Otoplasty | Ear Pinning

Due to variations in normal embryologic development, the ears (also called auricles) may excessively protrude from the skull. Under-developed folds in the cartilage located just inside the outer rim of the ear (the anatomic 'antihelical folds') and over-developed cartilage in the cup of the ear (the anatomic 'conchal bowl') are the most common anatomical causes of ear protrusion. While posing no physical detriment, protruding ears can cause significant psychological distress. Emotional strife is particularly common among school-age children who become the unfortunate victims of peer ridicule. In this setting, otoplasty surgery can "pin back" the ears, improving both the shape and position of the ears.

Successful otoplasty is expected to restore a more natural ear position and shape. Patients should feel comfortable styling their hair without thought of hiding the ears. It is hoped that all patients will feel confident and comfortable with their ear position and shape.

Goals of Surgery

Areas of concern that are successfully and commonly improved with otoplasty include:

  • Setting the ear position closer to the skull
  • Reducing the size of the ear "cup" (correction of conchal cartilage hypertrophy)
  • Improving the shape of the 'antihelical folds' (re-creation of the antihelical folds)
  • Improving the symmetry of the ears
  • Correcting excess protrusion of the ear lobes (cauda helicis resection)

Pre-Surgical Consultation

During the pre-surgical consultation, a detailed examination and analysis of the ears is performed. Digital photographs of the ears are reviewed on our advanced computerized imaging software to facilitate communication of the changes desired and to illustrate the expected post-surgical outcomes. A comprehensive surgical plan customized to address each patient's concerns is ultimately developed and carefully explained.

Technique

Otoplasty can be performed beginning at age 5-6, as children enter full-time elementary school education. By the age of 5-6, the ears are nearly adult-size, permitting surgery without significant compromise to future ear development and avoiding much of the peer ridicule that could potentially arise as schooling progresses. However, otoplasty can be safely undertaken in later childhood, adolescence, or even adulthood with equally successful results.

Incisions are placed exclusively behind the ears, making them invisible from the frontal view of the face. The surgical technique is customized to correct the specific factors contributing to ear protusion in each instance. Maneuvers commonly used to improve ear shape and position include:

  • Removal of a small portion of skin on the back surface of the ear
  • Weakening the conchal bowl cartilage strength in the "cup" portion of the ear
  • Suturing (stitching) techniques that hold the conchal ("cup") cartilage closer to the skull - Furnas sutures / conchomastoid sutures
  • Suturing (stitching) techniques that re-create the antihelical folds - Mustardé sutures

Post-Surgical Course

Otoplasty surgery is generally performed on an out-patient basis under general anesthesia. The procedure can safely be performed on both ears simultaneously. A physician on our care team is always available to answer any post-surgical questions that may arise. Bandages over the ears are left undisturbed until the first post-operative visit approximately one week after surgery. Thereafter, an athletic headband is advised for the next 6 weeks to protect the new ear shape and position while sleeping. Most patients return to school/work one week after surgery. Contact sports should be avoided for at least 6 weeks post-operative. (For these reasons, otoplasty is commonly performed during a school break or summer vacation). Routine post-operative office visits are periodically scheduled for the year following surgery to ensure optimal healing.