Your Questions Answered By Dr. Neavin
What is otoplasty?
Otoplasty is the correction of external ear deformities. The list of ear deformities is long and include prominent ear, telephone ear, Stahl’s ear, constricted ear, question mark ear, Cagot ear, Cauliflower ear, Lop ear, scroll ear, and cryptotic ear. In the adult, correction usually calls for surgery since the cartilage is difficult to mold after maturity. Most adult otoplasty procedures can be done under local anesthesia in the office. Children will often need some type of sedation.
What are some of the more common ear deformities?
Prominent ear describes what we typically refer to in layman terms as “big ears”. Ears tend to “stick out”. Chilidren and adolescents often get teased with this ear deformity. Women commonly cover their ears with their hair. Men on the other hand, generally cannot. While there are no functional issues related to prominent ears, the psychological impact is something that shouldn’t be trivialized.
Telephone ear deformity refers to the ear resembling a traditional telephone where the upper (helix) and lower part (lobe) of the ear stick out. Commonly, it can be related to trauma or prior otoplasty ear surgery.
Stah’s ear is also called Spock’s ear (yes, from Leonard Nimoy in Star Trek). The deformity consists of a pointy ear shape and an extra fold in the scapha part of the ear. Before the cartilage is matured, it can be molded in the neonate. Adults will need surgical correction to reshape the ear
Constricted ear (also referred to as lop ear or cup ear) is one of the more common deformities. It’s severity varies widely from minor to quite obvious. The condition is characterized by a tightening or constricted upper helix (rim) whereby it is folded in. Sometimes, there are concomitant middle ear deformities associated with a severe constricted ear deformity.
Question mark ear
Question mark ear (also called Cosman ear) is a malformation that involves a cleft between the earlobe and helix. It is often part of the auriculo-condylar syndrome.
Cagot ear refers to an ear with no lobe.
Cauliflower ear refers to the ear that has suffered significant internal scarring that has left the ear resembling a cauliflower. The ear is thickened and irregular in appearance. The most common cause is trauma. Blood from some type of impact collects between the skin and cartilage. If it is not adequately drained, it will sit and result in a hardening of the cartilage. Rugby players, wrestlers and boxers are frequent owner’s of this deformity. Surgical l correction is the rule and requires tedious carving and reshaping of the external ear framework. The prevention of cauliflower ear relies in adequate ear protection and urgent drainage of blood from injury.
Scroll ear is a congenital defect characterized by a curling in of the outer edge of the ear (like a scroll).
A cryptotic ear is a hidden ear. Essentially, the external ear components aren’t external.
How are prominent ears corrected?
Prominent ears are one of the most common reasons for adult men and women seeking plastic surgery. The deformation is generally related to two components: the antihelix and concha. The antihelix is often underdeveloped and the conch is generally overdeveloped. There may be a third component, the ear lobe, which often can protrude. Thus, the goals of surgery are to create a sharper anti helical fold to bend the mid and upper ear back toward the head, and pin back the middle and lower third of the ear with conchal resection or set back and lobule reduction or setback.
The procedure uses a combination of well described techniques. 1. Mustarde stitches refer to the use of stitches that are placed to create a more defined anti-helix. Usually about four of these are placed using a permanent stitch. 2. The anterior surface of the ear (front) where the cartilage needs to bend is weakened from a small incision placed beneath the helical fold of the ear. 3. A football wedge shape of concha is excised and sewn together and set back into the mastoid fascia (area behind the ear) with permanent stitches to set back the middle and lower ear. 4. The lobule if protruding is pinned back using a combination of skin removal and permanent stitches securing the protruding lobe to cartilage employing the technique described by Gosain. 5. A bolster is placed on the ear for about 5 days to reduce chance of blood formation between skin and cartilage. 6. Headband wraps around the ear are used for 2 weeks.
How long does it take to correct prominent ears?
Generally, the surgery takes about 1.5 hours but time range a bit from patient to patient and surgeon to surgeon.
Can prominent ears be corrected while I am awake?
In adults or mature teenagers, prominent ear surgery can be performed while the patient is awake. Often, an oral sedative and pain medication is given prior to starting. The ear is then injected with lidocaine to anesthetize the ear. Once the ear is anesthetized, the surgery should be totally painless. In children, it is generally very difficult to perform surgery unless the child is under general anesthesia or a deep sleep with intravenous sedation.
Is it painful to correct prominent ears?
For the patients who have prominent ear surgery while awake, the initial injections to anesthetize the ear may pinch. However, once the ear is anesthetized, the procedure should be pain free.
How much does it cost to correct prominent ears?
Price will vary from surgeon to surgeon, and patient to patient with an average cost of
of $4,000 to $5,500. Additional fees such as anesthesia and operating room may apply.
Is it common to have asymmetry of my ears?
Yes. Most patients who seek prominent ear correction surgery will have some asymmetry of their ears. In fact, it is not uncommon for one ear to be noticeably bigger than the other. The goal of surgery is to create as much symmetry as possible.
What is the post operative care of prominent ear surgery?
The post operative care of prominent ear surgery is critical for long lasting, good results. A bolster dressing is usually secured into place and removed on day 3 to 5. Stitches in the back of the ear will dissolve but can be trimmed or removed if they cause discomfort 7 days after surgery. An elastic headband is then worn 24/7 for 2 weeks to keep the ears pinned back. This is important because the cartilage of the ears has memory and will try to spring back. After 2 weeks, night time head band wrapping is encouraged.
What are the potential risks of prominent ear surgery?
Fortunately, prominent ear surgery is a very safe operation. Major nerves and vessels are not at risk of injury nor is the eardrum. The most common complications that arise from this type of surgery include bleeding (which is why a bolster is applied), infection, and recurrence. Bleeding is not life threatening, naturally, but blood that collects within the space between cartilage and ear can harden if left undrained leading to a cosmetic deformity (see cauliflower ear). Infections are rare. Perhaps the most common reason for reoperation is some type of recurrence. Usually, the ears won’t spring back much. In fact, the ears are generally pinned back slightly more than usual just to account for potential elasticity during healing. If the ears do spring back to a position that is not satisfactory, they can be re-pinned after 3 months once swelling subsides and tissues soften. Some type of recurrence will occur in about 25% of people.