2017 Sec 1 Green Book

Clinical Review & Education Review

Treatment of Prominent Ears and Otoplasty

Figure 2. Technique to Re-create the Antihelical Fold

Preoperative appearance 1

The skin is widely undermined to expose the area from the postauricular sulcus to the helical rim.

An elliptical-shaped incision is made posteriorly, and the skin is excised, exposing the auricular cartilage. 2

3

Poorly defined antihelix

Helical rim

~10 mm wide

Cauda helicis

2 mm

Postauricular sulcus

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. 4

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. 5

Permanent sutures

Temporary fixation sutures

Skin

Cartilage

Natural-looking curve of antihelix

Temporary suture

Permanent suture

Temporary fixation sutures are cut and removed anteriorly.

The antihelical fold is maintained in a corrected position by the permanent sutures.

6

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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 21 are credited as the first to use sutures to increase correction of conchal excess and deformity. The authors 21 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 21 was described by Furnas, 22 who described the use of nonabsorbablemattress sutures placed through both the perichondriumandconchalcartilageandsecuredtothemoreresilient mastoidperiosteum.Thistechniqueprovidedforalong-lastingcorrec-

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 18 reported the resectionof postauricular skin in an effort to correct a posttraumatic auricular de- formity. Limited success encouraged the development of additional techniques. Morestin 19 described the first attempt at the correction ofexcessconchalcartilagebyexcisinganovalofcartilagefromthebase of the conchal bowl without the use of sutures. The otoplasty de- scribedbyLuckett 20 wasoneofthefirsttoaddressdeficienciesofthe antihelix; however, the author also addressed conchal excess by ex-

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