The Otoplasty consists in the Surgical correction of congenital or acquired deformities of the pinna (the auricle => external ear).

What kind of deformities can be corrected by Otoplasty

The most common deformity is the so-called Lop ear or blowed ear or prominent ears, the basic defect is due to a lack of fold of the cartilage in the antihelix area. This condition gives the appearance of highly extended, prominent and flat ears.

This anomaly occurs when a part of the auricle cartilage of the ear is too developed in its portion of the skull-binding, thus appear the effect that the ears look too separate from the head and projected sideways (winged ears or Lop ears).

The term Lop ears or prominent ears describes external ears (pinna or auricle) that regardless of their size, protrude from the sides of the head.

The abnormal appearance exceeds the normal head to ear measures, wherein the external ear is less than 2.0 cms, and at an angle of less than 25 degrees, from the side of the head.

Ear configurations, of distance and angle, that exceed the normal measures, appear prominent when the patient (man or woman) is viewed from either the front or the back perspective.

In the occurrence of Lop or prominent ears, the common causes of anatomic defect, deformity and abnormality can occur individually or in combination; they are:

  1. Underdeveloped antihelical fold (inadecuate folding of the antihelix) which causes the protrusion of the scapha and the helical rim
  2. Prominent concha which is caused by an excessively deep concha or by excessively wide concha-mastoid angle, producing the prominence of the middle third of ear´s auricle or pinna
  3. Protruding earlobe, which causes the prominence of the lower third of the ear´s auricle or pinna

The average head to ear angle with this deformity is 47,7 degrees (normal patients have 31,1 degrees on average), the average scapha to concha angle with this deformity is 132,6 degrees (normal patients have 106,7 degrees on average)

There are other deformities of ear´s auricle or pinna such as Microtia, Macrotia, Scroll ear and Cup ears, but they are less frequent.

Otoplasty is a technique that allows to surgical solves these cases successfully.

It´s advisable to perform this type of operation from 6-7 years of age, since that time, the ears have already completed their development.

How the Otoplasty is performed

The operation is corrective. The otoplasty can be performed under general anesthesia or local anesthesia with intravenous sedation, usually the operation lasts about 2 hours and commonly it´s practiced on outcome basis.

An incision is made behind the ear auricle, the area where the cartilage has lack of folding or bending is dealt instrumentally, right there special points of suture of nonabsorbable material are placed, that will produce the fold of the ear in natural way, correcting the deformity.

If the deployment is not very pronounced, you can fold the cartilage and then, make stitches on the skin. If the deployment is very pronounced, after folding instrumentally the cartilage, the cartilage must be anchored to the Mastoid of Skull using special points and remove the local excess of skin and cartilage.

This surgical technique is known as Bristol technique with back Mustarde´s plication, achieving a well defined antihelical fold with the crura and rest of antihelix placed before the helix, thus restoring the normal anatomical shape of the ear and leaving well “glued” ears to the head, with successful outcome.

In the case of patients who have additionally defect  at the level of the ear´s Concha, also placed a few points that you push-up that part of the cartilage back. With that, gets to decrease the angle that forms the ear to the face on his back portion.

Possible Complications

Among the complications that can occur in a very small number of patients, are the following:

  • Bleeding
  • Infection
  • Dehiscence of the surgical incisions
  • Hematoma
  • Cartilage folding incomplete
  • Recurrence of deformity

However, with proper care and control, evolution tends to be very satisfactory.

Recovery

The recovery is fast and painless, with satisfactory result. The patients can make their normal lives after the first week, but must wait 8 weeks for exposure to the Sun, heat, go to beaches or physical exercises.

The pain or discomfort is mild and easily manageable with common painkillers. The patient must wears a voluminous non-compressive dressing upon the corrected ears for several days (no lymphatic drainage massages),during the convalescent period.

The patient must avoid excessive bandage pressure upon the ears, lest it cause pain and increase swelling, which might lead to the abrasion (rubbing) or even to the necrosis of ear´s skin.

After removing the dressing, the patient then must wears a loose headband whilst sleeping for a 3-6 weeks period; it should be snug, not tight, because its purpose is preventing the corrected ears from being pulled forward, when the sleeping patient moves whilst asleep.

The headband will help to avoid “tissue memory” and prevent the recurrence of the deformity. The stitches on the back side of the ears will be removed by the Plastic Surgeon in the doctor´s office 10 days on average in the postoperative time.

Without complications, the final result is excellent, permanent and very rewarding.

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