Surgical techqniues for Otoplasty are well-described. They are best understood by classifying them into manouvres aimed at correcting prominent ears.
5 Key points Otoplasty Techniques
- Otoplasty techniques focus on anti-helical fold, conchal defect and lobule position in correcting prominent ears.
- Helical fold can be created via cartilage scoring (e.g Chongchet), suture fixation (e.g. Mustardé) or a combination
- A deep conchal bowl can be corrected by anterior scoring, suturing (e.g Furnas) or a combination
- Lobule positioning through skin incision modifications
- Non-surgical techniques are available, but are of little success
Classification of Techniques
Multiple surgical otoplasty techniques exist. It can be confusing, but ca be simplified by classifying techniques via their manoeuvres, as outlined below.
1. Create the Anti-Helical Fold
2. Correct the Conchal Defect
3. Affect the Lobule positioning
Creation of the Anti-Helical Fold
There are different techniques available to correct the anti-helical fold. Generally speaking, techniques can be catageroised into Scoring or Fixaton or Combination.
Techniques to create Anti-Helical Fold
Combination of Scoring and Fixation
Cartilage Scoring to create Anti-Helical Fold
Scoring techniques are based on the Gibson (and Davis) Principle1. A key principle in prominent ear correction. Cartilage warps away from the injured surface. The extent of the warping is dependent on the extent of scoring.
Stenstrom2 and Chongchet3 applied this theory to Otoplasty techniques. Variations of scoring include anterior and posterior approaches, superficial and full-thickness scoring.
Suture Fixation to create Anti-Helical Fold
Various suturing techniques will also produce an anti-helix. The most commonly known is The Mustardé Approach4,5, which corrects prominence in the upper 1/3 of the ear. Matress sutures are placed between the scaphoid and conchal fossa.
These mattress sutures are placed in the posterior cartilage that incorporates the full thickness of the cartilage and the anterior perichondrium (but not the anterior skin).
Correction of the Conchal Defect
Conchal defects can be corrected by sutures, excisional techniques, and scoring.
Techniques to correct the Conchal Defect
Combination of Scoring and Fixation
These sutures are indicated in the correction of conchal excess or prominence in the superior 2/3 of the ear. The most well-known suture is the Furnas Technique6. This is to be performed before correction of the anti-helix defect.
Furnas used non-absorbable mattress sutures between the conchal cartilage and the mastoid fascia. It pulls the concha towards the head, reducing ear prominence.
Scoring and Excisional Techniques
Excisional techniques are suited for conchal hypertrophy. Excision of cartilage +/- skin is less commonly performed. Scoring the anterior surface of the concha, using Gibson’s Principle1, converts a prominent conchal wall into a scaphal surface.
A prominent lobule is less often an issue compared to anti-helical and conchal variations. Wood-Smith uses a modified fishtail correction, whilst Spira performs a wedge excision and a deep dermis-to-scalp periosteum suture7.
The following articles were reference in Otoplasty – Overview of Surgical Techniques.
- 1. Gibson T, Davis WB. The distortion of autogenous cartilage grafts: Its cause and prevention. British Journal of Plastic Surgery. 1957:257-274. doi:10.1016/s0007-1226(57)80042-3
- 2. STENSTROEM S. A “NATURAL” TECHNIQUE FOR CORRECTION OF CONGENITALLY PROMINENT EARS. Plast Reconstr Surg. 1963;32:509-518. https://www.ncbi.nlm.nih.gov/pubmed/14078273.
- 3. CHONGCHET V. A METHOD OF ANTIHELIX RECONSTRUCTION. Br J Plast Surg. 1963;16:268-272. https://www.ncbi.nlm.nih.gov/pubmed/14042756.
- 4. MUSTARDE J. The correction of prominent ears using simple mattress sutures. Br J Plast Surg. 1963;16:170-178. https://www.ncbi.nlm.nih.gov/pubmed/13936895.
- 5. Mustardé J. The treatment of prominent ears by buried mattress sutures: a ten-year survey. Plast Reconstr Surg. 1967;39(4):382-386. https://www.ncbi.nlm.nih.gov/pubmed/5336910.
- 6. Furnas D. Correction of prominent ears by conchamastoid sutures. Plast Reconstr Surg. 1968;42(3):189-193. https://www.ncbi.nlm.nih.gov/pubmed/4878456.
- 7. Spira M, McCrea R, Gerow F, Hardy S. Correction of the principal deformities causing protruding ears. Plast Reconstr Surg. 1969;44(2):150-154. https://www.ncbi.nlm.nih.gov/pubmed/5799297.