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There are a number of problems that can occur in the development of the ear which may lead to the need for corrective surgery, typically as a child but occasionally as an adult. Elective ear surgery is typically performed at the age of 6 or 7 to allow for near complete ear growth, the development of rib cartilage that may be used as a graft to correct the ear, and the avoidance of much childhood ridicule.
Microtia is due to underdevelopment of the ear cartilages and includes total absence of the ear. Reconstruction requires synthetic implants or rib cartilage grafts to create the framework of the ear, coverage of the ear, reconstruction of ear lobule and tragus (the prominent cartilage in front of the ear), and elevation of the reconstructed ear from the head. The ear canal may also require reconstruction.
Cup ears and lop ears are characterized by a constricting band which limits the diameter of the ear and deepening the depth of the ear creating a cup-like appearance or lopping of the remaining ear. Reconstruction is highly variable depending on the severity of the ear anomaly. In cryptotia, the upper pole is buried beneath the scalp, requiring release and reconstruction.
Macrotia technically means large ears, but prominent ears are more common and are normal size. Oversized ears can usually be treated with removal of a wedge of cartilage and skin. Prominent ears lack a normal antihelical fold, the inner ridge along the curve of the ear. This leads to widening of the angle between the ear and the skull, which may also be due to an excessive amount of conchal cartilage.
The operation to correct protruding ears is known as an otoplasty and is performed as an outpatient procedure either in an office operating facility or outpatient operating room with general anesthetic or local anesthesia and sedation (older children and adults). The procedure takes between 1-½ to 3 hours. Skin is removed from behind the ear, excess conchal cartilage is removed, a series of sutures are used to recreate the normal antihelical ear fold. A second row of sutures pulls the ear back towards the side of the head. Additional sutures may be used to bring the upper ear closer to the side of the head and scoring the cartilage can help it bend.
A bulky dressing is protective postoperatively. The final shape of the ear however, might not, be apparent for several weeks after that. A headband can help prevent trauma for several more weeks.
Cauliflower ear – Otohematoma is the term applied to the deformed and thick ear cartilage that occurs due to prior bleeding. Correction requires recontouring cartilage.
Repair of Torn Earlobe
A partial or complete tear of an earlobe is common, but can be repaired in the clinic under local anesthesia with an interdigitating skin flap.
All of the descriptions for the various procedures are condensed from the text of the upcoming textbook written by Dr. Christopher Park and Dr. Malcolm Marks and are copyrighted, "The Artistry of Plastic Surgery: Exploring the Experience” . |
