Q: Dr. Eppley, I’m hoping you can fix my ear. I have hardened cartilage on my left ear that has caused my helix to flatten. I am hoping you can shave/remove the hardened cartilage and return my ear to it’s original shape.
A: I am going to assume that the hardened cartilage in your left ear is from some form of trauma. Perichondrial sheering and hematomas can cause cartilage to grow and thicken the natural ear cartilage resulting in loss of the normally concave portions of the ear and/or making the convex areas even bigger. This is classically seen in the ‘cauliflower ear’ with varying presentations from smaller areas like yours to those that can even involve the entire ear cartilage.
You are correct is assuming that the hardened or thickened cartilage must be thinned down so that the helix fold can be recreated in an ear reconstruction procedure. This is done by raising the skin over the thickened area and shaving down the cartilage with a scalpel or dermal punches. Whether skin flaps must be raised on both sides of the ear to create adequate cartilage reduction can not be determined by a picture alone. The real key to this surgery is to ensure that a recurrent hematoma or fluid collection does not occur after surgery beneath the raised skin flaps as that will cause the same problem to recur. This is done by a combination of through and through resorbable sutures with a xeroform bolster dressing.
Dr. Barry Eppley
Q: I wrestled throughout high school and college and this has left me with both ears that are deformed. I am very interested in corrective surgery to both reduce their scarred appearance and gain better symmetry between them.
A: A very uncommon ear problem, while not unique to just wrestlers, is that of the ‘cauliflower ear’. So named because of its appearance, the cauliflower ear appears as raised hard irregular areas that cause the ear to become misshapen. Because these deformities can occur anywhere on the ear but the earlobe, it is the cartilage that is the source of the problem.
When the ear is traumatized, bleeding can occur under the covering of the ear cartilage known as perichondrium. This can particularly occur from shearing or severe rubbing forces on the ear. Blood is a stimulant for the perichondrium to form new cartilage. So wherever there is bleeding, cartilage nodules can form and grow distorting the very detailed hills and valleys that give the ear its form. When this occurs repeatedly (as in a wrestler), eventually the whole ear can become one knarled mass.
The cauliflower ear can be treated by cartilage removal and reshaping it as close as possible to its original form. To do this procedure, the skin must be carefully lifted off over the deformed areas. This requires an incision which can be placed on either side of the ear (front or back) depending upon the location of the excess cartilage. The key to the success of the operation is placing the skin back down and having it heal without forming new cartilage and allowing the new shape to be seen and maintained. This is done by placing a special dressing called bolsters onto the ear to keep pressure on the healing skin. These are removed one week after the ear reconstructive surgery.
Dr. Barry Eppley