Wednesday, September 19, 2007

Stahl's Ear

Stahl's ear is a rare congenital auricular malformation in which an abnormal "third crus" traverses the upper pole of the scapha. This results in a deformation that flattens and steers the helical rim posteriorly and superiorly. This deformity was originally described by Stahl in the nineteenth century. It is more prevalent in Oriental societies, especially Japan. It is seen bilaterally in 20% of cases. It is also known as Spock's ear or Vulcan Ear. Photo credit

In 1889, Binder stated that Stahl's ear has a hereditary tendency; however, this has never been substantiated. There is some evidence that this deformity is caused by an error in the development of the helix and scapha, approximately in the third embryologic month.
In this ear deformity, the main feature is that the free margin of the helix is longer than the outer margin of the auricula, and the helix does not fold in. This situation is just the opposite of the normal ear shape. When the deformity is marked, there is flattening of the helix and significant posterosuperior protrusion of the rim. There is no superior crus, but the inferior crus is usually present. The anomaly can be difficult to correct, and a number of different treatment options have been suggested.

Non-surgical Taping & Splinting

There are some who are able to correct this deformity with splinting and taping, as Dr. Dirk Lazarus did for his son (photo from his web site).



Neonatal auricular cartilage lacks elasticity. The moldability of auricular cartilage during the prenatal and neonatal periods is believed to be associated with the increased concentration of maternal estrogen. Estrogen relaxes the cartilage, ligaments and connective tissue of the fetus to pass through the birth canal. Ear molding takes advantage of this transient increase in estrogen. Researchers agree that, ideally, correction should be initiated within the first week of life. Early referral is critical. Maternal estrogen decreases within the first six weeks.


Ear molding relies on early splinting for correction of congenital auricular deformities. Splints or ear molds have been fabricated from dental impression materials including vinyl polysiloxane, guttapercha, triad, or thermoplastic material. Surgical tape has been used to secure the splint, obtain the correct helical and antihelical shape, and to position the auricle closer to the scalp. The splint is worn 24 hours a day, with removal and cleaning during bath time. The parents’ compliance with taping instructions is vital to the success of the technique. The duration of splinting ranges from six to 12 weeks. Treatment is completed when the splint can be removed for several days without relapse. Possible complications include skin irritation and ulceration.

Surgical Treatment
For reconstruction, a full-thickness, wedge-shaped (varying from triangular to trapezoidal), third crus excision is needed. Often small triangular excision (one or more) along the rim are needed to narrow the scapha, to prevent a dog-ear deformity and to get an adequate rotation of the helical rim. Full-thickness excisions are made according to the planned drawings. Auricular cartilage is sutured with 5-0 monofilament nylon, and skin is closed with 6-0 monofilament nylon sutures. Gentle pressure dressings are applied to the ears after the operation. Left photo set from 4th reference article, right photo set from 6th reference article)




References

  • Plastic Surgery Update, Winter 2006--Children's Hospital of Pittsburgh
  • Correction of deformational auricular anomalies by moulding – results of a fast-track service; Swee Tan, Anna Wright, Anna Hemphill, Kari Ashton and Joan Evans; Journal of the New Zealand Medical Association, 12-September-2003, Vol 116 No 1181 (molding technique photos from this article)
  • Aesthetic Otoplasty--Wedge Excision of a Flattened Helix to Create a Helical Curl; Peter F. Maurice, MD, MS; Karl J. Eisbach, MD; ARCH FACIAL PLAST SURG/VOL 7, MAY/JUNE 2005
  • BILATERAL STAHL'S EAR: A RARELY SEEN ANOMALY.; Plastic & Reconstructive Surgery; 115(1):345-346, January 2005; Tatlidede, Soner M.D.; Gonen, Emre M.D.; Bas, Lutfu M.D.
  • The third crus of the antihelix and another minor anomaly of the external ear; Plast. Reconstr. Surg. 58: 192, 1976; Fischl, RA
  • A Novel Surgical Method of Repair for Stahl's Ear: A Case Report and Review of Current Treatment Modalities; Plastic & Reconstructive Surgery; 103(2):566-569, February 1999; Kaplan, Hilton M. M.B., B.Ch.; Hudson, Don A. F.R.C.S.
  • London Centre for Ear Reconstruction--good photos

2 comments:

Kate said...

I know it's been a few years since you wrote this piece. I figured there had to be a name for the "type" of ears I have and started googling. Came across your blog, and so glad that I did! Of all the information online, this was the most helpful. You write that it hasn't been substantiated whether Stahl's ear is hereditary. It must be since my father, brother, my son, and I all have it--those same pointy ears. We've never thought to have surgery for it; we don't really think of them as strange. Probably because we all have them and just consider them another family trait (we're Caucasian, as well). (I like to think of us as a "walking genetic mess." We have a few other rather rare things going on). So... yes, I believe Stahl's ear is hereditary and wanted to say that there is a Caucasian family in the Texas Hill Country with them. Thank you for the wonderful blog! P.S.: I love quilting, too. :) adah25@aol.com

Xandra said...

Kate: My family, from Iowa, also has it. I get it from my father's side of the family, although only my father, my sister and I have it in the last two generations. I never saw anyone else with it in the States, but I think it comes from Germany, as that side of the family comes from what was East Prussia, now in Poland. The only other people I've ever seen that have it are also German-descent. Odds are, you got it from an ancestor from North-eastern Germany. And yes, I love mine too. I'd never let anyone change them, and if I ever have children, I hope they get them too. It's a visible link to my family and I'm quite proud of them.