Modified Island Technique for Prominent Ears.

There have been several methods described for the correction of prominent ears, including techniques that excise, bend, suture, score, or cut the auricular cartilage. The Island Technique, proposed by Pitanguy, is based on the creation of a cartilage island to define the antihelix and correct the conchoscaphal angle. Visibility of sharp edges has been the main criticism of this technique. To avoid them, we advise performing an internal bevel incision to round off the edges and achieve a more natural look. Also, sometimes prominent ears are asymmetric with different conchoscaphal angles, determining a residual but protruding upper pole, thus requiring different treatment on each side. For such cases, we propose the additional excision of a cartilage strip from the lower border of the auricular scapha, with a greater conchoscaphal angle. In this way, cartilage islands of similar width and identical antihelixes for both ears are created and a symmetric result is achieved. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A novel approach for classifying protruding ears is easy to calculate and implement in daily clinical practice.

AIM: Protruding ears are a prevalent deformity, with a reported incidence of 5% in the paediatric population, but it lacks a simple digital classification. The aim of this study was to find a parameter that would objectively allow the photographic classification of protrusion, by comparing frontal facial images of patients with protruding ears with aged-matched controls. METHODS: This prospective cohort study compared the frontal facial images of 105 patients with protruding ears with 112 aged-matched controls without protruding ears. A rectangle was drawn on the image for each ear, encompassing its full visible anatomy. The width of each rectangle was divided by its height to create an index. The mean value of both ears was defined as the Frontal Aesthetics Translation Index for Measurement of Amplitude of the Ears (FATIMAE). RESULTS: The calculated values for group with protruding ears were significantly higher than for the controls. No gender differences were found. However, the FATIMAE values decreased with age, establishing different classification criteria for separate age groups. CONCLUSION: The FATIMAE is easy to calculate and implement in daily clinical practice and establishes a practical approach for classification of protrusion, as well as for referral criteria for a specialised surgical consultation.

Diagnosis and Prevalence of Prominent Lobules in Otoplasty: Analysis of 120 Patients with Prominent Ears.

BACKGROUND: The prominence of the ear lobule is considered an anomaly of secondary importance and receives correspondingly less attention in literature. We reviewed a case series of otoplasty patients and analyzed the prevalence of lobule prominence. METHODS: Records of otoplasties between 2007 and 2013 were reviewed. Inclusion criteria were: (1) primary otoplasties; (2) prominence of both ears; and (3) otoplasties conducted by the main author. Patients were divided into two groups: (1) A general group (GG) containing all the patients, and (2) a lobule correction group (LG)-a subgroup of GG containing only the patients who needed lobule correction. RESULTS: From a total of 291 patients, 120 patients were included in GG and 27 patients in LG. There was no statistical difference between groups GG and LG in terms of age and gender. Preoperative diagnosis of lobule prominence was correctly established in 14 patients; 13 patients were diagnosed during surgery. CONCLUSIONS: Lobule prominence should not be underestimated since its diagnosis may be missed in the preoperative period-nearly 50 % in our case. Also its prevalence (22.5 %) is not as infrequent as some may think. Knowledge of lobule correction techniques before surgery is important to avoid less than optimal results in otoplasty. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

[Otoplasty]. / Cure d'oreilles décollées.

Prominent ears can have a significant psychological impact especially in children. It is often the subject of negative remarks among classmates. Prominent ears are the result of one or more congenital anomalies that may be associated together in various degrees. Absence of antihelical fold, opening the cephalo-conchal angle and conchal hypertrophy are the most common. The surgery aims to correct these anomalies, by reshaping the cartilage in order to obtain well-shaped ears that is normally positioned and oriented with natural size and appearance. It combines different steps that need to be simple and fast. Retro-auricular incision, and dissection posteriorly allows to expose and remove the post-auricular muscle. Modeling of antihelical fold aims to restore a natural relief by closing the scapha-conchal angle. The concha is then buried and is securely attached to the pre-mastoid periosteum, which by consequence closes cephalo-conchal angle. The result must be harmonious and sustainable. Each surgeon adopts a suitable technique for him to obtain best results, by avoiding complications mainly infection, which is fortunately exceptional.

Comparative study of the effectiveness of the surgical technique with and without preservation of the conchal cartilage in otoplasty through the measure of the cephalo-auricular and scapho-conchal angles.

OBJECTIVES: Prominent ear abnormalities affect 5% of the population. A prospective, double-blind study of patients who underwent otoplasty procedures to correct these abnormalities was conducted to compare two surgical techniques. They diverge by the preservation or not of conchal cartilage. METHODS: The two techniques were compared by measuring the cephalo-auricular and scapho-conchal angles. Measurements were performed in pre and 6-months post-operative periods using alginate molding. Twenty patients were randomly assigned to two groups (with and without cartilage preservation) with 10 participants each. Student's t-test, Covariance Analysis Model (ANCOVA), and non-parametric Mann-Whitney were used in the statistical analyses. RESULTS: A significant reduction in the average of the cephalo-auricular and scapho-conchal angles was observed in both surgical procedures (p<0.001). However, no significant difference was found between them (p=0.887). CONCLUSION: The two techniques analyzed in this study fulfilled their objectives. Therefore, further comparative studies are needed to confirm the superiority of one over the other. LEVEL I: Evidence obtained from at least one properly designed randomized controlled trial.

Objective evaluation of nonsurgical treatment of prominent ears: A systematic review.

Background: The prominent ear is a type of congenital ear deformity that can be corrected by a variety of nonsurgical treatments, such as splinting and the taping method. However, there is no objective evaluation method that is universally accepted. The aim of this review is to evaluate objective measurement methods that are used in the available literature to analyze nonsurgical treatment of prominent ears. Methods: A systematic review was performed in the MEDLINE and Embase databases in December 2022 and updated on April 2023 according to Preferred Reporting Items for Systematics and Meta-Analyses (PRISMA) guideline. Any study using objective measurements (continuous variables such as distance and angle) to evaluate the effect of nonsurgical treatment of prominent ears was included. The Joanna Briggs Institute (JBI) critical appraisal for case series was used for quality assessment. Results: A total of 286 studies were screened for eligibility, of which five articles were eligible for inclusion. All of the included studies were case series. The helix mastoid distance (HMD) is the most commonly used parameter to measure treatment outcome. Pinna and cartilage stiffness, length, and width were also used, but without clear statistical relevance. HMD was classified into grading groups (i.e. good, moderate, and poor) to evaluate the treatment's effect. Conclusion: Based on the included studies, objective measurements are rarely used, and when used, they are largely heterogeneous. Although HMD was the most frequent measurement used, all studies used different definitions for the measurement and grouped subsequent outcomes differently. Automated algorithms, based on three-dimensional imaging, could be used for object measurements in the nonsurgical treatment of prominent ears.

Quality of life after otoplasty for prominent ears in children.

AIM: Prominent ears are a common congenital malformation and are associated with low self-esteem, social isolation and diminished school performance. Our goal was to evaluate the influence of otoplasty on children's quality of life (QoL). MATERIAL AND METHODS: Patients submitted to otoplasty from 2016 to 2018 were summoned for a reevaluation. Seventy patients and respective caregivers agreed to participate. Surgical, demographic and clinical data were reviewed from electronic registries. TWO SETS OF INQUIRIES WERE PERFORMED: Pediatric Quality of Life Inventory 4.0 (for parent and child) and an adaptation of the Glasgow Children Benefit Inventory (GCBI-b). Fifteen patients were excluded for incomplete inquiries. RESULTS: Fifty-five patients were included, 70.9% were males. Median age at surgery was 7.7 ±â€¯3.3 years. Aesthetic dissatisfaction was the main previous negative experience. Median self-report quality of life was 85.6% and parent-report was 86.9%. Median GCBI-b was +20.5, indicating an improvement in patients' QoL. Bullying and high parental expectations for life change post-surgery were predictive of higher GCBI-b scores (p < 0.05). Ninety-six percent of parents would recommend surgery to other children. CONCLUSIONS: Otoplasty is a valid treatment option for prominent ears in children,improving not only aesthetics but also health-related QoL.

Our Experience With the Correction of Prominent Ear Deformity.

The ear has a unique architecture of cartilage and skin. The incidence of the prominent ear is about 5%. Surgical correction of the prominent or protruding ear can be carried out either by anterior or posterior approach. We created antihelical fold of cartilage by utilizing a posterior incision to score the anterior cartilage of the lateral scapha with a knife. Sutures were often used to uphold the produced fold. The additional procedure of conchal reduction and concho-mastoid suture was done when required. The objective of our research is to evaluate the patient's and surgeon's satisfaction with our technique of prominent ear correction and identify any complication if it occurs post-operatively. This is a retrospective study over a period of eight years (2011-2018) which includes all patients presented to Liaquat National Hospital with prominent ear. A total of 47 patients were included. Patients with a previous history of otoplasty were excluded. Patients were followed up for at least six months postoperatively. The outcome was assessed via Visual Analogue Score by a patient, surgeon, and a third observer (assessor). The average score by the surgeon was 7.9, by the patient it was 8.4 and by the assessor it was 8.1. The average pre-operative concho-mastoid distance was 2.2 cm which decreases to 1.4 cm post-operatively. Correction of the prominent ear by this technique is safe and easy. We did not experience any major complication, giving reproducible and good aesthetic results.

Repair of the Protruding Lobule.

BACKGROUND: In this paper, the author describes a novel step-by-step setback procedure for correcting protruding lobules; the success of correcting protruding lobules depends on the nature and severity of the auricular lobule deformity. Although the auricular lobules occupy small areas on either side of the head, protruding or misshapen lobules exert a significant and sometimes exaggerated disfiguring influence on the otherwise aesthetically pleasing appearance of the ears. Because the lobule is a soft structure without a cartilage skeleton, the correction of a protruding ear and lobule is always a challenge. METHODS: Protruding lobule abnormalities stem from deformities of the cauda helicis (cartilaginous helical tail) of the auricular lobule, soft tissue, and/or a shortage of anterior skin; however, the abnormalities are usually a combination of all of the above. Therefore, surgical procedures should address all of the causes of lobule deformity and preserve as much tissue and blood supply as possible. Achieving a successful intervention depends on reducing the tension that affects the entire lobule. RESULTS: This is a retrospective analysis of 660 patients who had otoplasty performed by the first author between January 2010 and December 2017. Correction of the ear lobule was needed in 398 (60.3%) patients. Of these, 44.6% patients were male, 55.4% female and the average age was 9 years (range 4-18 years). In this patient cohort, 356 (89.4%) required bilateral and 42 (10.5%) unilateral ear lobule correction. Standardized pre- and postoperative images were recorded for each patient. CONCLUSION: The goal of a setback procedure is a natural and harmonious auricular lobule appearance that is achieved through simple, optimal surgery that addresses all of the features of the auricular anatomy.

Neonatal ear splinting for congenital ear deformities✰.

Splinting of ears in neonates to correct the congenital auricular deformities has been well described. Despite being a non-invasive technique and having a potential to prevent need for correctional surgery, it's up-take across the UK has been poor. This study evaluates the outcomes of neonatal ear splinting for congenital ear deformities from a regional ear splinting service. The retrospective study of patients undergoing neonatal ear splinting from 2009- 2015 was conducted at the Welsh Centre for Burns and Plastic Surgery. A total of 82 (n = 123 ears) neonates were treated. At the cessation of treatment 93% were reported as improved/excellent by a clinician. Longer-term parent evaluation showed improved/excellent result in 78.89%. Neonatal ear splinting is relatively inexpensive and has a high rate of success for a variety of neonatal ear deformities. Promoting awareness, identifying patients early and commencing treatment may reduce surgical correction of auricular deformities.

The psychological, social and educational impact of prominent ears: A systematic review.

BACKGROUND: Prominent ears are the most common congenital abnormality of the head and neck, occurring in 5% of the Caucasian population. Facial disfigurement can cause psychosocial distress, low self-esteem and varying levels of social isolation most notable in school-age children. Although prominent ear correction is the most frequently performed aesthetic operation in children and adolescents, to our knowledge, the relationship between prominent ears and psychological, social and educational issues has not been systematically assessed. PURPOSE OF STUDY: To investigate the psychological, social and educational impact of prominent ears and to examine how prominent ear correction affects health-related quality of life (HRQoL). METHODS: A systematic review was conducted using a protocol registered with PROSPERO and in line with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses statement. A comprehensive search of the literature was conducted using MEDLINE, EMBASE, PyscINFO, HMIC Health Management Information Consortium, Ovid Journals Database, NHS Wales Full-Text Journals and The Cochrane Database. The inclusion criteria stated that any study investigating the association between psychological, social or educational issues, or HRQoL and prominent ears or otoplasty should be incorporated. All studies were reviewed by two authors, with data extracted for the studies finally included. FINDINGS: Fourteen articles were finally included, with a total of 786 patients. Thirteen out of 14 papers analysed the post-operative effect of surgical correction of prominent ears. The most common motivating factor for surgery was bullying, with young males of school age being the worst affected. Prominent ear patients report higher levels of bullying and social problems, and lower levels of physical activity than patients with more severe facial disfigurements. Every study that assessed the psychosocial impact of surgery on prominent ears found a significant benefit to HRQoL. CONCLUSION AND RELEVANCE: Prominent ears pose severe psychological and social issues that should not be underestimated. Surgical correction has consistently been shown to significantly improve HRQoL.

Traumatic atlanto-axial rotatory subluxation after surgical correction of prominent ears: Case report and review of the literature.

Corrective surgery of prominent ears may be justified for social or aesthetic reasons during childhood or adulthood. Post-operative complications occur in approximately 0 to 8.4% of cases. This case describes a rare atlanto-axoid rotatory subluxation after bilateral surgical correction of prominent ears under general anesthesia. Orthopedic treatment was done after two months of medical roaming outside of our center. The one-year post-operative clinic consultation and radiological exam were normal. Only the psychological impact of the episode remained. Traumatic atlanto-axial rotatory subluxation is a rare complication but should be considered after post-operative torticollis in order to aid with diagnosis and allow doctors to implement the appropriate course of treatment.

Comparative study of the effectiveness of the surgical technique with and without preservation of the conchal cartilage in otoplasty through the measure of the cephalo-auricular and scapho-conchal angles

Abstract Objectives Prominent ear abnormalities affect 5% of the population. A prospective, double-blind study of patients who underwent otoplasty procedures to correct these abnormalities was conducted to compare two surgical techniques. They diverge by the preservation or not of conchal cartilage. Methods The two techniques were compared by measuring the cephalo-auricular and scapho-conchal angles. Measurements were performed in pre and 6-months post-operative periods using alginate molding. Twenty patients were randomly assigned to two groups (with and without cartilage preservation) with 10 participants each. Student's t-test, Covariance Analysis Model (ANCOVA), and non-parametric Mann-Whitney were used in the statistical analyses. Results A significant reduction in the average of the cephalo-auricular and scapho-conchal angles was observed in both surgical procedures (p < 0.001). However, no significant difference was found between them (p = 0.887). Conclusion The two techniques analyzed in this study fulfilled their objectives. Therefore, further comparative studies are needed to confirm the superiority of one over the other. Level I Evidence obtained from at least one properly designed randomized controlled trial.

Management of the Prominent Ear.

This article incorporates the opinions and preferred surgical options in managing patients of 3 prominent facial plastic surgeons who have large otoplasty practices. Six different questions covering the management of prominent ears are answered by the 3 practitioners. Nonsurgical options for the treatment of prominent ears are discussed. The role of cartilage-cutting and cartilage-sparing techniques as well as individual preferred otoplasty techniques are thoroughly covered. Postoperative management of these patients is presented by the individual surgeons.

Pinna synthetic mold for otoplasty techniques application.

INTRODUCTION: The ear deformity Tanzer type V, also known as prominent ears, is the most common genetic defect of the pinna. The surgery designed for its correction is known as otoplasty. This esthetic surgery can be performed using different techniques, which requires great skill of its operator. OBJECTIVE: The purpose of this work is the development of a new tool for otoplasty techniques training, aimed on the possibility to minimize errors during the otoplasty. METHODS: Synthetic molds of the external ear from patients with Tanzer type V deformity were made, using silicone material and rayon. RESULTS: The main procedures of otoplasty could be performed in the molds made of silicone and rayon with a good esthetic result. CONCLUSION: The elaborated molds had identical size and shape of a human ear and could be positioned in the same shape of the patient ears. Thus, the synthetic molds were presented as promising simulation tools for the training and surgical enhancement of otoplasty, especially for doctors beginners.

The 'WiFi' otoplasty : Combined concentric posterior microchondrectomies and sutures for correction of prominent ears.

BACKGROUND: Prominent ears are by far the most common congenital ear deformity. Many techniques have been described using one or a combination of 3 basic methods: cartilage cutting, cartilage weakening and pure cartilage shaping techniques. The ideal otoplasty technique should yield a natural correction of the deformity, with low recurrence rates and with little risk of complications. METHODS: A new cartilage shaping technique using closing wedge concentric microchondrectomies through an entirely posterior approach is presented. Between 2006 and 2017, 200 bilateral otoplasties using this 'WiFi' pattern technique were performed. This technique combined with Mustarde sutures is based on the excision of concentric partial thickness cartilage wedges designed in the pattern of the WiFi symbol. RESULTS: There were no major complications such as anterior skin necrosis and no returns to theatre for infections or haematomas. 3 patients (1.5%) had complete recurrence of the deformity and 10 patients (5%) had to undergo a minor revision for recurrence at the upper pole. 5 patients have had exposure of the end of the permanent upper pole scapho-temporal suture more than 3 months after surgery requiring simple outpatient suture trimming/removal without any recurrence of results. Palpable or bridging sutures were present upon clinical examination in 10 patients (5%) but did not require revision surgery. CONCLUSIONS: Here, we describe a fast, safe and reliable technique for otoplasty with no need for extensive dissection, which is applicable to the full range of deformity.

Otoplasty for prominent ears - demographics and surgical timing in different populations.

INTRODUCTION: Prominent ears are seen in approximately 5% of the population. This benign condition can be treated surgically to reduce or prevent psychological and social problems, most commonly in children before the start of school. Our aim was to examine the demographic characteristics of patients undergoing prominent ear surgery in Finland, and compare findings with international data. METHODS: A retrospective study of all the patients treated for prominent ears in our academic tertiary care referral center during 2007-2011 was performed to gather demographic details of operated patients. A systematic review of published series of prominent ear surgery after the year 2000 was performed to gather demographic details for international comparison. RESULTS: A total of 180 patients were operated in our institution for prominent ears, most of the cases (78.9%) were bilateral. Age at operation ranged between 3 and 36 years, with mean of 9.2 y and median of 7 y. The most common reason for seeking operative treatment was aesthetic complaint, followed by bullying. Review process gathered 20 publications, describing a total of 4433 patients who had been operated for prominent ears. There was wide variation the mean age at operation, ranging 7-38 y while the mean overall was 15.0y. Gender distribution of patient samples was also very variable, with percentage of females ranging from 38 to 71% (overall 52%). There was also considerable variation in the tendency to perform unilateral operations: from 0% up to 21% of the reported population. There were no statistically significant correlations linking these demographic variables, though there was a trend that females are more likely to have this operation performed at an older age. CONCLUSIONS: The treatment culture of prominent ear surgery varies substantially in international comparison. The age at which this operation is performed showed most variation. Omitting some of the basic demographic variables while reporting the results of surgery was common in the reviewed publications.

Complications after prominent ear correction: A systematic review of the literature.

BACKGROUND: There is great diversity in reported post-operative outcomes for otoplasty, with the incidence of haematoma or infection ranging from 0% to 15.6% and 0%-10%, respectively. With such variability, it is difficult to determine an overall 'average' incidence of common post-operative complications. METHODS: A systematic review of the most relevant medical databases was conducted for studies available in English published between January 1, 2000, and December 31, 2015. Using the dataset, pooled estimates for the incidence of the primary and secondary outcomes were calculated for all included studies. The primary outcome was haematoma and/or bleeding incidence, and the secondary outcomes included infection, skin/wound healing problems, suture-related problems, scarring, pain and itching, and revision surgeries/recurrence. Comparable sub-group analysis of studies was also performed using calculated pooled proportions. RESULTS: After screening, 28 articles involving 3493 patients were included in the study. Pooled proportions revealed that haematoma and/or bleeding incidence was 2.5% (95% CI: 1.4-3.8%), infection 0.8% (95% CI: 0.4-1.3%), skin/wound healing problems 3% (95% CI: 1.4-5.1%), suture-related problems 1.8% (95% CI: 0.8-3.2%), scarring 1.6% (95% CI: 0.8-2.6%), pain and itching 13% (95% CI: 5.4-23.1%) and revision surgeries/recurrence 5% (95% CI: 2.9-7.7%). CONCLUSIONS: By pooling proportions of reported complications, the results of this study could be useful in the personal audit of practice and will be a point of reference for comparing novel surgical techniques in the future.