Otoplasty

Otoplasty Basics - Ear Essentials

• Definition: Surgical reshaping of the external ear (auricle) to correct deformities (e.g., prominent ears) or improve aesthetics.
• Goals:
  • Correct prominent ears (common indication).
  • Restore normal auricular appearance and achieve symmetry.
• Key Anatomy: Helix, antihelix (underdevelopment causes prominence), concha (hypertrophy contributes), tragus, lobule.
• Ideal Proportions:
  • Width ~50-60% of length.
  • Helical rim visible beyond antihelix.
  • Conchoscaphal angle: ~90°.
  • Cephaloauricular angle: 20-30°.
  • Helical rim to mastoid: 1.5-2.0 cm.

  ⭐ Normal cephaloauricular angle is 20-30 degrees and the conchoscaphal angle should be approximately 90 degrees.

Indications & Candidates - Fixing Flaps

• Primary Indication: Prominent ears ("bat ears") needing correction ("fixing").
  • Key Deformities:
    • Underdeveloped antihelical fold.
    • Conchal cartilage excess (deep concha).
    • Increased auriculocephalic angle (>30°).
• Ideal Candidates:
  • Age: >5-6 years (ear ~90% adult size, cooperative).
  • Significant psychological/social distress.
  • Good general health & realistic expectations.
• Other Correctable Deformities:
  • Constricted ears (e.g., lop ear).
  • Post-traumatic ear defects.

⭐ The most common cause of prominent ears is an underdeveloped antihelical fold, often combined with conchal excess (deep conchal bowl).

Pre-Op Assessment - Planning Perfection

• History: Prior surgeries, keloid tendency, bleeding disorders.
• Examination:
  • Helico-mastoid distance (Normal: 1.5-2.0 cm).
  • Antihelical fold: definition/effacement.
  • Conchal bowl: depth/angle (prominent if >90°).
  • Lobule: position/size.
  • Skin quality, cartilage stiffness.
• Photography: Standard views.
• Counselling: Expectations, risks.

⭐ Preoperative assessment must meticulously evaluate the three key components potentially contributing to ear prominence: the antihelical fold definition, the conchal bowl depth/angle, and the lobule position/size.

Surgical Techniques - Sculpting Success

• Anesthesia:
  • Local + adrenaline ± sedation (adults, older children).
  • General (young children).
• Core Goals: Recreate antihelical fold, ↓ conchal prominence, correct lobule.
• Approaches: Tailored to deformity.
  • Cartilage-Sparing: Suturing (e.g., Mustardé for antihelix, Furnas for concha).

    ⭐ Mustardé sutures are mattress sutures used to create or accentuate the antihelical fold by approximating scaphal cartilage to conchal or mastoid periosteum, a cartilage-sparing technique.

  • Cartilage-Cutting/Scoring: Incisions/excisions to reshape (e.g., Chongchet, Stenstrom).
  • Combined techniques common.
• Sutures: Permanent, non-absorbable (e.g., Prolene) for lasting results.
• Incision: Posterior auricular, concealed.

Post-Op & Pitfalls - Healing & Headaches

• Healing & Care:
  • Mastoid dressing 24-48 hrs, then headband.
  • Headband: Wear 2-6 weeks (nightly).
  • Sutures out ~7-10 days (if non-absorbable).
  • Activity: No strenuous activity 2-3 wks; no contact sports 6-8 wks.
• Potential Pitfalls:
  • Early Complications:
    • Hematoma: Most common; drain promptly.
    • Infection/Chondritis.
    • Pain.
  • Late Issues:
    • Suture extrusion/granuloma.
    • Keloid/Hypertrophic scarring.
    • Asymmetry/Recurrence (telephone ear).
    • Sensory changes (numbness, cold).

⭐ The most common early complication following otoplasty is hematoma, which requires prompt attention to prevent cartilage damage.

High‑Yield Points - ⚡ Biggest Takeaways

• Otoplasty corrects prominent ears; ideal age 5-6 years (pliable cartilage, near-complete growth).
• Key defects: underdeveloped antihelical fold, conchal hypertrophy, increased conchomastoid angle.
• Mustarde technique: Sutures create/enhance the antihelical fold.
• Furnas technique: Concha-mastoid sutures reduce conchal depth and angle.
• Hematoma: most common early complication. Other risks: infection, keloid.
• Late issues: suture extrusion, recurrence, telephone ear deformity.
• Stahl's ear: Features a third crus and flattened scaphoid fossa_._