2017 Sec 1 Green Book

Techniques to Address Conchal Excess

Multiple techniques have been described to address conchal ex-

cess. These include suture techniques and excision of cartilagewith

or without skin and scoring. The techniques are furthermodified by

whether they are performed by a posterior or anterior approach.

Earlyattempts at treatment of conchal excess andcupping relied

solely on the excisionof skin. Dieffenbach

reported the resectionof

postauricular skin in an effort to correct a posttraumatic auricular de-

formity. Limited success encouraged the development of additional

techniques. Morestin

described the first attempt at the correction

ofexcessconchalcartilagebyexcisinganovalofcartilagefromthebase

of the conchal bowl without the use of sutures. The otoplasty de-

scribedbyLuckett

wasoneofthefirsttoaddressdeficienciesofthe

antihelix; however, the author also addressed conchal excess by ex-

cising conchal cartilage adjacent to the antihelix. These early at-

temptswereoftenlimitedbytheamountofcartilagethatcouldbeex-

cised and frequently did not adequately correct the deformity.

Decades would pass until suture techniques would be used in

addition to cartilage resection. Owens andDelgado

are credited as

the first to use sutures to increase correction of conchal excess and

deformity. The authors

described placing sutures that penetrated

only the posterior conchal perichondriumandwere anchored to the

fascia, but not the periosteum overlying the mastoid. This tech-

nique led to early recurrence of the auricular deformities in a large

number of patients, making future modifications necessary.

Themostfrequentlycitedmodificationofthetechniquereported

by Owens and Delgado

was described by Furnas,

who described

the use of nonabsorbablemattress sutures placed through both the

perichondriumandconchalcartilageandsecuredtothemoreresilient

mastoidperiosteum.Thistechniqueprovidedforalong-lastingcorrec-

Figure 2. Technique to Re-create the Antihelical Fold

Preoperative appearance

An elliptical-shaped incision is made posteriorly, and

the skin is excised, exposing the auricular cartilage.

The skin is widely undermined to

expose the area from the postauricular

sulcus to the helical rim.

The helix is bent with slight manual pressure toward the mastoid to help

identify an optimal, natural-looking location for creating the antihelical fold.

The curve is marked, and temporary black 4-0 nylon horizontal mattress

fixation sutures are placed anteriorly to recreate the antihelical fold.

The ear is retracted anteriorly. Using the previously placed fixation sutures

as a guide, permanent 4-0 clear nylon horizontal mattress sutures are placed

posteriorly through the cartilage and perichondrium only.

Temporary fixation sutures are cut and

removed anteriorly.

The antihelical fold is maintained in a

corrected position by the permanent

sutures.

Postauricular sulcus

Natural-looking

curve of antihelix

~10 mm wide

2 mm

Cauda

helicis

Helical rim

Cartilage

Temporary

suture

Temporary

fixation sutures

Permanent

suture

Permanent

sutures

Skin

Poorly defined

antihelix

Clinical Review & Education

Review

Treatment of Prominent Ears and Otoplasty

JAMA Facial Plastic Surgery

November/December 2015 Volume 17, Number 6

(Reprinted)

jamafacialplasticsurgery.com