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Otoplasty: The Belfast Experience. A 10-year Review

McGarry, Kevin MBBCh, BAO, MSc, MRCS; McBride, Michael J. MBBch, BAO, MSc, MRCS; Martin, Serena V. MBBCh, BAO (Hons), BSc (Hons), MRCS; Black, Claire FRCS (Plast); Khan, Khalid FRCS (Plast); Rashid, Abid FRCS (Plast); Fogarty, Brendan FRCS (Plast)

Plastic and Reconstructive Surgery - Global Open: August 2019 - Volume 7 - Issue 8S-1 - p 6-7
doi: 10.1097/01.GOX.0000584220.23590.d5
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Royal Belfast Hospital for Sick Children, Belfast, United Kingdom

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

PURPOSE: Prominent ear is a common congenital anomaly with an estimated incidence of 5%. Otoplasty aims to address the abnormal shape of the auricular cartilage framework. The vast range of operative techniques and refinements belies a lack of consensus as to the proper surgical approach to this common condition. Recent publications favor cartilage suturing techniques over cartilage scoring methods. The Belfast experience of different otoplasty techniques of 1,199 patients over a 10-year period is reviewed.

METHODS AND MATERIALS: All pediatric cases undergoing correction of prominent ear/ears from 2005 to 2015 were included in this retrospective case note analysis and follow-up study. Data collected included age, sex, age at referral, age at outpatient clinic, indication for referral, laterality, family history, and cause of prominence. Also collected was age at surgery, time on waiting list, method of anesthesia, surgeon grade/supervision, surgical technique utilized, hospital stay, duration and compliance with head bandage, and complication rate associated with each technique. Experience including number of cases and follow-up. Over a 10-year period, 1,199 otoplasties were performed: 1,134 bilateral and 65 unilateral (a total of 2,333 ears corrected). Of these, 707 (59%) cases were male and 494 (41%) were female. Patient review was at 1 week and 3 months postoperatively.

SUMMARY OF RESULTS: Mean age at surgery was 9 years, median 9 years, and range 2–14 years. Surgery under combined general and local anesthetic in 94% cases, general anesthetic-only 4%, and local anesthetic-only 2%. Surgery performed by a consultant in 29%, registrar 68%, and a core trainee in 3% of cases. Surgical technique: conventional anterior cartilage scoring in 1,575 (68%) cases, suture-only technique in 215 cases (9%), conchal/cartilage reduction in 82 cases (3%), combined conventional cartilage scoring and suturing in 444 cases (19%), and combined suturing and conchal reduction in 17 cases (1%).

Complication rates for:

Anterior scoring (1,575 ears)

16 ears (1.01%) bleeding requiring early redressing

25 ears (1.58%) developed hematoma requiring theater for evacuation

8 ears (0.32%) infection requiring antibiotics

5 ears (0.32%) wound dehiscence

27 ears (1.715%) developed pressure necrosis

3 ears (0.63%) developed keloid scars

11 ears (0.69%) deemed to have a residual asymmetry deformity

Suture-only otoplasty (215 ears)

0 ears (0%) bleeding requiring redressing

0 ears (0%) hematoma requiring evacuation

4 ears (1.39%) infection requiring antibiotics

1 ear (0.47%) wound dehiscence

0 ears (0%) developed pressure necrosis

0 ears (0%) developed keloid scarring

0 ears (0%) were deemed to have a residual asymmetry deformity

The remaining ears underwent combination procedures, again with low associated complication rates. For all patients, satisfaction based on an objective questionnaire was found to be 96% postoperatively.

CONCLUSIONS: Otoplasty with anterior scoring is a safe procedure, and overall, our results highlight it to be a reliable, reproducible technique with high patient satisfaction. We feel that our institution presents results that are comparable to other studies that rely only on suture correction otoplasty, with a complication rate that is similar if not superior to this technique.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.