The main anatomical basis of the prominent ear are as follows:
(1) conchal hypertrophy or excess (upper pole, lower pole, or both)
(2) inadequate formation of the antihelical fold (the root, superior crus, inferior crus, or all)
(3) a conchoscaphal angle greater than 90 degrees
(4) a combination of conchal hypertrophy and underdeveloped antihelical fold.Occasionally, conchal excess can be difficult to appreciate. A well-described technique for these difficult cases is to apply medially directed pressure along the helical rim. This maneuver allowsprominent conchal cartilage to be visualized. It is important to note that usually the prominent ear deformity is bilateral; however, Spira et al. point out that the cause of the defect maybe different for each side. Any procedure to correct a prominent ear should therefore address the underlying anatomical defect and attempt to correct it. Clearly, one approach will not work for all clinical presentations. (photo from second reference article)
The correction of prominent ears should keep in mind McDowell’s basic goals of otoplasty:
Timing of the Otoplasty
There is a very nice algorithmic approach to otoplasty is given in the article (second reference) by Rohrich, etc. This is the procedure Dr Spira (reference 1, procedure sketch/photo from same article) employs when ear protrusion is caused by incomplete development of the antihelix with some degree of accompanying conchal enlargement, the most common situation encountered.
Attention is directed to the posterior surface of the ear, where an incision is extended from superiorly near the helical rim above down to the level of the earlobe in a straight line; a minimal fusiform ellipse of the skin of the lobe is incised. It should be noted that skin removal is not planned over the majority of the back of the ear, in contradistinction to most other otoplasty techniques for protruding ears. The skin from the incision over the back of the ear is dissected laterally, almost to the helical rim, with small, curved, blunt-tipped scissors, exposing the methylene blue dye marks in the cartilage. Medial dissection is carried to the postauricular sulcus and then to the mastoid periosteum; the posterior auricular muscle is moved aside with blunt dissection.
Attention now turns to the earlobe, which, if protuberant, requires a single suture from the dermis on the lateral side of the previously excised fusiform ellipse to the most inferior portion of the concha. One suture is usually all that is needed.
Next, the root of the helix is checked for outward angulation. If this is present and if the earlobe has not been set back, a postoperative "telephone ear" deformity may result. If the angle is too obtuse or if the patient wears glasses, a 4-mm incision in the sulcus, where the root of the helix abuts the scalp, exposes the underlying cartilage and the deep temporalis fascia. The same type of suture described above is placed between the helical rim and the underlying temporalis fascia; when tied, this should bring the helical rim into a more pleasing position closer to the ear. The wound is irrigated with an antibiotic solution and checked for hemostasis.
Late sequelae include unsightly scarring, patient dissatisfaction, suture problems, and dysesthesias.
Hematoma is heralded by the acute onset of severe, persistent, and often unilateral pain. If encountered, the head dressing should be removed and sutures released to drain the hematoma.If there is evidence of ongoing bleeding, reoperation and exploration are mandatory.
Residual deformity is, by far, the most common unsatisfactory result of otoplasty. It usually is apparent by 6 months postoperatively. It is manifested by one or more of thefollowing: a sharply ridged antihelical fold; lack of normal curvature of the superior crus; irregular contouring; a malpositioned or poorly constructed antihelical roll; an excessively large scapha; and a narrow ear.
- Otoplasty: What I Do Now-A 30-Year Perspective; Plastic & Reconstructive Surgery, 104(3):834-840, September 1999; Spira, Melvin M.D.
- Otoplasty; Plastic & Reconstructive Surgery, 115(4):60e-72e, April 1, 2005; Janis, Jeffrey E. M.D.; Rohrich, Rod J. M.D.; Gutowski, Karol A. M.D.
- Prominent Ears in Children Younger than 4 Years of Age: What Is the Appropriate Timing for Otoplasty?; Plastic & Reconstructive Surgery. 114(5):1042-1054, October 2004; Gosain, Arun K. M.D.; Kumar, Ajay M.D.; Huang, George M.D.
- Ear, Prominent Ear by Samuel J Lin, MD--eMedicine Article (very nice article)
- Ear Surgery, Otoplasty--American Society of Plastic Surgeons
- After prominent ear correction (Looking after your child at home)--Information Leaflet by Birmingham Children's Hospital