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corded.Measurements fromthe superior helical rim,midhelical rim,
and cauda helicis to the mastoid should also be recorded. Normal
values for these measurements are typically 10 to 12 mm superi-
orly, 16 to 18mm at the middle third, and 20 to 22mm at the cauda
helicis.1 Patientswith prominent ears frequently exceed thesemea-
surements. The position of the lobule in relation to the helical rim
should also be noted; this position determines whether reposition-
ing of the lobule will be required during surgery. Finally, the stiff-
ness of the auricular cartilage should be noted. The auricular carti-
lage becomes less pliable with age and may dictate the surgical
maneuvers required to achieve a satisfactory result.
Treatment of Prominent Ears
The fact that hundreds of techniques for the correction of prominent
ears have been described over the past 50 years attests to no 1 tech-
niquebeingeffectiveinallcases.Whilenonsurgicalcorrectionofpromi-
nent ears can be effective in some newborn patients, treatment after
the first fewweeks is primarily surgical. Surgical techniques to correct
prominent ears can be divided into categories based on the defor-
mity addressed, such as excess conchal cartilage or the underdevel-
opment of the antihelix. The appropriate technique to correct thede-
formity relies on an accurate preoperative physical examination, and
more than 1 techniquemay be necessary to achieve optimal results.
Ear Splinting and/or Molding
Thenewbornperiod is uniqueowing to the ability to correct auricular
deformities using nonsurgical techniques. The incidence of auricular
deformities has been estimated to be as low as 11.5 per 10 000 live
births5andashighas47%ofallbirths.5 Onlyaboutone-thirdoftheau-
riculardeformitiesnotedatbirthwillself-correctwithinthefirstweek.6
The pliability of auricular cartilage in the newborn period is be-
lieved to be secondary to the high levels of circulating maternal es-
trogens. Maternal estrogens reach their peak in the fetus just before
birthandquicklydissipate tonormal levels at approximately6weeks
to 3 months of age, paralleling the time frame during which nonsur-
gical treatment of auricular deformities is most successful. The high
levels ofmaternal estrogens are believed to promote higher levels of
proteoglycans within cartilage further promoting its pliability.7
Figure 1. Auricular Anatomy of Normal and Prominent Ears
VIEW
L R
Scapha
Antihelix
Conchal bowl
Concha cymba
Concha cavum
Tragus
Antitragus
Crus of
helix
Cauda helicis Lobule
Helix
Superior and inferior
crura of antihelix
A Normal auricular anatomy
Underdeveloped
antihelix
Protrusion
of lobule
Prominent
conchal bowl
B Features of prominent ears (prominauris)
C Comparative measurements of normal and prominent ear
Absent
root of
helix
Auriculocephalic angle
~25° males, ~20° females
Distance frommastoid to helix
Increased distance
frommastoid to helix
Distances from helix to mastoid
frequently exceed normal measurements
10-12 mm
Mastoid
Mastoid
20-22 mm
16-18 mm
Superior helix
Mid helix
Cauda helicis
Superior helix
Mid helix
Cauda helicis
Conchoscaphal angle
90°
Conchomastoid
angle 90°
Conchal bowl depth
15 mm
Increased
auriculocephalic
angle
Increased
conchoscaphal angle
Increased
conchal bowl depth
Normal ear (approximate
measurments)
Prominent ear
MASTOID
Increased
conchomastoid angle
Clinical Review & Education Review Treatment of Prominent Ears and Otoplasty
JAMA Facial Plastic Surgery November/December 2015 Volume 17, Number 6 (Reprinted)
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