Large protruding ears often cause deeper emotional upset than is generally realized by the patient’s friends or parents. Because the visual and psychological improvement following the operation is usually dramatic, otoplasty is rewarding to the patient, the family, and the surgeon (Fig. 16.1).
The predisposition to protruding ears tends to permeate a family’s genetic tree, but with a varying degree of penetrance. In some cases an entire generation may be skipped. Some family members will have ears that look fairly normal, but others will have one or usually both ears that protrude, at least to some degree.
Even if only one ear appears to protrude excessively, it is usually necessary to correct both to obtain the desired surgical result.
For children to avoid classroom teasing and “nicknames,” the surgery is preferably performed before they begin school. However, otoplasty can be performed at any age. By the age of 6, the ears have reached about 90% of their adult size. Little growth of the ears occurs after this time.
It is often helpful to teach patients and their families that, embryologically, the anterior one-half of the head develops from two opposing sides. In keeping with anatomical variations in other parts of the face and body, rarely are the two ears identical (prior to surgery). If they are not, chances are the ears will not be identical after surgery. It is crucial that patients and parents be advised of this fact. Let them know that—before birth, during embryonic development—ears exhibit none of the curves and creases seen at birth. Until the latter trimester of development, ears project straight out away from the head. Toward the end of gestation, however, the cartilages begin to curl, usually assume a position closer to the head, and develop the natural folds and convolutions. In patients whose ears unduly project from the head and lack the usual folds and convolutions, this aspect of the developmental process simply stopped short of completion.
The otoplasty procedure is designed to “complete” the developmental process by contouring the cartilage and positioning the ears closer to the head. Natural curvatures on the antihelix are generally created by placing sutures in the ear cartilages so that they can “heal” in their desired position over the ensuing weeks.
Fig. 16.1 (a) Large or protruding ears can be repositioned with the otoplasty procedure. (b) Although the size of the ears is not changed, they assume a much more natural relationship to the head.
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