Ear deformities cause anxiety and self-consciousness in many patients, possibly leading to behavioral problems, social avoidance, and psychological distress. Although the deformity is often corrected during childhood, subtle irregularities may not be realized until adulthood when the patient is more conscious of his or her appearance.
Otoplasty is a common cosmetic procedure. There is a 5% incidence of ear deformities in the white population. Eight percent of these patients will inherit the deformity as an autosomal dominant trait. In 2006, according to a survey by the American Society for Aesthetic Plastic Surgery, there were 20,417 otoplasties performed in the United States. It is, therefore, crucial that plastic surgeons understand the anatomy of a normal ear, the pathology of ear deformities, and the possible corrective surgical procedures. There are many proposed techniques to correct the complex three-dimensional nature of the deformed ear including resection, suturing, molding, scoring, and repositioning, indicating that there is no one technique appropriate for all patients. By understanding the multitude of techniques and evaluating each ear individually, the surgeon may use these fundamental principles to correct all ear deformities and provide gratifying results.
Interest in the appearance of a child’s auricle is recorded in ancient times. A newborn’s ear was believed to foretell his future character. Although Sushruta and Tagliacozzi described otoplasty techniques, the modern era of otoplasty is credited to Dieffenbach, who in 1845 used the term “otoplastick” for the correction of microtia. In 1881, Ely described a technique to electively correct congenitally prominent ears. His treatise details the procedure being performed on a 12-year-old boy who was psychologically crippled by his deformity. In a two-staged operation, Ely first corrected the right ear and then corrected the left 6 weeks later. He excised both skin and cartilage to alter ear shape via a postauricular elliptical incision and then used horsehair sutures to reapproximate the cartilage and skin.
In 1910, Luckett modified Ely’s procedure by introducing the need for antihelical restoration, which he achieved by a single skin and cartilage incision along the length of the neo-antihelical fold. He secured the new fold with horizontal mattress sutures. This procedure leads to a sharp and unnatural appearing antihelix. To soften the contour of the antihelix, Becker introduced the idea of conical antihelical tubing in which parallel incisions are cut along the neo-antihelical fold, excising a strip of cartilage. The band of cartilage is placed in the position of the desired antihelix and then the edges of the cartilage are rolled to form a tube-like antihelix. Mustardé modified the concept of antihelical tubing by adding permanent conchoscaphal mattress sutures to bend and secure the cartilage to maintain an antihelical fold without cartilage excision.
To further mold the cartilage, Chongchet and Stenstroem applied Gibson and Davis’ concept of cartilage manipulation. Gibson and Davis discovered that altering the costal cartilage by scoring caused the ...