Otoplasty

Otoplasty is surgery that corrects the shape, size or position of the ears. Its most common indication is prominent ears, but it also treats asymmetry, overly large ears and other cartilage deformities. It is one of the few cosmetic operations frequently performed on children.

History

The first correction of prominent ears is attributed to Edward Ely in New York in 1881, who removed skin and cartilage. Modern techniques are based on reshaping the cartilage rather than removing it: in 1963 John Mustardé described the sutures that recreate the antihelical fold, and in 1968 Furnas described the sutures that bring the concha closer to the mastoid bone. Both techniques, often combined, remain the basis of otoplasty today.

Indications

• Prominent ears, due to an underdeveloped antihelical fold, an oversized concha or both.
• Asymmetry between the two ears.
• Macrotia (large ears) and prominent earlobes.
• After-effects of trauma.

It can be performed from 5-6 years of age, when the ear has almost reached its adult size, and at any point in adulthood. Operating before school age helps avoid teasing.

Techniques

• Mustardé sutures: permanent stitches on the back of the cartilage that create the antihelical fold.
• Furnas sutures (concha-mastoid): bring the concha closer to the head.
• Concha reduction: a small piece of cartilage is removed when the concha is very deep.
• Cartilage scoring techniques (Stenström and similar), which weaken the front surface so it folds.

The incision is made in the groove behind the ear, where the scar is hidden.

Risks and complications

The most common are haematoma, infection and discomfort in the first weeks. In the longer term there may be partial recurrence (the ear moves out again slightly), overcorrection, asymmetry, extrusion of a stitch or, in predisposed skin, hypertrophic scars or keloids.

Recovery and results

A bandage is worn for the first few days, followed by an elastic headband at night for several weeks. Discomfort is mild. The result is visible when the bandage comes off, settles in two or three months and is permanent in the vast majority of cases.