Sir:
In practical situations, the prominent ear as a single deformity is encountered less frequently compared with multiple underlying deformities of the auricle.1,2 Thus, a sound technique is not the one that ensures a simple reduction of the cephaloconchal angle, but the one that can also correct other associated deformities of the auricle.1–5
During the course of 12 years, we used this approach with 403 patients. The age of our patients ranged from 6 to 35 years. Seven patients had unilateral prominence of the ear. Others had bilateral prominence, very frequently accompanied by other deformities of the auricle. Most of the patients were followed for 6 to 12 months postoperatively (some of them were followed for up to 7 years).
Before surgery, we always make a thorough preoperative assessment of prominent ears. Then, subperichondrial resection is used to separate the complete anterior surface of the auricle with its entire configuration, which must be visible.
The new antihelix is made by making a full-thickness incision of the cartilage over its new projection, leaving the perichondrium intact. The incision is Y-shaped, which resembles the antihelix with its crura. Then, we shape the cartilage by trimming, modeling, and removing the sharp margins of the antihelix; we further thin out the cartilage, so that it becomes still easier to fold and regain its natural aspect.
Having thus shaped the new helix, we place one or two absorbable sutures using 5-0 Vicryl (Ethicon, Inc., Somerville, N.J.) or polydioxanone thread. These sutures serve only for support until fibrosis anchors the new antihelix in its position. We solved prominence in all patients subjected to the described procedure with the natural shape and configuration of their ears (Fig. 1).
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Fig. 1: A 7-year old boy with prominent ears before and 1 year after surgery. (Left) Preoperative frontal view. (Right) Postoperative frontal view.
The place of incision is difficult to see because it is hidden on the posterior side of the ear, in the sulcus formed by the helical fossa. After surgery, none of our patients had the prominence of the upper part of the ear as a complication.
We place the incision high at the level of retroauricular projection of the fossa helicis so that it is more difficult to notice. In our opinion, excessive retroauricular skin excision should be avoided; otherwise, it will make the auricle tense and the incision visible. We thin out the cartilage by trimming it to make it more compliant, and remove all sharp margins, deepening and modeling the triangular fossa so that the auricle assumes its normal and natural-appearing configuration.
Using this technique, we can very easily shape the cartilage, bringing it into the natural configuration. The prominence of the ear is efficiently resolved by a Y-shaped incision in the region of the new antihelix and the anterior and posterior crura, and subsequent shaping and modeling of the configuration of the cartilage by trimming.
Milan D. Jovanović, M.D., Ph.D.
Miodrag M. Colić, M.D., Ph.D.
Lukas Rasulić, M.D., Ph.D.
Department of Plastic and Reconstructive Surgery, University of Belgrade School of Medicine, and, Institute for Burns, Plastic, and Reconstructive Surgery, Clinical Center of Serbia, Belgrade, Serbia
DISCLOSURE
The authors have no financial interest to declare in relation to the content of this article.
PATIENT CONSENT
Parents or guardians provided written consent for use of the patient's images.
REFERENCES
1. Wolfe SA. Timing of otoplasty for prominent ears. Plast Reconstr Surg. 2006;117:680; author reply 680–681.
2. Mustarde JC. The correction of prominent ears by using simple mattress sutures. Br J Plast Surg. 1963;16:170–178.
3. Stenstrom SJ. A “natural” technique for correction of congenitally prominent ears. Plast Reconstr Surg. 1963;32:509–518.
4. Janz BA, Cole P, Hollier LH Jr, Stal S. Treatment of prominent and constricted ear anomalies. Plast Reconstr Surg. 2009;124:27e–37e.
5. Lentz AK, Plikaitis CM, Bauer BS. Understanding the unfavorable result after otoplasty: An integrated approach to correction. Plast Reconstr Surg. 2011;128:536–544.
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