OTOPLASTY (EAR SURGERY)
Season 1, Episode 6
This episode explores a comprehensive overview of otoplasty, a surgical procedure to correct prominent ears. It traces the history and evolution of otoplasty techniques, highlighting various approaches including sculpting, suturing, and combined methods. The authors discuss anatomical considerations, patient selection, and different surgical management options, including both traditional and newer, minimally invasive techniques. Furthermore, the article examines outcomes and presents patient examples to illustrate how tailored surgical approaches can achieve optimal, patient-centered aesthetic results in otoplasty.
Comprehensive Study Guide
Short Answer Questions
Instructions: Please answer the following questions in 2-3 sentences each.
Describe two key anatomical measurements that define a "normal" adult auricle, according to the text.
Explain Matsuo's theory regarding the cause of prominent ears in newborns, highlighting the role of maternal hormones and cartilage development.
What are the two most common anatomical findings in patients with prominent ears, as mentioned in the pathophysiology section?
Briefly describe the Mustarde technique for otoplasty and its primary goal in correcting prominent ears.
What is the primary advantage of incisionless otoplasty compared to traditional surgical otoplasty, according to the text?
Explain the purpose of conchal-mastoid (C-M) sutures in otoplasty procedures.
According to the text, what is the ideal timing for performing otoplasty on children to potentially mitigate psychological effects? Explain the reasoning.
Name one historical figure credited with an early description of a surgical technique for prominent ear correction and briefly outline their approach.
What is the "Gibson effect" in the context of otoplasty, and how has it influenced modern techniques?
Briefly describe a situation where a combined surgical approach in otoplasty might be preferred over a single technique, based on the patient examples provided.
Short Answer Key
Two key measurements include the length of the adult auricle (approximately 5.5–6.5 cm) and the projection of the superior third of the helical rim from the scalp (approximately 1–1.2 cm). The width is also normally 50–60% of the length.
Matsuo theorized that high levels of circulating maternal estrogens in neonates make the auricular cartilage soft and malleable. This allows the stronger intrinsic muscles of the anterior ear to overpower the weaker posterior auricular muscle, potentially leading to deformity before the cartilage gains resilience as estrogen levels decrease.
The two most common findings in protrusion of the external ear are a valgus deformation of the concha with a cranioauricular angle greater than 40 degrees and underfolding of the antihelix. Rarely, hypertrophy of the concha may also be observed.
The Mustarde technique involves using horizontal mattress sutures placed from the concha to the scapha on the posterior aspect of the ear. The primary goal is to mold and recreate a smooth and well-defined antihelical fold, thus reducing ear prominence.
The primary advantage of incisionless otoplasty is that it avoids external skin incisions, leading to easier recovery with no need for long-term dressings and reduced visible signs of surgical intervention, making it ideal for patients needing a quick return to work or school.
Conchal-mastoid (C-M) sutures are horizontal mattress sutures placed from the posterior conchal wall to the mastoid periosteum and fascia. Their purpose is to lower or flatten a protruding concha, thereby reducing the distance between the conchal rim and the mastoid area.
Recent studies suggest that otoplasty should be performed before 4 years of age. This is because prominent ears typically do not affect a child’s self-image until they are older than 5 or 6 years, and surgery prior to this age has been shown to improve quality of life.
Edward Talbot Ely described an early operation in 1881 involving a continuous, crescentic resection of a strip of cartilage and a conchomastoid fixation suture to correct bilateral prominent ears. This is considered a significant early contribution to aesthetic otoplasty.
The "Gibson effect" refers to the observation that cartilage incised on only one side will warp or bow to the opposite (unincised) side and contract on the incised side. This understanding became the basis for modern scoring and incision otoplasty techniques that aim to reshape cartilage without complete excision.
A combined surgical approach might be preferred in a patient with both conchal hypertrophy and a poorly developed antihelical fold. In such a case, the surgeon might use conchal resection techniques to reduce the conchal prominence and combine them with suture-based techniques like Mustarde sutures to create the antihelical fold, as demonstrated in the pediatric patient example in Figure 5.
Key Terms
Aesthetic Otoplasty: Surgical procedures performed to improve the appearance and proportions of the ear.
Antihelix: The curved cartilaginous ridge in front of the helix on the outer ear. Its proper formation is crucial for reducing ear prominence.
Auricle: The external, visible part of the ear.
Concha: The deepest, bowl-shaped depression of the external ear, which can contribute to ear prominence if it is deep or excessively projected.
Conchal-Mastoid Sutures (C-M Sutures): Sutures placed between the concha and the mastoid periosteum to reduce conchal projection.
Gibson Effect: The phenomenon where cartilage incised on one side warps or bows to the opposite side.
Helix: The outer rim of the auricle.
Hydro-dissection: A technique involving the injection of fluid to separate tissue layers, sometimes used in otoplasty to facilitate cartilage manipulation.
Incisionless Otoplasty: A minimally invasive otoplasty technique that uses percutaneous needles to score the cartilage and sutures to reshape the ear without significant skin incisions.
Lobule: The fleshy, lower part of the ear that lacks cartilage. Its position and projection are considered in otoplasty.
Mastoid Process: A bony prominence behind the ear.
Patient-Centric Outcomes: Treatment outcomes that prioritize and are aligned with the individual patient's goals, expectations, and quality of life.
Perichondrio-Adipo-Dermal Flap: A surgical flap containing perichondrium (tissue covering cartilage), fat, and skin, used in some otoplasty techniques for reshaping and support.
Prominent Ear: A condition where one or both ears protrude excessively from the side of the head, typically defined by a projection of more than 20 mm and an angle greater than 35 degrees from the scalp.
Scapha: The elongated, shallow depression between the helix and the antihelix.
Scaphomastoid Sutures: Sutures placed from the scaphoid fossa to the mastoid periosteum, used as an alternative technique for correcting prominent ears.
Scoring (Cartilage): The process of making partial-thickness incisions or abrasions on the cartilage to weaken it and facilitate bending or reshaping.
Suturing (Otoplasty Technique): The use of sutures to reshape the auricular cartilage without significant incision or excision of cartilage.
Valgus Deformation: An outward angulation or bending of a structure, in this context, referring to the concha.
