2017 Sec 1 Green Book

Clinical Review & Education Review

Treatment of Prominent Ears and Otoplasty

Figure 1. Auricular Anatomy of Normal and Prominent Ears

B Features of prominent ears (prominauris)

A Normal auricular anatomy

Superior and inferior crura of antihelix

Underdeveloped antihelix

Helix

Scapha

Absent root of helix

Crus of helix

Antihelix

Conchal bowl Concha cymba Concha cavum

Tragus Antitragus

Prominent conchal bowl

Cauda helicis

Lobule

Protrusion of lobule

C Comparative measurements of normal and prominent ear

Normal ear (approximate measurments)

MASTOID

Conchal bowl depth 15 mm

10-12 mm

Superior helix Mid helix Cauda helicis

R

L

Conchomastoid angle 90°

16-18 mm

Conchoscaphal angle 90°

20-22 mm

Auriculocephalic angle ~25° males, ~20° females

Mastoid

VIEW

Distance frommastoid to helix

Distances from helix to mastoid frequently exceed normal measurements

Prominent ear

Increased conchal bowl depth

Increased conchomastoid angle

Superior helix Mid helix Cauda helicis

Increased conchoscaphal angle

Increased auriculocephalic angle

Mastoid

Increased distance frommastoid to helix

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 births 5 andashighas47%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

JAMA Facial Plastic Surgery November/December 2015 Volume 17, Number 6 (Reprinted)

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