Ear Surgery (Otoplasty) Specialist
Barry L. Eppley, MD, DMD, is one of the few plastic surgeons with years of ear reshaping experience helping patients who have protruding ears or congenital or traumatic ear deformities.
Small as the ear is on the side of the head, it has a very complex anatomical shape. Filled with various ridges and valleys created by its cartilaginous component, it is a miracle of genetics and embryologic development that it consistently develops with an overall basic shape and form. A normal shaped and positioned ear is inconspicuous, but when it sticks out too far, has a deformed shape or is even partially absent, it becomes a very evident deformity.
EAR RESHAPING FOR EARS THAT STICK OUT (Pinback Otoplasty)
Ears that abnormally stick out (protruding ears) are the most common ear deformity and are a frequent source of embarrassment for many patients and may make one very self-conscious. This is particularly true for children and teenagers… although it is often no less so in adults. The cause of prominent ears is a congenital absence of a natural curve in the ear’s cartilage which causes it to protrude rather than conform to the side of the head. They may also occur because the bowl (concha) of the ear is too big, driving the external shape of the ear outward. In some cases of protruding ears, it is a combination of both cartilage abnormalities that make the ears stick out.
Its surgical correction is an ear reshaping procedure called otoplasty which has often been called a ‘pinning back’ of the ears. In this ear procedure, the antihelical fold of the ear is recreated by sutures, the size of the concha reduced or weakened, or a combination of both techniques is used from an incision on the back of the ear. While it is commonly performed in children (can be done as early as two years old), it may also be successfully done as a teenager or adult. There is no upper age limit at which an otoplasty can be successfully performed. The changes that result from otoplasty can be some of the most dramatic of all reshaping ear surgeries.
Otoplasty surgery largely uses permanent sutures placed through an incision on the back of the ear to reshape the cartilages. This produces an immediate and dramatic change in ear shape as soon as the sutures are tied down.
Setback ear reshaping can also be done in select cases by a method known as ‘incision less otoplasty’. This is a percutaneous method (no incision on the back of the ear) in which permanent sutures are placed to reshape the ear and create an anti helical fold through needle entrances sites. Prior to placing the sutures a needle is used to weaken the cartilage by multiple needle tracks through it.
EAR RESHAPING BY RECONSTRUCTION
The ear is prone to congenital deformities which occur in a wide variety of presentations from helical problems (e.g., lop ear, cupped ear, Spock ear, Darwin’s tubercle) to partial or near complete absence of the ear (microtia). Reconstruction of congenital ear deformities is far removed from the more simpler cosmetic ear pinning procedures and often involves cartilage and skin grafting.
The prominence of the ear on the side of the head also makes it prone to traumatic deformities in which part of the ear may be missing from avulsive type injuries. Like congenital ear deformities, reconstruction of part so the ear that are missing from lost of parts or from burn injuries require an intricate background in ear reconstructive plastic surgery techniques.
Ear reconstruction should not be confused with more simple cartilage techniques that are used in cosmetic ear reshaping. Such ear reconstructions are much more complex and require a good understanding of skin flap rotations, skin grafting and cartilage harvesting and cartilage graft shaping. Such techniques are maximally required in the microtia ear deformity where rib graft harvesting is the mainstay method of its reconstruction to replace the major part of what is missing.
The earlobe occupies small portion of the ear and is the only ear part that has no cartilage. Since it is frequently adorned by variety of metal devices for aesthetic purposes, it is prone to developing variety of problems due to the easy disruption of its unsupported skin. It can develop earlobe tears and lacerations, stretched earlobe tissues (gauging) and pathologic scarring (keloids).
Repair of earlobe deformities could be closure of earlobe tears commonly caused by heavy ear ring wear, reconstruction of the gauged or stretched out earlobes, earlobe reduction for large earlobes from aging or ear ring wear of the very difficult problem of excising hypertrophic scars and keloids (which usually have as their source the use of ear ring wear). Earlobe reconstruction can almost always be done using the surrounding earlobe tissues.
NEONATAL EAR MOLDING (Earwell System)
Some congenital ear deformities in which the cartilage is misshapen (e.g., lop ear, protruding ear) can be effectively reshaped without surgery if treatment is begun within the first few weeks after birth. In the neonatal period (first month after birth) the ear cartilage is very soft and has little memory. By using a specially designed device that uses a soft plastic framework to mold the ear (Earwell), a new shape can be created as the ear cartilage begins to stiffen. Worn over a period of six weeks, good ear reshaping can be achieved.
Before Ear Surgery
The ears are examined and the form and shape of the ear analyzed. The effectiveness of the procedure can be determined by folding the rim of the ear back and seeing if this gives the desired shape in protruding ear patients. Whether tissue grafts may be needed to reconstruct the ear is determined at this time. Photographs are taken prior to surgery for documentation. Patients should wash their hair the night before surgery.
Most ear surgeries are performed as an outpatient under general anesthesia. The otoplasty for protruding ear operation is done through an incision on the back of the ear. The cartilage of the ear is exposed and sutures are placed to provide the proper fold and shape to the ear cartilage. Occasionally, it may be necessary to remove some cartilage to acquire the proper ear shape. When the incision is closed, some skin on the back of the ear may also be removed. A circumferential ear dressing is then applied which is worn for 24 hours after surgery. For those ears that need reconstruction by grafting, the most common areas for cartilage harvesting are the other normal ear or rib grafts for larger reconstruction. (microtia) Skin grafts, if needed, are usually taken from behind the other ear.
After Ear Surgery
Pain is moderate in nature as the ears are sensitive to manipulation. Bruising is very limited although the swelling is more evident. Some bruising and swelling are reduced from the gentle pressure of the head dressing. The head dressing is removed after one week in children and the next day in teenagers and adults. An elastic headband (or ski band) is to be worn at nighttime for several more weeks for protection in the protruding ear patient. The temporary swelling of the ears usually resolves completely in two to three weeks after surgery. The hair may be gently washed when the head dressing is removed. Physical activities such as sports, where the risk of ear trauma exists, should be done cautiously for up to one month after surgery.
Significant complications are exceedingly rare from this procedure. Minor risks include delayed healing of the incisions, infection of the ear cartilage, extrusion of the sutures used to shape the cartilages, and asymmetry in the shape of the ears between the two sides.