Since protruding ears often have negative effects on psychological health, a surgical correction can improve quality of life and avoid mental dysfunctions. In protuberant ears, the auricular cartilage is insufficiently folded especially at the crease, which faces the auricle (antihelical fold). Prominent ears are not pathological. However, pronounced congenital auricular malformations can also be associated with middle or internal ear alterations and in that case, are definitely considered to be a disease.
By means of so-called otoplasty (otopexy) a surgical correction of the malformation can be performed as early as age six. At this time 90% of the ear is fully developed, so that the intervention can be carried out before the patient starts school and as a result is spared his classmates' teasing. But it can also be performed at any other time, in older children or adults, and even with local anesthesia.
For a routine otoplasty a number of very different surgical techniques are available. To date, there is as a result no ideal, uniform OP technique. Experience has mainly shown that the use of a combination of several techniques is best to achieve an optimal postoperative outcome. We prefer a combination of suture techniques to reposition the ear in an anatomically normal configuration and location.
In most cases of protruding ears the main auricular fold is poorly formed or insufficiently creased. Operative access with separation of skin from cartilage is retroauricular (i.e. the incision is behind the ear) so as to avoid visible scarring. Usually, the auricular cartilage must be weakened or thinned with special instruments and the remodeled with suturing techniques. In order to achieve bilateral symmetry, we measure the distance to the outer edge of the ear from three standardized landmarks.
In most cases an accentuation of the antihelical fold is sufficient. However, in particularly large ears a supplementary excision of cartilage may be required. In addition, the pinna is solidly anchored to the mastoid bone (the mastoid process of the cranial temporal bone). Application and fixation of a special dressing and ointment concludes the operation.
Postoperative follow-up care
- Outpatient surgery or one night hospital stay
- Oral analgesia as needed
- Dressing change and loop removal on the first day based on presentation
- Suture removal around day seven, depending on suture material a little later
- Elastic strap or contoured bandage for approximately two weeks, depending on technique used; school attendance or work are however unrestricted
- Firm forehead bandage at night for an added two to four weeks
- Light physical activity allowed after three to seven days
- Light exercise after six to eight weeks, with increased stress three months postoperatively
- Avoid strong sunlight or intense cold (skiing) for three to six months, even longer if there is disturbance of the sensitivity to touch
- Hygiene of the newly formed post-auricular crease: at least twice weekly with cotton swabs and baby oil or mild skin cream.
If your operation is performed by a qualified plastic surgeon, complications tend to be rare and general a good lasting result is achieved – however, it is not possible to guarantee surgical results.
- Risk of anesthesia (general anesthesia until the tenth year, after which local anesthesia or analog-sedation [twilight sleep] is possible)
- General risk of surgical complications (infection, postoperative hemorrhage, etc.)
- Risk of not achieving the desired result (in about 5% of cases a second intervention is possible)
- Special postoperative problems:
- Bloody effusions
- Keloid formation (scar proliferation/hypertrophy)
- Hypersensitivity of the pinnae
- Suture extrusion
Key points at a glance
- Anesthesia: general, twilight sleep, or local anesthesia
- OP duration: one to two hours
- Hospital stay: outpatient or overnight
- Forehead-ear bandage: two weeks
- Forehead bandage: for two to four additional weeks
- Suture extraction: after one week
- Disability: approx. two weeks
- Exercise restriction: six to eight weeks