Ear Reshaping or Pinning (otoplasty)
Otoplasty describes external ear surgery for cosmetic enhancement of the ear. Cosmetic ear surgery is routinely performed in both children and men.
Under the umbrella of otoplasty exists a variety of ear reshaping procedures related to either congenital defects or trauma. Earlobe surgery, while it could be included in this section, has its own devoted page. For earlobe reduction or repair please see the earlobe page on this website.
One of the most common otoplasty procedures performed addresses prominent ears (also known as protruding ears) in both children and men.
Prominent or protruding ears may also be referred to as otapostasis, bat ear, or “Dumbo” ear. The condition may be one sided (unilateral) or both sides (bilateral). It is considered congenital in nature, and while it poses no health risk, functional problems, or hearing issues, prominent ears can be emotionally devastating for children and even adults dues to teasing and long-term impact on self-image. The problem is a common one affecting an estimated three to five percent of the population, although there are not true measurements or mathematical calculations to define the diagnosis. Once prominent ears are developed, they rarely subside on their own. However, prior to six months of age, because the cartilage is so pliable and soft, bandaging and taping alone can be quite successful in reshaping the ear. After six months, surgery is the only effective means to set the ear back.
The hallmarks of prominent or protruding ears include malformations of cartilage in the concha, antihelix, and scapula. The concha is the concave bowl of cartilage that sits at the root of the ear just behind the ear canal. In prominent ears, the concha is overdeveloped, leading to protrusion of the ear from the skull. The antihelix is the convex, curved prominence of cartilage that parallels the outer curvature of the ear known as the helix (see diagram). In protruding ears, the antihelix is often underdeveloped, causing the outer part of the ear to stick out. In most scenarios, a combination of a malformed concha and antihelix is the culprit of the protruding ear and both must be addressed to produce the best results.
Surgery for Prominent Ears
Pinnaplasty or otoplasty can be performed on a child prior to the start of school. The advantages to early intervention include the elimination of potential teasing and bullying and the possibility of better long-term results, since the cartilage is more pliable and has less memory to spring back. Of course, the disadvantage is that the procedure for children will require either a general anesthetic or sedation and the recovery can be quite painful in a child. Adults, can have the procedure performed under local anesthesia in the office, although the cartilage will be thicker and more difficult to set back than in the child. Nonetheless, adults can still achieve wonderful results.
Details of the Surgery for Prominent Ears
The procedure and goals for both children and adults are similar. In children, a general anesthetic or deep IV sedation is required. Adults can tolerate local anesthesia in most cases.
The surgery requires an incision behind the ear to access the back of the ear and its underlying malformed cartilage components, the concha and antihelix. The principles include the concealment and resection of the cartilage and the creation of an antihelical fold with permanent stitches.
The prominent ear is usually marked by an oversized concha. To adequately set back the ear, a wedge of this cartilage is often removed, sutured together, and then sutured to the fascia behind the ear. In most cases, this alone won’t correct the protruding ear deformity since a poorly developed antihelical fold often accompanies the deformity.
Antihelical fold creation
The second principle of prominent ear correction involves the creation of a sharper antihelical fold. When the antihelical fold is poorly developed, the upper third of the ear protrudes. By sharpening this fold with permanent stitches, the upper third of the ear can be folded back closer to the head. The technique specifically involves the placement of permanent mattress stitches, referred to as the Mustarde otoplasty technique. Because the cartilage in adults is thick and has memory, the anterior surface of the antihelix is scored to weaken it and allow it to reshape easier.
The Mustarde stitches will shape the antihelix by setting the upper third of the ear back toward the head. Generally, over-correction is desired (and obtained) surgically to counteract the expected rebound of the cartilage forces, given their strength and memory.
After surgery, a bolster is applied and the ears will be wrapped for five days. After five days, the bolster is removed and wraps should continue for one to two weeks to allow the ears to heal in the set-back position. Sometimes, nighttime head wrapping is advisable for an additional week. Headbands can frequently substitute for medical elastic wraps to achieve a more suitable public appearance. Stitches placed behind the ear are usually dissolvable, but can be removed in the office after a week if desired.
The goal of prominent ear surgery is to create permanently symmetrical ears that protrude within the normal degree from the temporal scalp, which is 17 to 21 mm. While perfect is not always achievable, excellent results can almost always be obtained. Because the cartilage in the adult ear is thick and has memory, the set-back is usually over-corrected by a few millimeters in anticipation that the ear will spring back within six months or more.