Otoplasty – Overview of Techniques

5 Key points Otoplasty Techniques

1. Otoplasty techniques focus on anti-helical fold, conchal defect and lobule position in correcting prominent ears.
2. Helical fold can be created via cartilage scoring (e.g Chongchet), suture fixation (e.g. Mustardé) or a combination
3. A deep conchal bowl can be corrected by anterior scoring, suturing (e.g Furnas) or a combination
4. Lobule positioning through skin incision modifications
5. 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

Overview

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
Cartilage Scoring
Suture Fixation
Combination of Scoring and Fixation

Cartilage Scoring to create Anti-Helical Fold

Scoring techniques are based on the Gibson (and Davis) Principle^​1​. 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.

Stenstrom^​2​ and Chongchet^​3​ 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 Approach^​4,5​, 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

Overview

Conchal defects can be corrected by sutures, excisional techniques, and scoring.

Techniques to correct the Conchal Defect
Suture Fixation
Cartilage Scoring
Combination of Scoring and Fixation
Excisional Techniques

Conchal-Mastoid Sutures

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 Technique^​6​. This is to be performed before correction of the anti-helix def

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 Principle^​1​, converts a prominent conchal wall into a scaphal surface.

Lobule Position

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 suture^​7​.

References

The following articles were reference in Otoplasty – Overview of Surgical Techniques.

1. 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. 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. 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. 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. 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. 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. 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.