2017 Sec 1 Green Book

Clinical Review & Education Review

Treatment of Prominent Ears and Otoplasty

ears, and about the same number reported attempting to cover their protrudingearswithvarious hairstyles or headwear. They founda sig- nificant increase in the HRQOL following otoplasty in approximately 95% of both adults and children. In addition, both groups (including parents)reportedahighsatisfactionratefollowingtheprocedure.Since Braunetal 29 publishedtheirinitialstudy,otherauthorshavefoundvery similar QOL results after otoplasty. 30,31 Future Trends Recently, electromechanical reshaping (EMR) has been studied as away to reshapeauricular cartilage. Usingan invivo rabbit earmodel, Yau et al 32 studied the degree of shape change and histological find- ings after EMR and splinting. They found a dose-dependent rela- tionship between the voltage applied and the degree of shape change and histologic findings showing areas of tissue injury, which were limited to a small area around the needle insertion sites. This type of technology has potential application as a minimally inva-

sive technology that could be used for office-based otoplasty; how- ever, further clinical studies in humans will be necessary.

Conclusions Prominent ears are frequently treated by facial plastic surgeons. An intricate knowledge of normal auricular anatomy is required to de- velop an appropriate operative plan to address the deformed ear. The trend in otoplasty techniques has consistently moved toward less invasive options, ranging from nonsurgical newborn ear mold- ing to cartilage-sparing surgical techniques andeven incisionless, of- fice-basedprocedures.Whilemost surgeonswho treat auricular de- formitieswill developpreferences andexpertise ina fewtechniques, theymust remain flexible in order to deal with the variety and com- plexity of deformities that exist. Both surgical and nonsurgical oto- plasty techniques continue to evolve and future advancements in minimally invasive technologies and tissueengineeringwill likely cre- ate even more possibilities to address auricular deformities.

21 . Owens N, Delgado DD. The management of outstanding ears. South Med J . 1965;58:32-33 . 22 . Furnas DW. Correction of prominent ears by conchamastoid sutures. Plast Reconstr Surg . 1968; 42(3):189-193 . 23 . Sie KC, Ou H. Otoplasty: an alternative approach to management of the deep conchal bowl. Laryngoscope . 2006;116(11):2092-2094 . 24 . Fritsch MH. Incisionless otoplasty. Laryngoscope . 1995;105(5, pt 3)(suppl 70):1-11 . 25 . Fritsch MH. Incisionless otoplasty with conchal bowl recession [in German]. HNO . 2012;60(10): 856-861 . 26 . Haytoglu S, Haytoglu TG, Yildirim I, Arikan OK. A modification of incisionless otoplasty for correcting the prominent ear deformity [published online October 14, 2014]. Eur Arch Otorhinolaryngol . doi: 10.1007/s00405-014-3329-3 . 27 . Mehta S, Gantous A. Incisionless otoplasty: a reliable and replicable technique for the correction of prominauris. JAMA Facial Plast Surg . 2014;16(6):414-418 . 28 . Haytoglu S, Haytoglu TG, Bayar Muluk N, Kuran G, Arikan OK. Comparison of two incisionless otoplasty techniques for prominent ears in children. Int J Pediatr Otorhinolaryngol . 2015;79(4):504-510 . 29 . Braun T, Hainzinger T, Stelter K, Krause E, Berghaus A, Hempel JM. Health-related quality of life, patient benefit, and clinical outcome after otoplasty using suture techniques in 62 children and adults. Plast Reconstr Surg . 2010;126(6):2115-2124 . 30 . Songu M, Kutlu A. Health-related quality of life outcome of children with prominent ears after otoplasty. Eur Arch Otorhinolaryngol . 2014;271(6): 1829-1832 . 31 . Hao W, Chorney JM, Bezuhly M, Wilson K, Hong P. Analysis of health-related quality-of-life outcomes and their predictive factors in pediatric patients who undergo otoplasty. Plast Reconstr Surg . 2013;132(5):811e-817e . 32 . Yau AY, Manuel C, Hussain SF, Protsenko DE, Wong BJ. In vivo needle-based electromechanical reshaping of pinnae: New Zealand White rabbit model. JAMA Facial Plast Surg . 2014;16(4):245-252 .

7 . Matsuo K, Hirose T, Tomono T, et al. Nonsurgical correction of congenital auricular deformities in the early neonate: a preliminary report. Plast Reconstr Surg . 1984;73(1):38-51 . 8 . Kurozumi N, Ono S, Ishida H. Non-surgical correc- tion of a congenital lop ear deformity by splintingwith Reston foam. Br J Plast Surg . 1982;35(2):181-182 . 9 . van Wijk MP, Breugem CC, Kon M. A prospective study on non-surgical correction of protruding ears: the importance of early treatment. J Plast Reconstr Aesthet Surg . 2012;65(1):54-60 . 10 . Doft MA, Goodkind AB, Diamond S, DiPace JI, Kacker A, LaBruna AN. The newborn butterfly project: a shortened treatment protocol for ear molding. Plast Reconstr Surg . 2015;135(3):577e-583e . 11 . Mustarde JC. The correction of prominent ears using simple mattress sutures. Br J Plast Surg . 1963; 16:170-178 . 12 . Hilger P, Khosh MM, Nishioka G, Larrabee WF. Modification of the Mustardé otoplasty technique using temporary contouring sutures. Plast Reconstr Surg . 1997;100(6):1585-1586 . 13 . Converse JM, Nigro A, Wilson FA, Johnson N. A technique for surgical correction of lop ears. Plast Reconstr Surg (1946) . 1955;15(5):411-418 . 14 . Pitanguy Y, Rebello C. Ansiform ears-correction by “island” technique. Acta Chir Plast . 1962;4:267-277 . 15 . Farrior RT. A method of otoplasty: normal contour of the antihelix and scaphoid fossa. AMA Arch Otolaryngol . 1959;69(4):400-408 . 16 . Obadia D, Quilichini J, Hunsinger V, Leyder P. Cartilage splitting without stitches: technique and outcomes. JAMA Facial Plast Surg . 2013;15(6):428-433 . 17 . Jost J. Atlas of Aesthetic Plastic Surgery. Paris, France: Masson; 1975. 18 . Dieffenbach JF. Die Operative Chirurgie. Leipizig, Germany: F. A. Brockhaus; 1845. 19 . Morestin M. De la reposition et du plissement cosmetiquesdupavillondel'oreille. Revued'orthopedie . 1903;14. 20 . Luckett W. A new operation for prominent ears based on the anatomy of the deformity. Surg Gynec Obst . 1910;10.

ARTICLE INFORMATION Accepted for Publication: May 18, 2015. Published Online: July 9, 2015. doi: 10.1001/jamafacial.2015.0783 . Author Affiliations: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee (Pawar); Koch Facial Plastic Surgery and Spa, West Des Moines, Iowa (Koch); Division of Facial Plastic Surgery, Department of Otolaryngology–Head and Neck Surgery, Virginia Mason Medical Center, Seattle, Washington (Murakami). Author Contributions: Dr Pawar had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Koch, Murakami. Acquisition, analysis, or interpretation of data: Pawar, Koch. Drafting of the manuscript: Koch, Murakami. Critical revision of the manuscript for important intellectual content: Pawar, Koch. Administrative, technical, or material support: Pawar. Study supervision: Pawar, Murakami. Conflict of Interest Disclosures: None reported. REFERENCES 1 . Adamson PA, Litner JA. Otoplasty technique. Otolaryngol Clin North Am . 2007;40(2):305-318 . 2 . Macgregor FC. Ear deformities: social and psychological implications. Clin Plast Surg . 1978;5 (3):347-350 . 3 . Janis JE, Rohrich RJ, Gutowski KA. Otoplasty. Plast Reconstr Surg . 2005;115(4):60e-72e . 4 . Balogh B, Millesi H. Are growth alterations a consequence of surgery for prominent ears? Plast Reconstr Surg . 1992;90(2):192-199 . 5 . Matsuo K, Hayashi R, Kiyono M, Hirose T, Netsu Y. Nonsurgical correction of congenital auricular deformities. Clin Plast Surg . 1990;17(2):383-395 . 6 . Byrd HS, Langevin CJ, Ghidoni LA. Ear molding in newborn infants with auricular deformities. Plast Reconstr Surg . 2010;126(4):1191-1200 .

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