| BEST PRACTICE | ARTICLE BerlinÕs Charit• hospital when he started operating
otoplasties. It was to the merit of the Austrian Robert Gersuny,
who pointed out the importance of the elastic restoring forces of the cartilage in 190319
. Subsequently, the first
antihelical reconstructions were performed by the Americans Max Aaron Goldstein in 190820 H. Luckett in 191021
. Since the 1950s, a number of ways in which to sculpt
the cartilage of the protruding ear have been described. Based on the works of Oscar J. Becker22
. , John Marquis
Converse described a procedure which included the cutting of the cartilage following the antihelix with subsequent shaping by sutures23
Scoring of the anterior cartilage surface in a
longitudinal sense to strengthen the folding of the antihelix was published in 1963 by Vasant Chongchet24 and Sten Stenstr˜ m25
. Concomitantly, with the propagation of the cutting
and scoring techniques, Jack C. Mustard• rediscovered the folding of the antihelix only by sutures26 already known to Hippolyte Morestin27
, today the variety , a method and Luckett21
more than 50 years previously. Although almost 100 techniques to operate on protruding ears have been published28
of different otoplasty techniques can still be grouped into three basic concepts: cutting, scoring and pure suture techniques.
Otoplasty is more than folding the antihelix The most frequent form of deviation leading to a protruding
auricle is an insufficiently shaped or
distinctive antihelix. In some cases, there is an additional hyperplasia of the conchal cavum, which is usually only a pseudo-hyperplasia owing to a missing antihelix, while a real hyperplasia is very rare. Also, a prominent lobule can pose an independent problem.
Correction of the concha cavum Sickle-shaped resections of the lateral aspects of the concha cavum or even resections of large parts of the concha cartilage, are used in combination with the Converse technique, or as a separate procedure to correct a hyperplastic concha cavum. However, this is unnecessary in most cases as only
a pseudo-hyperplastic concha cavum is present with the main deformity being an underdeveloped antihelix. Only in rare cases of real hyperplasia, can a sparing
cutting edges of the cartilage are subsequently sutured together. Another method to flatten a protruding concha
cavum is via cavum rotation (or conchal setback). This technique uses conchaÐ mastoid sutures, thus bringing the antihelix edge closer to the skull. These sutures were described at the beginning of the 20th century by Morestin27
and Goldstein20 Furnas since 196829
, and popularised by David W. . Caution must be taken not to
confine the external auditory canal.
Figure 2 Aggressive cutting or scoring otoplasty techniques bury the risk of asymmetry and undesired edges or creases, which are difficult to correct and often cause an appearance which is more annoying than the preoperative state of protruding ears
Correction of the protruding lobule A number of techniques are known to correct a protruding lobule, most of them using skin resections28
. .
An elegant and effective method was described by Ralf Siegert, who used a special mattress suture to fix the subcutaneous layer of the lobule to the concha cartilage30
Skin resection: is it really necessary? From the early beginnings of otoplasty, it became routine to resect a more or less broad strip of skin in the course of the postauricular skin incision. This procedure is the result of the idea that an excess of skin will be present after otoplasty, and that the suture being under tension will help in approximating the auricle to the skull. Although it was recognised more than 100 years ago that corrections of the skin are of minor impact on the position of the auricle19
, many surgeons continue to
routinely resect skin when performing otoplasty. This is also surprising since it is well known that a skin suture under tension is a risk factor for the development of keloids, a dreaded complication of otoplasty31
. Owing to
excessive skin resection, an effacement of the postauricular sulcus can result, therefore hampering the wearing of spectacles or hearing aids.
resection be indicated. Usually, the
Relinquishment of aggressive otoplasty techniques In most cases, a surgeon will adopt the technique from his/her senior or teacher. This can lead to the passing down of methods from one generation of surgeons to the next, independent of their risks or effectiveness. It is important to consider that otoplasty is an aesthetic operation, which is predominantly performed in children, who must cope with the result for the rest of their lives. Therefore, possible complications of otoplasty are of paramount importance. While minor complications such as postoperative pain and hypersensitivity, relapse or asymmetry, thread granuloma, othematoma, or scar and small keloid formation, if handled adequately by the experienced surgeon, do not threaten the beneficial effect of otoplasty15
, difficult or impossible to reverse
complications must be taken seriously as auricular deformities after failed otoplasty often result in an appearance which is more striking and unfortunate
prime-journal.com | April/May 2012 ❚ 51 and William
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