Overview of Otoplasty
Otoplasty, a surgery used to reshape ears, was first described by Furnas in 1959. His technique used permanent sutures on a part of the ear called the conchomastoid to correct a condition known as prominauris, which is when the ears stick out more than normal.[1] A few years later, in 1962, Mustarde added another method which involved using permanent stitches (conchoscaphal sutures) to enhance the appearance of the ear.[2] This write-up is mainly about the main reason for otoplasty, which is to address prominauris.
Anatomy and Physiology of Otoplasty
Before a doctor can perform surgery on the ear, they need to have a solid knowledge of how the ear forms and is structured. The formation of the ear starts around the third week of pregnancy with something called the otic placode. By the seventh week of pregnancy, cartilage, a flexible connective tissue, begins to form. Certain structures important to the shape of the ear, known as the hillocks of His, fully develop by the 12th week of pregnancy and the rest of the ear continues to shape until around six months.
The hillocks of His are made up of six parts: the tragus (the small pointed piece of cartilage just in front of the ear opening), helical crus (the curved upper edge of outer ear), helix (the rim of the outer part of the ear), antihelix (inner ridge of the ear), antitragus (a small prominence just above earlobe), and lobule (what we know as the earlobe).
The first three parts (tragus, helical crus, and helix) grow from what is called the first pharyngeal arch during development. The last three parts (antihelix, antitragus, and lobule) come from the second pharyngeal arch.
Why do People Need Otoplasty
An otoplasty is a type of cosmetic surgery that is done to change the shape, size, or position of the ears. It can be done for a number of reasons, but the main reason is typically to correct protruding ears, a condition known as prominnauris. This occurs when the angle between the ear and the side of the head is more than 30 degrees. The ideal angle is between 20 to 30 degrees.
For an attractive appearance, the ideal distance from the edge of your ear to the scalp is about 15 to 20 millimeters, and the length of your ear should be about six centimeters. Additionally, the width of the external ear should be about 35 millimeters—which is about 55% of the ear’s length—and the distance from the outer rim of the ear to the skin covering the bone behind your ear should be roughly 2 to 2.5 centimeters.
When drawing parallel lines from the ridge of your nose to the long axis of your ear, your ear should be rotated backward by about 15 degrees from the vertical plane. Furthermore, the length of your ear should match the length of your nose, and the top of your ear should align with your eyebrow, while the bottom lines up with the base of your nose.
An interesting fact to know about the outer ear is that its feeling is supplied by multiple nerves, including those from the trigeminal nerve, facial nerve, and other major cranial nerves. This makes it a bit difficult to obtain satisfactory pain relief with localized anesthesia. The blood supply to the outer ear comes from several arteries near the ear.
About 5% of Caucasians have prominent ears. This condition often runs in families, with the actual cause attributed to two aspects: an underdeveloped fold that runs along the outer rim of the ear, and excessive ear cartilage. The first cause is the more common one. It’s recommended that the surgery be done between the ages of 5 and 6, when the ear has grown to about 90% of its adult size and the cartilage has become firmer.
How is Otoplasty performed
The Mustarde Technique is a surgical procedure used to fix an improperly formed part of the ear known as the antihelical fold. The goal is to create a more natural fold in the ear that was previously underdeveloped. First, the surgeon gently presses on the ear to determine the location of the new fold. They will then use a special type of stitch, known as a mattress suture, to create this fold. In preparation for this, the surgeon will inject a local numbing agent, typically a mixture of lidocaine and epinephrine, to minimize discomfort and control bleeding. They might also use a method called ‘cartilage tattoo’, where they mark the area to be sutured with a harmless dye. To gain access to the area, an incision is made behind the ear.
In some cases, the surgeon may opt to weaken the ear cartilage to enhance the flexibility of the ear. They do this by scoring, or making small cuts into the cartilage. Typically, three separate stitches are placed, spread around 10mm apart.
Another procedure for ear correction is the Furnas technique, which is designed to correct an area of the ear known as the conchal cartilage when it’s causing problems. In this procedure, around four permanent stitches are used to joint the outer layer of the conchal cartilage to the mastoid part of the ear, taking care to avoid the skin on the front side of the concha, or ear bowl.
The Davis technique might also be an option. This involves removing some of the conchal cartilage if there’s too much of it.
After any of these surgeries, the ear is typically padded with a special gauze to protect it and support healing. Then additional padding and a dressing that doesn’t obstruct vision is applied. The dressing is usually removed the next day to make sure there’s no build-up of blood.
Possible Complications of Otoplasty
Some of the complications after ear reshaping surgery, also known as otoplasty, can occur early or later. Early complications include blood clots (hematoma), bleeding, infections such as inflammation of the ear cartilage (perichondritis), the surgical wound not healing well (dehiscence), and death of skin tissue (necrosis). The most serious issue soon after the operation is a hematoma. If a hematoma is not treated right away, it can progress to an infection, which can worsen cartilage and skin damage and lead to a “cauliflower” shaped ear deformity. Cartilage necrosis can also come from sutures (stitches) that are too tight or from too much pressure from bandages. Hematomas usually show up one to three days after surgery and can cause pain. If you feel pain, you should get it checked out promptly.
Late complications can include excessive scarring, sutures breaking through the skin, hypersensitivity, and, most importantly, dissatisfaction with how the ear looks. The most common complication of ear surgery is not being happy with the results. Some complications can affect the shape of the ear. For instance, a ‘telephone ear’ deformity can occur if the middle stitch is too tight compared to stitches at the top and bottom of the ear. A reverse telephone ear results from tightening the top and bottom stitches too much. Improperly placed sutures can cause a sharp vertical fold in the ear’s inner rim, resulting in a ‘vertical post’ deformity. Lastly, if the stitches are too tight, the inner rim of the ear might not be visible from the front, a complication called the ‘hidden helix’.
What Else Should I Know About Otoplasty?
Otoplasty is surgery to change the shape, position, or size of your ears. Knowing why and how it is done can lead to better results. Understanding the reasons for the surgery (indications) and the exact methods the surgeon uses (surgical techniques) can help you make the best decision and lead to successful results.
