Auricular Repair & Otoplasty Flashcards
Describe the normal dimensions and angles of the adult ear
- Superior limit: Brow level
- Vertical axis: 20 degrees inclination posteriorly
- Vertical height: around 6cm
- Width: 55% of height (Goode = 0.55-0.6)
- Protrusion: 1-2cm = 15-30 degrees
Kevan FP Page 69
What is the normal growth pattern of the ear after birth? At what age does it reach adult size?
- Rapid growth in first 3 years of life
- 85% growth by 3 years of age
- 95% growth by 5 years of age
- Then growth proceeds slowly until age 12
Otoplasty recommended ~age 5-6 years old (when child starts school)
Define Prominauris. What causes it, list two most common reasons
Prominauris = prominent ears
Top two common deformities:
1. Deep conchal bowl
2. Absent antihelical fold
3. Lobule malpositioning (also addressed during otoplasty)
What are the ideal helix-mastoid distances when conducting otoplasty?
- Mastoid to Superior helix = 10-12mm
- Mastoid to Mid-helix = 16-18mm
- Mastoid to Lobule = 20-22mm
Describe non-surgical management of protruding ears
- Observation
- Auricular molding or surgical taping (usually has poor results unless started within days of birth. Auricular molding from 3 days of birth until 6 months. Surgical tape also ideally done within days of birth)
- Adhesive based prosthetic
What is the usual timing of otoplasty?
Age 5-6
Ear has achieved almost its adult size, but before school starts to prevent teasing
Describe 4 techniques for creating/modifying the anti-helical fold
- Stenstrom Technique
- Involves scoring the anterior cartilage with a rasp, anterior to the proposed antihelix, tunnel beneath the perichondrium
- Cartilage then bends AWAY from the scored side
- To remember how this bends, think of how a scored sausace bends when you cook it (away from the side thats scored)
- Results in mind improvement - Mustarde Technique
- Cartilage sparing technique
- Involves making a posterior auricular incision and reconstituting the antihelical fold with horizontal mattress sutures
- Advantages: Cartilage sparing, can create normal appearing antihelical fold
- Disadvantages: Can cause suture extrusion, does not address conchal bowl - Converse Technique
- Involves creating/cutting an island of cartilage which then sits anteriorly to the rest of the conchal cartilage; suture the island of cartilage onto itself so it is folded over
- Advantages: More permanent antihelical fold, can also create a normal appearing fold, useful in patients with thick cartilage
- Disadvantages: Experienced surgeon must perform. Not cartilage sparing - Pitanguy Technique
- Similar to converse technique, except the island of cartilage is excised and removed, and the remaining parts are opposed and sutured together/overlapped
- Similar advantages and disadvantages to converse
Kevan FP Page 70
Describe 2 techniques to modify the conchal bowl
- Cartilage excision or overlapping
- Excise or overlap the cartilage in the conchal bowl to reduce the depth. - Furnas Conchomastoid sutures
- Sutures the conchal cartilage to the mastoid fascia to achieve a set-back
Kevan FP Page 71
Describe an approach to address both the conchal bowl and antihelical fold in prominent ears
Farrior Technique
- Involves removing wedges from posterior concha to change curvature of conchal bowl (reduce depth and flatten it) and then excise a portion and projecting it to create an antihelical fold
- Essentially a combination of a cartilage scoring technique + Pitanguy’s technique
Kevan FP Page 71
Describe the technique for lobule repositioning
Modified fishtail excision
Kevan FP Page 71
What is cryptotia?
Where the root of the helix is buried in temporal lobe skin
Kevan FP Page 72
What is Stahl’s ear?
Where there is an addition (third) crus of the antihelix that traverses the scaphoid fossa, resulting in a poiny, ‘Spock’ ear
Kevan FP Page 72
What is a constricted ear?
= Lop ear
Lidding or folding over of helical skin over the triangular ± scaphoid fossa
Kevan FP Page 72
What is a helical rim?
Flattened helix
See Kevan FP Page 72
What is a cup ear?
Excessive helical rim and cupped (see Kevan FP Page 72)
What is a conchal crus?
Abnormal fold of cartilage crossing the mid portion of the concha symba that appears to divide the ear in half. Often a result of prominent ear
https://s40764.pcdn.co/wp-content/uploads/sites/242/2022/12/Conchal-Crus.jpg.optimal.jpg
Kevan FP Page 72