Otoplasty

Chapter 34. Otoplasty

Emily B. Ridgway, MD; Charles H. Thorne, MD

INDICATIONS

The indications for otoplasty include the patient with the prominent ear, constricted ear, Stahl’s ear, or cryptotia. The prominent ear is most common, affecting 5% of the Caucasian population and is typically a result of 3 anatomical variants: underdevelopment of the antihelical fold, overdevelopment of the conchal bowl and wall, and a conchoscaphal angle greater than 90 degrees. The human ear obtains 85% of its final size by age 3 years. The ear width reaches its adult size by age 7 years for boys and 6 years for girls. The length matures to its adult size at age 13 years in boys and age 12 years in girls. Ear surgery is best addressed at younger ages as the ear becomes firmer, less malleable, and calcified with age. At infancy, the prominent ear can be addressed with nonsurgical molding. A myriad of techniques exist for otoplasty, indicating that there is not one definitive approach, and each surgery must be tailored to the individual patient. Advantages of the technique described here are its simplicity and reproducibility.

PREOPERATIVE PREPARATION

Adequate time in consultation and preoperative planning is essential. Patient and parent expectations and understanding of complications must be verified. The surgical technique varies with each patient; each of the components of the ear resulting in a prominent ear must be defined.

ANESTHESIA

Local anesthesia with monitored conscious sedation or general anesthesia is suitable for this procedure. In younger patients, general anesthesia is recommended.

POSITION AND MARKINGS

The patient is placed in the supine position, prepped and draped in the usual sterile fashion with both ears, and the retroauricular skin exposed. The patient’s head may be placed on a doughnut.

The incision is marked along the retroauricular sulcus and less frequently on the posterior surface of the concha if a conchal excision is planned. If a lobular setback is planned, a triangular area of skin is marked for incision at the most medial area of retrolobular skin. The intended region of antihelical fold creation is marked.