Classification and Algorithmic Management of Constricted Ears: A 22-Year Experience.

ABSTRACT

BACKGROUND: The classification and corrective methods for the constricted ears continue to be controversial. To clarify them, the authors have reviewed and analyzed cases operated on at their Center from January of 1992 to January of 2014. METHODS: A total of 164 ear cases (involving 139 patients), showing features of lidded helix, compression of scapha and fossa triangularis, and/or cup-like protrusions, were included in their study (microtias with constricted ear features were excluded) and reviewed through medical records, photographs, analysis of surgical methods, and postoperative outcomes. RESULTS: The deformed ears were classified into four graded types by means of the antihelical tubing test and the scapha-helix push test as follows type I (n = 21), type II (n = 63), type III (n = 38), and type IV (n = 42). Throughout this series, the authors have continued the improvement and performance of consistent operative techniques. Antihelical tubing, concha cartilage grafting, tumbling concha-cartilage flap, antihelical wrapping, and helical expansion were the preferred techniques. A total of 144 ear cases (88 percent) were followed for 1 month to 14 years (average, 13.2 months). The average score of aesthetic outcomes, rated on a four-point Likert scale (i.e., 1 = poor, 2 = fair, 3 = good, and 4 = excellent), was 3.3. Corrective methods and aesthetic outcomes for patients with each graded type of deformity were described. CONCLUSIONS: Constricted ears were effectively corrected by a graded surgical approach. All corrections were performed in one stage, without removal of deformed auricular cartilage. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.