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Cagatay Han ULKU, MDSelcuk University School of Medicine,Department of Otolaryngology HNS,Konya-TURKEYEmail: chanulku@yahoo.comPhone: +90 332 2237250Website: www.selcuk.edu.tr

Objective: To evaluate the performed surgical technique for protruding ear deformity from the point of complications and aesthetic results.Patients and Methods: Seven patients who were operated with protruding ear deformity diagnosis between September 2006 -September 2007 were included in this study. In all cases for anti-helix formation horizontal mattress sutures with Mustardé technique were used and reformation of the cartilage was maintained. Besides toprevent the protrusion effect of the conchal bowl, concha mastoid sutures were used. If it was required, in order to maintain a better aesthetic angle in the superior pole, additional fixation suture was inserted to the helix. Mastoid bandage was applied to patients in the first week and a sports headband was recommended in the second week. Cases were evaluated from the point of early / late complications and aesthetic results. Results: Surgery was applied to 13 ears of 7 patients. 3 of the patients were female and 4 were male. The average age was 18.1. Deformation in 6 cases were bilateral and unilateral in one. Surgery was performed under local anesthesia except for 2 patients. Horizontal mattress and concha mastoid sutures were used in all ears. Additional fixation suture was required between the helix and temporal boneperiosteum in three ears. Average follow up period was 11.8 months. No complications were encountered in the early postoperative period. In one ear, due to suture failure in late period, partial asymmetry occured. The problem was solved with limited revision surgery.Conclusion: We observed that in the cases with protruding ear deformity who operated with Mustarde and Furnes combined technique, it was possible to obtain satisfactory results by performing only suture techniques without additional work on the cartilage, if careful preoperatve evaluation was carried out.

Our Surgical Approach and Results for Protruding Ear DeformityCagatay Han ULKU, MD

Departments of Otolaryngology Head and Neck Surgery, Selcuk University, School of Medicine, Konya - TURKEY

mattress sutures, concha-mastoid sutures apply as an adjuvant(4).Cartilage cutting techniques include, cartilage incisions, wedge excisions, scoring

or abrasion of either the posterior or anterior surface of the auricular cartilage. These techniques have the risk of sharp edges and the unnatural ear appearance. This irregular edges are essentially not seen in cartilage sparing techniques(7-12).

Mustarde suture technique is popular with many surgeons due to its simplicity, effectivity and reversibility(13). Care is taken to make sure that the suture is not too close to the skin and good bite of the cartilage is taken. The sutures are tied to create a new antihelical fold. Initially the suture material and later the scar tissue reaction forms and splints the cartilage in its new position(13).

We prefered to use cartilage sparing techniques in our cases. Mustarde’s horizontal mattress and Furnes’s concha mastoid sutures were used in all ears. Additional fixation suture was required between the helix and temporal bone periosteum in three ears. Mastoid bandage was applied to patients in the first week and a sports headband was recommended in the second week (Figure 2a, 2b, 3a, 3b).

Complications from the procedure occur in less than 3% of cases. Hematoma, infection, skin and cartilage necrosis are early comlications. Suture comlication, unacceptable scarring, loss of correction, hypoesthesia and patient dissatisfaction are late complications(3). Suture failures requiring reoperation typically ocur within the first 6 months after the procedure(2).

Among our cases, average follow up period was 11.8 months. No complications were encountered in the early postoperative period. In one ear, due to suture failure in late period, partial asymmetry occured. The problem was solved with limited revision surgery.

Seven patients who were operated with protruding ear deformity diagnosis between September 2006 - September 2007 were included in this study. In all cases for anti-helix formation horizontal mattress sutures with Mustard technique were used and reformation of the cartilage was mantained. Besides, to prevent the protrusion effect of the conchal bowl, concha mastoid sutures were used. If it was required, in order to mantain a better aesthetic angle in the superior pole, additional fixation suture was inserted to the helix. Cases were evaluated from the point of early / late complications and aesthetic results.

We observed that in the cases with protruding ear deformity who operated with Mustarde technique, it was possible to obtain satisfactory results by performing only suture techniques without additional work on the cartilage, if careful preoperatve evaluation was carried out.

The pinna is a complex combination of the cartilage and skin(1). A poorly developed or absent antihelical fold and abnormal large concha are the most common defects for protruding ear. The primer aim of surgery for this deformity is to create a normal pinna with acceptable form and symmetry(2).

In this study, we summarized our combined surgical technique for protruding ear deformity from the point of complications and aesthetic results.

INTRODUCTION

METHODS AND MATERIALS

CONCLUSIONS

REFERENCES

Figure 1a.

ABSTRACT

CONTACT

Figure 1b.

DISCUSSION

1. Sevin K, Sevin A.Otoplasty with Mustarde suture, cartilage rasping, and scratching. Aesthetic Plast Surg. 2006;30:437-41.2. Burningham AR, Stucker FJ. Otoplasty technique: how I do it. Facial Plast Surg Clin North Am. 2006;14:73-7.3. Adamson PA, Litner J. Otoplasty Technique. Facial Plast Surg Clin North Am. 2006;14:79-87.4. Nuara MJ, Mobley SR. Nuances of otoplasty: a comprehensive review of the past 20 years. Facial Plast Surg Clin North Am. 2006;14:89-102.5. Mustardé JC. The correction of prominent ears using simple mattress sutures. Br J Plast Surg 1963;16:170-8.6. Furnas DW. Correction of prominent ears by conchamastoid sutures. Plast Reconst Surg 1968;42:189-93.7. Gibson T, Davis W. The distortion of autogenous cartilage grafts:Its cause and prevention. Br J Plast Surg 1958;10:257.8. Sternstrom SJ A simple operation for prominent ears. Acta Otolaryngol. 1966;27 (Suppl): 224:393.9. Chongchet V. A method of antihelix reconstruction. Br J Plast Surg 1963;16:268-72.10. Sternstrom SJ, Heftner J. The Sternstrom otoplasty. Clin Plast Surg 1978;5:465-70.11. Tanzer RC, The correction of prominent ears.Plast Reconstr Surg Transplant Bull. 1962;30:236-46.12. Janis JE, Rohrich RJ, Gutowski KA. Otoplasty. Plast Reconstr Surg. 2005 ;115:60-72.13. Connolly A, Bartley J. 'External' Mustarde suture technique in otoplasty. Clin Otolaryngol Allied Sci. 1998;23:97-9.

Figure 2a. Figure 2b.

Figure 3b.Figure 3a.

Surgery was applied to 14 ears of 7 patients. 3 of the patients were female and 4 were male. The avarage age was 18.1. Deformation in 7 cases were biletaral and uniletaral in one.Horizontal mattress and concha mastoid sutures were used in all ears (Figure 1a,1b). Additional fixation suture was required between the helix and temporal bone periostium in three ears. No complications were encountered in the early postoperative period. In one ear, due to suture failure in late period, partial asymmetry occured. The problem was solved with limited revision surgery.

RESULTS

Anatomic features of the protruding ear should be meticulously analysed by the surgeon to achieve a satisfactory result(3). Ely described the first otoplasty technique consisted of a full thickness skin and cartilage excision in 1881. Many surgical techniques have been described to correct the protruding ear later(4). Cartilage cutting and cartilage sparing techniques are described as two main surgical approaches in modern otoplasty. The best technique is simple, reversible, safe and versatile(3).

Surgery may be performed for the protruding ear since age 5, because of the auricular cartilage growth is almost completed. At this age, the auricular cartilage is characteristically pliable; but, it becomes, less elastic, more calcified and brittle with age. Because of that reason, more aggressive cartilage surgery is required for reconstruction in adults. Meanwhile, the early performed surgery prevents the child from any emotional upset due to the deformity(3). In our cases, the average age was 14.0 (range 7 to 20 year). Surgery was applied to 13 ears of 7 patients. Deformation in 6 cases were bilateral and unilateral in one. Surgery was performed under local anesthesia except for 2 patients.

Cartilage sparing techniques preserve the cartilage and reshapes it with precisely placed sutures. There are two main cartilage sparing techniques introduced by Mustarde and Furnes(5,6). Mustarde described the most well-known techique in 1963. Mattress sutures are placed on the posterior surface of the auriclar cartilage to achieve the new antihelix in this technique. Furnes introduced a technique consisted of conchal-mastoid sutures to medialize the conchal bowl to the mastoid periostium, thus reducing auricular protrusion. If excess protrusion persist after

DISCUSSION