral procedures were performed in 9 patients and unilateral in 3 patients. Length of follow-up ranged from 21 months to 7.5 years. No patient demonstrated disturbance in growth of the ear following otoplasty. At follow-up, none of the 3 children with unilateral otoplasty showed any difference in growth between the ear operated on and the uncorrected ear. Notable recurrence occurred in only 1 of the 12 patients (8%) or 1 of 21 ears operated upon (4.8%). A follow-up questionnaire was sent to parents 1 year or more post-operatively. All 10 of the families returning the questionnaire responded that if asked again, they would choose to have the procedure performed at the same age, rather than waiting until their child was older. The authors conclude that otoplasty can be performed safely and without growth disturbance of the surgically corrected ear in patients younger than 5 years of age. They suggest that patients undergoing early surgical correction of prominent ears might benefit from enhanced development of self-esteem. Financial Disclosure: Dr. Burstein has disclosed that he has no relationships relevant to this commentary. This paper raises several issues of concern to plastic surgeons and parents. For example, will a child’s self-image suffer if a prominent ear deformity is not corrected before 4 or even 3 years of age? Since a child of 3 or 4 years of age is not capable of understanding or desiring surgical correction, are we treating the child or the parents when we perform this operation on young children? While a case series of 12 patients is not an adequate evidence base for a recommendation, it is sufficient to spur further exploration of the benefits and risks of early otoplasty.... You do not currently have access to this content.

Effect of transdermal hyoscine on nausea and vomiting after surgical correction of prominent ears under general anaesthesia

In a double-blind, randomized study, we have compared the efficacy of transdermal hyoscine with placebo in the reduction of nausea and vomiting in 50 patients, ASA I-II, after surgical correction of prominent ears under general anaesthesia. In the placebo group, 28%, 4% and 48% of patients suffered nausea, retching and vomiting, respectively, during the first 24 h after anaesthesia. The corresponding values in the hyoscine group were 12%, 0% and 16% (P < 0.01). In the placebo group more patients (48%) needed droperidol as an antiemetic compared with the hyoscine group (16%; P < 0.05). There was significantly more sedation in the hyoscine group.

Reduction in postoperative vomiting after surgical correction of prominent ears

There is a high incidence of postoperative nausea and vomiting after surgical correction of prominent ears. A prospective, randomized study was performed to determine if the method of dressing the ears influenced the incidence of postoperative vomiting. Avoidance of packing the external auditory meatus and concha produced a significant reduction in postoperative nausea (83% vs 30%; P < 0.005) and vomiting (63% vs 22%; P < 0.01).

A simple variant of surgical correction of prominent ears. Description of the surgical technique and follow-up examination in 36 patients.

A technically simple technique of otoplasty has been developed. An ovular skin excision is made on the posterior side of the auricle and then a transcartilaginous incision that corresponds to the future dorsal part of the antihelical fold. A parallel anterior incision of the anterior aspect of the cartilage helps to create a normal and harmonious configuration by smoothing the inward bending. Thirty-six patients were operated on and followed up for between six months and two years. The surgical results are satisfactory and there have been only two recurrences.

Prominent ears: a follow-up study.

Following a minimum observation time of 14 months, 74 patients having undergone surgical correction of prominent ears were re-examined. The applied surgical technique was modified from Stenström and Warrer utilizing the scoring technique and subcutaneous mattress chrome catgut sutures for fixation. Satisfactory results were achieved in more than 95 per cent of the patients, when assessed by both the patient and the surgeon. Only few complications were revealed.