Ear Surgery - Otoplasty

Ear surgery: Otoplasty

Otoplasty is one of the most common plastic surgery procedures for children. The majority of patients who undergo Otoplasty are between 4 and 14 years old, although many adults also elect to have the procedure.

Ear surgery can correct protruding ears (excessive ear cartilage), large or otherwise deformed earlobes, "lop ear" (where the ear tip bends down and forward), and "cupped" or "shell ear" (which could be a very tiny ear or an ear without natural creases). Surgeons have developed techniques to create ears for patients who are missing all or part of their ears as a result of a birth defect or traumatic injury.

Malformed Ears

Malformed ears include cupped ears, shelled ears, or ears that are otherwise not visible due to a birth defect. The ears are assessed for excessive cartilage, malformed cartilage, mal-positioned cartilage, and soft-tissue (skin and fat) deformity.

When Is the Best Time for Otoplasty?

Children's ears are most often fully developed by age 4. There are no additional risks associated with age. The procedure is usually performed to improve the appearance of the ears so that the child would not have to go through childhood in miseries of being ridiculed for his ears.

Firmer cartilage of fully developed ears in adults does not provide the same molding capacity as in children. Having the procedure at a young age is highly desirable for two reasons:

The cartilage is extremely pliable, thereby permitting greater ease of shaping.
The child will experience psychological benefits earlier from the cosmetic improvement.

Initially, surgeon will examine the structure of the ears and discuss possibilities for correcting the problems. Even if only one ear needs "pinning back," surgery will probably be recommended on both ears to achieve the most natural, symmetrical appearance.

The Procedure

The Otoplasty procedure is performed in an outpatient medical surgery center, physician's office, or hospital. Surgeons typically suggest a general anesthesia for young patients and a local anesthetic combined with a mild sedative for older children and adults. For certain general anesthesia cases, an overnight hospital stay may be appropriate. Otherwise, patients return home within hours of the procedure on the same day. Under normal conditions, time in surgery is about two hours.

HOW Otoplasty IS PERFORMED

Factors determining the choice of technique include the general anatomy of the ears, the extent of the ear cartilage, excessive skin in the surrounding area, or level of deformity in other areas of the ears.
There are two common Otoplasty techniques:

First, the surgeon determines the incision location by finding the most inconspicuous site on the back of the ear. After the incision is made, the surgeon will sculpt the exposed ear cartilage and re-position it closer to the head for a more natural-looking appearance. The surgeon may use non-removable stitches to help the cartilage maintain its position. In some cases, the surgeon will remove more excessive cartilage in order to enhance the ultimate appearance of the ear.
In the second technique, skin is removed and the ear cartilage is folded back. Removing of cartilage is not necessary in this technique. Non-removable stitches are used to help the cartilage maintain its position. Dissolvable or removable stitches are used for the incision location, which are removed or dissolve within seven days.

MICROTIA PROCEDURE

For total ear reconstruction, also known as congenital microtia (ear absence), a common approach begins with developing a framework from the ribs, then elevating the back, and placing a skin graft. The ear canal is then carved out — often it is necessary to rotate the lobule. Ears that are malformed due to trauma (including burns) may undergo a variation of the reconstruction process, possibly with more extensive skin grafting, depending upon the extent of the tissue damage.

After Surgery

After the procedure, the head is wrapped in a thick bandage. Fitting of the bandage helps to maintain the new position of the ears and enhances the healing process. Patients usually return to the surgeon's office within the first few days to exchange the bandage for a lighter one. Your surgeon will provide specific instructions regarding the use of the lighter bandage. Your surgeon will also provide a complete post-operative instruction list, which you should follow strictly to reduce the chance of complications.

Young patients are to refrain from normal activity for at least seven days after surgery. Special care must be given to children throughout the first three weeks of recovery to limit them from playful activities that may disrupt the ears. Adult patients usually return to normal activity within three days after surgery. More complicated procedures may require a longer recovery time. The ears should not be bent for at least a month or more.

During recovery, Otoplasty patients may experience

temporary discomfort and numbness — managed with oral medications
headaches — relieved through use of a long-acting local anesthetic
swelling — managed with head elevation, decreases within a week
unusual sensations — may include itching or the lack of sensation at the incision line, which can disappear over the course of six months

Otoplasty will not impair hearing ability. After a successful Otoplasty procedure, the ears will be in proportion to the size and shape of the face and head.