Otoplasty - Surgical Otoplasty

Surgical Otoplasty

The corrective goal of otoplasty is to set back the ears so that they appear naturally proportionate and contoured, because they are harmoniously set back, without evidence or indication of surgical correction. Therefore, when the corrected ears are viewed, they should appear normal, from the:

(i) Front perspective. When the ear (pinna) is viewed from the front, the helical rim should be visible, but not set back so far (flattened) that it is hidden behind the antihelical fold.

(ii) Rear perspective. When the pinna is viewed from behind, the helical rim is straight, not bent, as if a “letter-C” (the middle-third to flat), or crooked, as if a hockey stick” (the earlobe is insufficiently flat). If the helical rim is straight, the setback is harmonious; that is, the upper-, middle-, and lower-thirds of the pinna will be proportionately setback in relation to each other.

(iii) Side perspective. The contours of the ear should be soft and natural, not sharp and artificial.

Timing otoplastic correction

The ear deformity to be corrected determines the advantageous timing of an otoplasty, for example, in children with extremely prominent ears, 4-years old is a reasonable age. In cases of Macrotia associated with prominent ears, the child’s age might be 2-years, nonetheless, it is advantageous to restrict the further growth of the deformed ear. Moreover, regardless of the patient’s age, the otoplasty procedure requires that the patient be under general anaesthesia.

Ear reconstruction

Generally, for reconstructing an entire ear, or a portion of the rim cartilage, the surgeon first harvests a costal cartilage graft from the patient’s rib cage, which then is sculpted into an auricular framework that is emplaced under the temporal skin of the patient’s head, so that the skin envelope encompass the cartilage framework, the ear prosthesis. Once emplaced and anchored with sutures, the surgeon then creates a pinna (outer ear) of natural proportions, contour, and appearance. In the next months, in follow-up surgeries, the surgeon then creates an earlobe, and also separates the reconstructed pinna from the side of the head (ca. 15–18 mm), in order to create a tragus, the small, rounded projection located before the external entrance to the ear canal.

In the case of the patient encumbered with several congenital defects of the ear or who has insufficient autologous cartilage to harvest, it might be infeasible to effect the corrections with grafts of rib cartilage. In such a case, the reconstructive Antia–Buch helical advancement technique might apply; it moves tissues from behind the ear rim, and then around and forward to repair the defective front of the ear rim. To perform the Antia–Buch helical advancement, with ink, the surgeon first designs the incision inside the helical rim and around the crus (shank) of the helix. Then cuts the skin and the cartilage — but does not pierce the posterior skin of the ear. The helical rim then is advanced to allow the suturing (closure), and a dog-ear-shaped graft of skin is removed from the back of the ear. The closure of the sutures advances the crus of the helix into the helical rim.