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"My ears are too big" or "My child ears are too big" is a common complain from patient and parents. Pinning the ears behind the head solve the whole problem. People with prominent ears are easy targets among friends and colleges. The earlier they are fixed the better children after six years age can have the surgery. The procedure gives good result.
Modern techniques in cosmetic otoplasty incorporate both historical procedures and recently developed combined procedures with laser assistance to correct protruding ear or "lop ear" deformity. The multiple-procedure technique is conceptually sound and uses simple, innovative methods to reduce surgery time and yield predictable outcomes for both young and older patients. Early indications are that complications and revision rates have been reduced with the introduction of lasers in otoplasty. Modern technology allows physicians to correct "lop ear" deformity and help amend patients' distorted self-images.
Though there are a number of different approaches which address this procedure, the most common one involves the reshaping or removing of some of the cartilage behind the ear. After opening the back of the ear, the doctor either removes some of the cartilage or folds it on to itself and sutures it together. Since the work is done on the back of the ear, any scars are usually faint and can be hidden in the creases.
This procedure offers dramatic, immediate results that will last a lifetime. It's a great example of the important psychological benefits that often result from Cosmetic Surgery.
Complications with this procedure have been minimal, with rare instances of infection or hypertrophic scarring. Less than 2-3% of patients require additional surgeries, although occasionally a secondary revision of the anterior Mustardé procedure may be necessary. The conchal set-back technique seems to be long-lasting and permanent with minimal incidence of suture extrusion. The conchal set-back appears to account for 70-80% of the aesthetic correction.
The Procedure
Ear Surgery alone takes approximately about 1 hour to perform and may be combined with other facial procedures.
A local anaesthetic is generally used. In addition to the local, various drugs are used before, during and after surgery to make you comfortable and steady.
Dissolving sutures are used which mean you do not have to return to the clinic to have them removed.
After surgery, the ears are covered with a dressing that is removed after 4 - 5 days. A support head band will be given to you to wear at night for the next four weeks to prevent damage to the surgery while the ears are healing, during your sleep.
After surgery, any minor pain or discomfort you experience can be controlled with medication. Postauricular Incision
The incision is made in the postauricular crease with the length varying from 2.5 to 2.7 cm.
Undermining
The undermining is carried out either with laser or with conventional surgical methods. The skin is degloved, first anteriorly and then posteriorly. Posteriorly the soft tissue of the postauricular muscle mass is exposed and, using the laser, the tissue - a triangular soft-tissue mass measuring between 1.5 and 2.5 mm containing the postauricular muscle group - is resected in a relatively bloodless field. The mastoid periosteum is exposed while avoiding perforation of external auditory canal. Once the area is dry, a #15 blade is used to score the posterior aspect of the antihelical fold parallel to the axis of the antihelical fold, thus weakening the cartilage on its concave surface short of perforation anteriorly through the perichondrium.
Hillock Shaving
With the ear rotated anteriorly, the ear canal and major cavae of the hillocks (cavum conchae, scaphoid fossa, and fossa triangularis) are exposed. The major cavum concha is progressively shaved with a #10 blade, lowering the hillock of the cavum conchae down to the anterior perichondrium without perforating the skin. Repositioning the ear and examining its apposition to the skull allows the desired amount of cartilage to be excised by adjusting to achieve the exact aesthetic correction and creating a window of approximately 1.5 cm. Following the shave, the excision of the lesser cavae is done based on the needs of the case.
Conchal Set-Back
Once the hillock shaving is completed, the ear is rotated back for the conchal set-back procedure. The conchal set-back includes the strategic placement of permanent suture (3-0 Mersilene) in a two or three point fixation, burying the knot and attaching the perichondrium to the lateral mastoid periosteum. Thus, the dimension between the helical rim and the skin of the mastoid area is reduced, causing the ear to rotate closer to the skull. The incision site is then thoroughly irrigated with gentamycin solution for bacteriostatic and bacteriocidal control. The incision is closed with continuous 5-0 plain catgut suture.
Anterior Mustardé Technique
The anterior Mustardé technique is utilized to reconstitute the antihelical fold anatomically. Several strategically placed 1-2 mm shave incision are made, longitudinally, along the crest of the antihelical fold and several (usually four) counter incisions are made at right angles to the antihelix fold. A 16 chondrium to create scoring along the axis of the crest of the antihelical fold. This further weakens the antihelical fold on its convex surface and allows for the final rotation and reconstitution of the antihelical fold anatomically. To secure this position, multiple (four to five) horizontal mattress sutures of 5-0 Vicryl are used to hold the antihelical fold until healing is complete. A stay suture off 5-0 Vicryl is used to anchor the superior pole of the helix to the adjacent scalp skin, and the suture is removed in 1 week.
At this point, the ear lobule is elevated. In some cases where the ear lobule is malformed or anteriorly displaced after surgery, lobular rotation, elliptical excision, or Z-plasty of the lobule would be considered.
Second Ear
Otoplasty is now performed on the second ear to achieve a comparable anatomical correction. By first operating on the most difficult ear and then matching the second (less difficult ear), symmetry is more easily achieved.
Preparing for The Operation
Products that contain Aspirin, Vitamin E, or Evening Primrose oil should be avoided for four weeks before surgery. The use of Vitamin K (10mg daily) for three days before surgery is recommended.
Strong alcoholic drinks should be avoided before surgery. Important: Patients should not smoke for two weeks before surgery and for a few days after surgery. Smoking interferes with the circulation of blood to the skin and can cause death of the skin flaps.
Patients should purchase Betadine shampoo use it to wash their hair the night before surgery (if surgery is scheduled for the morning) or the morning before (if surgery is scheduled for the afternoon). Hair may be conditioned and blow dried.
If the patient develops any signs of infection, pustules or boils on the face or body before surgery, the doctor should be notified immediately.
On the day of the surgery, the patient should wear comfortable, loose clothing that do not have to be pulled over the head, to the hospital.
Patients must not wear any make-up (including mascara and nail polish) when they go into surgery. If the patient tints, dyes or bleaches his or her hair, this should be done no later than one week before surgery.
Closure and Dressing
Cotton sponges soaked in gentamycin and polysporin are used to fill al cavities and a bilateral mastoid dressing is applied. Intravenous antibiotics are not used during surgery or postoperatively. Cephalosporin type antibiotics are prescribed for oral use for 1 week postsurgery. Patients are discharged within an hour following surgery, after appropriate postsurgical and anesthesia recovery.
Post Operative Care
Full recovery from surgery and anesthesia takes approximately 2 weeks and complete healing may take up to 1 year. After the first 24 hours, dressing are removed and the patient may shower. On the second postoperative day the patient is allowed to start moderate activities and after 2 weeks normal activities can be resumed. During the first 1 to 2 weeks, the patient wears a four-inch stockinette ear dressing, graduating to a ski headband or something comparable at night to a ski headband or something comparable at night for the next 6 weeks. The dressings not only serve to support the ear, but also as a helpful reminder.
With the use of high-tech laser in surgery, along with intravenous sedation techniques, patients typically have minimal bruising or pain. Recommended pain medications include ketorolac tromethamine.
On removal of the dressing, patients can observe an almost complete correction of their deformity. Within a few weeks, the wound has dramatically improved and the surgical corrections are less apparent and more natural in appearance. Patients should be advised of the normal time of wound healing which is 40% at 6 weeks, 70% at 6 months, and 90% at 1 year.
Typically, most patients are up and around a day or two after surgery. You will be quite presentable 1 week after surgery however full healing can take up to 3 months.
Rest with your head elevated for the first 2 - 4 days. You can shampoo your hair once your dressing has been removed. Do not wrap the towel around your head as this will pull the ears forward. Dry thoroughly behind the ears after each shower. Burning, tightness, itchiness and puffiness are normal for the first few weeks. Any excessive bleeding, discolouration or swelling should be immediately reported to The Centre.
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