Question
Otoplasty: Pros & Cons of two approaches
I am planning to undergo otoplasty to reduce the conchal bowl (i.e., to change the orientation of my ears from a prominent angle to one further back). I have consulted two surgeons, who each suggest using different approaches.
One surgeon suggests an approach that involves (among other things) resecting sections of cartilage from the conchal bowl. He suggests that this procedure is likely to be free of re-drift (i.e., ears folding out again), that the ears can be set at a natural angle (e.g., 15-20 degrees), but that there may be some difference in the angle on each side. The other surgeon suggested using permanent sutures (approx. 1 cm from base of ear) to pin the ears to the fascia of the skull. He suggests that this will help prevent re-drift (that he thinks is more likely when using only cartilage resection from the conchal bowl). He also says that using permanent sutures, the ears can only be positioned flat back against the head (rather than a more natural angle).
I respect the advice of both surgeons (who both appear to be competent and honest), but am confused by the conflicting opinions. What are the pros and cons of each approach? For example, how likely will complications (i.e., re-drift and/or asymmetry) using cartilage resection (i.e., without permanent sutures to the cranial fascia) occur? And could the permanent sutures be ripped (e.g., in contact sport etc.) or pulled through over time (e.g., as I age)? Thank you.
Sincere Regards,
John
Answers (2)
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1
November 21, 2008
Setback Otoplasty
Both of the techniques you described work, but the indications differ. If you concha is really in excess (too much cartilage), then the resection technique is more appropriate. When you leave the cartilage intact and only use a suture to "tighten" the bowel back, the change you get in ear prominence is minor (you often have to remove some excess soft tissue behind the ear when using this technique.) The suture technique is normally used when the conchal bowl is not the main reason for prominent ears, rather when the anti-helix is poorly defined, and suture techniques are already being used. In these cases, the minor additional setback of the bowl is a refinement on the already decreased ear.
I hope this helps!
2
November 21, 2008
Otoplasty- a great procedure - not discussed enough
Dear John,
Why not perform both procedures at once? It sounds like you have only one of the two concerns for prominent ears - the large conchal bowl. For those uneducated like yourself -- the conchal bowl is that part of the ear that surrounds the ear canal and is shaped like a bowl. The best treatment is to remove some excess cartilage and then stitch the remainder of the bowl to the tissue on top of the bone behind the ear. For some children, sutures alone are adequate, but as we get older the cartilage gets more brittle and the suture alone are not enough. The second concern in prominent ears is an unfolding of the upper 1/3 of the ear, the only way to treat this problem is with sutures the refold the ear.
Best of luck. Robert M. Freund, MD, FACS
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Check out more Q+A about Otoplasty
Will otoplasty help headphones stay in the ears better?
Answered by Toby G. Mayer, MD, Beverly Hills Facial Plastic Surgeon
Read all 1 answers
11/21/08
Dear John,
Both methods work well. The criticism of experts like Dr. Burton Brent is that resection or scoring of cartilage may result in irregularities that become visible through the thin anterior skin of the ear when swelling decreases. Conchal mastoid set back sutures usually do not cause flattening of the angle behind the ear. It is rather removal of skin ebhind the ar that is more likely to cause this and close the sulcus.
When the problem of prominent ears is caused by excessive conchal height, then something must be done to address this problem. I have done both, and both work, but it is true that unless one is very careful the repaired anterior conchal bowl may be slightly visible or palpable to the patient along the closure line. This is not usually significant to the patient and can be smoothed in a revision as needed. If it is d esired to completely avoid this possibility, then a posterior approach only with conchal-mastoid sutures would be the way to go.
The unfurled helix is the second major factor in prominent ears and this must be addressed as well as the too high conchal bowl. Sutures are needed to hold the helix in a backward folded direction. Scoring the cartilage anteriorly has been traditionally recommended but certainly can lead to palpable irregularities or too sharp a fold if the scoring is too aggressive. So look up Dr. Brents article in October, 08 Plastic and Reconstructive surgery and use this to discuss further with your surgeons. Good surgeons use both of these methods.
11/24/08
Thanks Dr Lowen.
That's helpful.
Regards, John.