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Revision Otoplasty: An Algorithm

Szychta, Pawel M.D., Ph.D.; Orfaniotis, Georgios; Stewart, Ken J. M.D.

Plastic and Reconstructive Surgery: October 2012 - Volume 130 - Issue 4 - p 907–916
doi: 10.1097/PRS.0b013e31825dc363
Cosmetic: Original Articles
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Background: The purpose of this study was to propose a surgical algorithm for revision otoplasty, based on an evaluation of patient concerns, desires, and clinical findings. A series of instructive cases is presented.

Methods: Thirty-six patients with an average age of approximately 15 years (range, 6 to 61 years), who underwent revision otoplasty between 2006 and 2011, were included. Demographic data, complications, indications for revision surgery, and operative details were retrieved from case notes and preoperative and postoperative photographs. Aesthetic outcomes were assessed by three independent plastic surgery consultants using a survey with 15 questions.

Results: Indications for revision otoplasty included recurrent prominence/undercorrection, distortion of scaphoid fossa, distortion of antihelical fold, hypertrophic conchal bowl, and telephone ear. The relevant surgical technique was performed according to the patient’s concerns and aspirations in line with the proposed protocol of treatment and included the following: posterior suturing, conchal bowl reduction, reconstruction with conchal cartilage, or reconstruction with cost al cartilage.

Conclusions: Otoplasty is performed frequently in young patients, and unsuccessful surgery can have a negative impact on their quality of life. Suturing techniques are safer than sculpting techniques, which can cause permanent ear deformity. Complications after sculpting techniques can lead to ear reconstruction. The proposed algorithm for revision otoplasty addresses the whole variety of ear deformations, providing the surgical options available to address these abnormalities.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Edinburgh, United Kingdom

From the Department of Plastic and Reconstructive Surgery, Royal Hospital for Sick Children; and the Department of Oncological Surgery and Breast Diseases, Polish Mother’s Memorial Hospital-Research Institute.

Received for publication November 7, 2011; accepted April 2, 2012.

Presented at the Annual Meeting of the British Association of Aesthetic Plastic Surgeons, in Birmingham, United Kingdom, September 29 through 30, 2011, and at the 2011 Winter Meeting of the British Association of Plastic, Reconstructive and Aesthetic Surgeons, in London, United Kingdom, November 30 through December 2, 2011.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Ken J. Stewart, M.D., Department of Plastic and Reconstructive Surgery, Royal Hospital for Sick Children, Sciennes Road, London EH9 1LF, United Kingdom, ken.stewart@luht.scot.nhs.uk

©2012American Society of Plastic Surgeons