Modified bilateral fasciaperichondrial flap for prominent ear correction

Abstract Objective: Various techniques have been described in the literature for prominent ear correction. These cartilage-preserving or cartilage-shaping techniques have their own advantages and disadvantages. We aim to achieve aesthetic and stable results with low complication rates using combinations of these methods. Herein, we present our results of prominent ear surgery with a modified bilateral fasciaperichondrial flap in combination with concha-mastoid and concha-scaphal sutures. Methods: Patients whose surgeries included a modified bilateral fasciaperichondrial flap for prominent ear deformities were included in the study. Patients' demographic data, pre- and postoperative Concha-Mastoid Angle (CMA) and upper-middle Helix-Mastoid Distances (HMD), follow-up time, complications, secondary operations, and postoperative Visual Analogue Scale (VAS) results were evaluated. With a postauricular fish-mouth incision, the bilateral fasciaperichondrial flap was planned into two: proximal- and distal-based. They were then elevated from the cartilage subperichondrially on the proximal side and supraperichondrially on the distal side. Concha-scaphal sutures were used to form an antihelical rim along with concha-mastoid sutures to reduce the concha-mastoid angle. Conchal cartilage resection was done if needed. Then, the bilateral fasciaperichondrial flaps were sutured together to cover the concha-mastoid and concha-scaphal sutures. Results: Between May 2017 and May 2021, 32 ears of 17 patients were operated on dueto prominent ear deformity. No hematoma or infection was observed in any patient, and there were no instances of recurrence, suture exposure, hypertrophic scars, or keloids. The satisfaction level of all patients was 8.2 ± 0.9 points on average according to the VAS. In the anthropometric measurements, a statistically significant difference was found between preoperative and postoperative sixth month CMA and HMD values. Conclusion: A combination of suture techniques and a modified bilateral fasciaperichondrial flap may be used in prominent ear cases, with low recurrence rates and high patient satisfaction. Level of evidence: III.

Otoplastia en oreja prominente

La oreja alada es la deformidad congénita más frecuente en cabeza y cuello, con una incidencia de 5% en la población caucásica. Queda definida por una distancia entre el hélix y la mastoides mayor a 21 mm o un ángulo mayor a 90° entre la concha auricular y la fosa escafoidea, siendo causada en el 70% de los casos por un antihélix mal plegado. Su corrección, a través de la otoplastia, se vuelve fundamental en prevenir los impactos psicológicos, siendo indicada antes de los 6 a 7 años, cuando la oreja ha alcanzado un ancho similar a la oreja adulta. El abordaje quirúrgico se divide en aquellas técnicas incisionales y no incisionales, cuya tasa de éxito y complicaciones como el otohematoma, necrosis de cartílago y deformidad irreversible, entre otras, son variables. La recidiva varía entre 6% a 12,5%, según el abordaje, no existiendo a la fecha una única técnica de elección. En el presente trabajo se discutirán cuatro técnicas principales: Incisionless, Furnas, mustardé y técnica de los pilares.

The prominent ear is the most common congenital deformity in head and neck, with an incidence of 5% in the Caucasian population. It is defined by a distance between the helix and the mastoid greater than 21 mm or an angle greater than 90° between the concha and the scaphoid fossa, being caused in 70% of the cases by a misfolded antihelix. Its correction, through the otoplasty, becomes essential in preventing psychological impact, being indicated before the age of 6 or 7, when the ear has reached a similar width of an adult ear. The surgical access is classified on incisionless and non-incisionless techniques, where the success rate and complications like hematoma, cartilage necrosis and irreversible deformity, among others, are variables. Recurrence varies between 6%-12.5%, depending on the approach, and to date there is no single technique of choice. In this revision, we will discuss the four principal techniques: Incisionless, Furnas, Mustardé and the abutment technique.

Clinical study on the treatment of prominent ear by personalized horizontal mattress suture combined with cartilage tube method / 中华整形外科杂志

Objective@#To study the effect of individualized treatment of prominent ears using mattress suture combined tubed cartilage method.@*Methods@#A total of 21 patients (28 ears) with prominent ear deformity were retrospectively analyzed from January 2013 to December 2015. Horizontal mattress suture and tubed cartilage were used to correct the deformed ears. The patients were followed up for 6 months to 1 year (mean: 9 months).@*Results@#Hematoma occurred in 3 cases after operation, but the wounds were healed after removal of hematoma. No infection, flap necrosis, cartilage absorption or deformation, or other complications occurred. 28 ears were corrected. The shape of the antihelix was smooth and the auriculocephalic angle and scapha-conchal angle were significantly reduced, compared with preoperative. No obvious scar hypertrophy was left on incision.@*Conclusions@#The method of horizontal mattress suture combined with tubed cartilage is simple to use for prominent ear, result in satisfactory and stable outcomes.

Current progress of laser-assisted cartilage reshaping for prominent ear / 中国修复重建外科杂志

Objective: To summarize the current progress of laser-assisted cartilage reshaping (LACR) for prominent ear. Methods: The domestic and abroad article concerning the LACR in treatment of prominent ear was reviewed and analyzed. Results: As a new technique, there were three types of LACR therapies that been used for prominent ear. LACR with the 1 064 nm Nd/YAG laser is painful and the penetration depth of the 1 064 nm Nd/YAG laser is greater than that of the 1540 nm Er/Glass laser which is caused more tissue injury. LACR with the 1 540 nm Er/Glass laser has high absorption by the ear cartilage and produce less injury to the surrounding tissue. Use of the CO 2 laser permitted cartilage reshaping combined with both vaporization and incisions, which complicates the technique, although, with low recurrence rate and definite effect. Insisting on wearing ear mold is the key to get satisfactory effectiveness for postoperative patients. The complications of LACR for prominent ear, such as the dermatitis, perforation of the skin, hematoma, or infection, should be noticed. Conclusion: Application of LACR for prominent ear just has a short period of time, limited number of cases, and few relevant literature reports. Its effectiveness needs to be further studied and clarified.

A Simple Corrective Method for Prominent Ear

Various methods have been used to correct the prominent ear, in which the deformity is due to lack of formation of the normal antihelix. In 1963, Mustard presented a method which creates the antihelical fold by placing permanent mattress sutures through the cartilage without using any actual cartilaginous incisions. However, the main disadvantage of this method is difficulty in accurate full- thickness transcartilaginous suture without an injury to the anterior auricular skin. To solve this problem, the authors separated the anterior auricular skin from the cartilage by a subcision method using a 21-gauge needle without making a skin incision. Between 2001 and 2002, a total of 16 prominent ears in 12 patients were corrected by this method. Eight patients underwent unilateral correction and four patients underwent bilateral correction. Seven were female and 5 were male. Patients' age at operation ranged from 5 to 24 years(mean 9.7 years). Patients were followed up from 5 to 14 months(mean 8.6 months). No major complications were observed while using this method and good aesthetic result was achieved in all cases, except one recurrence case that needed revision procedure. This method is a simple and safe technique with reliable aesthetic results and no scar on the anterior auricular skin.

Noninvasive and Simple Correction of Prominent Ear

Prominent ear means congenital ear anomaly which has the obtuse conchoscapal angle caused by underdeveloped antihelix and has the larger concha shape than normal. It can be corrected by non-surgical method such as molding process with splint when ear cartilage keep flexibility right after birth and by surgical method with manipulating the ear cartilage directly. To correct prominent ear, we used simple and effective technique consisted of (1)anterior cartilage surface scoring and (2)two horizontal mattress suture without skin excision because we have the opinion that the most important deformity in prominent ear is lesser projection of antihelical fold. From March 1998 to February 2003 this method was applied to 12 patients. During the follow-up period no particular side effects were detected and we had an excellent aesthetic result.

Surgical Correction of the Prominent Ear using the Posterior Approach

In prominent ears, major common deformities are a poorly developed antihelical fold and the formation of excessive conchal cartilage, in particular the posterior conchal wall. Goal of the surgical correction of prominent ears is narrowing of the conchoscaphal angle by folding of the antihelix and reduction of the concha. In this study, cartilage sparing otoplasty is refined by the addition of minimal dissection of the medial and lateral margin of the medial and lateral cut cartilage through the posterior approach and horizontal mattress sutures between two margins. A total of 9 patients were operated between 1999 and 2001. Among them, 4 patients were bilateral and 5 patients were unilateral. There were no hematomas. There was mild recurrence of the upper antihelical fold in one patient who requested further surgery. Two patients developed suture extrusion. This technique is a simple and safe procedure with reliable results and does not cause anterior scarring or skin necrosis.

A Quilting Suture Technique for the Correction of Prominent Ears

A great number of operative techniques has been described about the correction of the prominent ears. The most primary deformity of the prominent ears comes from an underdeveloped or unfolded antihelix, which results in widening of the conchoscaphal angle and/or flattening of the superior crus, and which, in severe forms, involves antihelical body and inferior crus. Most authors manage the prominent ear deformity by excising, suturing, scoring, or sculpturing the auricular cartilage. We carried out a modified quilting suture technique in order to produce an antihelix. This technique provides several advantages; 1) it prevents the bowstring of the suture material during the formation of the helix; 2) the procedure is easy and time-saving; 3) the reconstructed ear shows reliable results in firmness and stability against external force or trauma; 4) the recurrence rate is not more than that of the conventional methods.