Chapter 79. Otoplasty & Microtia

Essentials of Diagnosis

• Prominauris (prominent ears) occurs in approximately 5% of the population.
• Conchal prominence and the absence of an antihelical fold represent the most common causes of prominence of the ears.
• Although there are hundreds of techniques to correct auricular prominence, the most common are suture techniques for conchal setback (technique of Furnas) and for creation of an antihelical fold (technique of Mustarde).
• Otoplasty refinement techniques exist for deformities such as large earlobes and excessive helical prominences.
• Complication rates from otoplasty range from 7% to 12% and may be subdivided into early, late, and aesthetic/anatomic in etiology.
• Auricular hematoma occurs in 1% of otoplasties. Complaints of unilateral pain or tightness within the first 48 hours postoperatively require prompt removal of dressings to examine the wound site for hematoma collection.

Preoperative Evaluation/Timing of Surgical Correction

The incidence of excessively prominent ears is about 5%. It is inherited as an autosomal dominant trait with 25% partial penetrance; it most commonly results from two anatomic irregularities, specifically the absence of an antihelical fold and excessive depth or projection of the conchal bowl.

Precise analysis of auricular deformities is paramount to achieving successful outcomes. Surgeons must identify the specific cause of auricular prominence in the formulation of an appropriate surgical plan. Although frequently bilateral, asymmetries in ear protrusion should be noted. As such, standard preoperative photography should be performed, including frontal, full right and left oblique, full right and left lateral, and close-up right and left lateral views.

Although there exist proponents of earlier surgical correction, most authors agree that the ideal age for otoplasty is between 5 and 6 years. Physiologically, the auricle is roughly 90% of adult height by 6 years of age. Psychosocially, correction is undertaken before or soon after a child's entrance to grammar school, where children are subject to peer ridicule. Moreover, by 5 or 6 years, children are able to participate in their own postoperative care (ie, not pulling off bandages or disturbing the wound).

Techniques of Surgical Correction

Over 200 techniques have been described for correction of the prominent ear. Conceptually, they can be subdivided into procedures that address an absent antihelical fold, procedures that reduce excess in the conchal bowl, and those that reduce prominent or enlarged lobules. Most of the latter techniques involve reshaping auricular cartilage, which can be accomplished through a number of cartilage-manipulating techniques such as suturing, scoring, and excision/repositioning, to name a few. Herein, the most commonly used technique for correction of an absent antihelical fold, originally described ...