Otoplasty - History

History

Antiquity

Otoplasty (surgery of the ear) was developed in ancient India, in the 5th century BC, by the ayurvedic physician Sushruta (ca. 800 BC), which he described in the medical compendium, the Sushruta samhita (Sushruta’s Compendium, ca. AD 500). In his time, the physician Sushruta and his medical students developed otoplastic and other plastic surgical techniques and procedures for correcting (repairing) and reconstructing ears, noses, lips, and genitalia that were amputated as criminal, religious, and military punishments. The ancient Indian medical knowledge and plastic surgery techniques of the Sushruta samhita were practiced throughout Asia until the late 18th century; the October 1794 issue of the contemporary British Gentleman’s Magazine reported the practice of rhinoplasty, as described in the 5th-century medical book, the Sushruta samhita. Moreover, two centuries later, contemporary otoplastic praxis, slightly modified, derives from the techniques and procedures developed and established in antiquity, by the Indian ayurvedic physician Sushruta.

Nineteenth Century

In Die operative Chirurgie (Operational Surgery, 1845), Johann Friedrich Dieffenbach (1794–1847) reported the first surgical approach for the correction of prominent ears — a combination otoplasty procedure that featured the simple excision (cutting) of the problematic excess cartilage from the posterior sulcus (back groove) of the ear, and the subsequent affixing, with sutures, of the corrected pinna to the mastoid periosteum, the membrane covering the mastoid process at the underside of the mastoid portion of the temporal bone, at the back of the head.

Twentieth and Twenty-first centuries

In 1920, Harold D. Gillies (1882–1960) first reproduced the pinna by burying an external-ear support framework, made of autologous rib cartilage, under the skin of the mastoid region of the head, which reconstructed pinna he then separated from the skin of the mastoid area by means of a cervical flap. In 1937, Dr. Gillies also attempted a like pediatric ear reconstruction with a pinna support framework fabricated with maternal cartilage. That otoplasty correction technique proved inadequate, because of the problems inherent to the biochemical breakdown and elimination (resorption) of the cartilage tissue by the patient’s body.

In 1964, Radford C. Tanzer (1921–2004) re-emphasized the use of autologous cartilage as the most advantageously reliable organic material for resolving microtia, abnormally small ears, because of its great histologic viability, resistance to shrinkage, and resistance to softening, and lower incidence of resorption.

The development of plastic surgery procedures, such as the refinement of J.F. Dieffenbach’s ear surgery techniques, has established more than 170 otoplasty procedures for correcting prominent ears, and for correcting the defects and deformities of the pinna; as such, otoplasty corrections are in three surgical-technique groups:

Group I — Techniques that leave intact the cartilage support-framework of the external ear, and reconfigure the distance and the angle of projection of the pinna from the head, solely by means of sutures, as in the permanent suture-insertion of the Mustardé technique for creating an antihelical fold; the Merck method technique; and the incisionless Fritsch otoplasty.

• An absent antihelical fold is created with the application of Mustardé sutures to the deformed pinna. The surgical needle is inserted through the cartilage at a right angle (90-degrees), in order to encompass a sizeable “bite” that will allow the plastic surgeon to position the cartilage by traversing the needle through the skin, and then (again) redirecting it through the same (initial) needle-hole from which it exited the skin of the pinna.

• In the 1990s, Michael H. Fritsch, developed an incisionless otoplasty technique that resolved the occurrence of prominent ears with the application of skin-traversing (percutaneous) retention sutures, whereby the corrected pinna is affixed to the head at the distance and at the angle of projection appropriate to a normally configured ear.

Group II — Techniques that resect (cut and remove) the pertinent excess cartilage from the support-framework of the pinna, which then render it pliable to being re-molded, reconfigured, and affixed to the head at the projection distance-and-angle characteristic of a normal ear; the relevant procedures are the cartilage-incision Converse technique and the Chongchet–Stenstrom technique for the anterior-correction of prominent ears.

Group III — Techniques that combine the excision of cartilage portions from the support framework of the pinna, in order to reduce the degree of projection and the distance of the external ear from the head.