Treatment Options
Prominent Ear
Since there's no shortage of skin or cartilage in the prominent ear deformity, it is perfectly amenable to early diagnosis and correction with ear molds, best started in the first week following birth. If the opportunity for molding is missed or fails, surgical correction of the prominent ear deformity is generally deferred until three to five years of age. I prefer correction at approximately five years of age since 90% or greater of ear growth has occurred by that age. With the growth of the ear completed at the time surgery is performed, I believe there is less error in obtaining a precise adjustment to the projection of the ear.
Almost always a slight difference will persist between the two sides after surgical correction. If this difference is 3 millimeters or less, then acceptable results have been achieved and secondary surgery is not justified. Revision may be needed when this difference exceeds 3 millimeters. In my practice this occurs in approximately one out of twenty patients.
Constricted Ear
While this deformity seems rather simple to correct, a recurrence and irregularity in the outcome is common. Frequently, partial resection of the overhanging rim segment is the procedure of choice. This decision should be carefully contemplated, as it can leave the vertical height of the ear short, thereby creating a mismatch with the normal side. Generally, a reduction in vertical height up to 5 mm is acceptable.
As the constricted ear becomes more severe, partial absence of the scapha and conchal cartilage with absence of the overlying anterior skin occur. These deformities require the addition of skin and cartilage for their correction and thereby become increasingly more complex and less predictable in their outcome. Procedures for the correction of the milder varieties of constricted ear involve the use of full-thickness skin grafts taken from behind the ear, flaps transposed from behind the ear, and conchal cartilage grafts taken from the same or opposite ear. In its more severe form, total ear reconstruction as required for microtia frequently becomes the treatment of choice.
A thorough discussion with your surgeon regarding his experience and his projected outcome with the proposed procedure is suggested before you embark on the treatment of constricted ear.
Ear Molds: An Alternative to Otoplasty
To the pediatrician and primary care physician:
Deformities of the ear are a frequent occurrence among newborn infants, and frequently parental concern is directed away from these deformities with reassurance that the ear will get better as the child grows older. While improvement and shape may occur in some infants, it is not the rule and recent evidence suggest that the opportunity to mold or reshape the pinna exist only in the first seven days following birth. Accordingly, if significant deformities are overlooked at the time of birth, the only alternative for correction is otoplasty, which is a surgical procedure performed between the age of three and five years. The expense and concern surrounding this elective surgical procedure can often be avoided if early diagnosis is made and ear molding initiated.
Common deformities such as prominent ear, Stahl's ear, cup ear, and lop ear may be successfully treated with the early application of ear molds. All of these deformities that may be successfully treated have in common an underlying cartilage malformation but no deficiency of skin or cartilage.
Those deformities with absence or deficiency of skin and cartilage (i.e., constricted ear, microtia, anotia) respond less favorably to ear molds. The technique of ear mold treatment is fairly simple and involves a combination of methylmethacrylate glue, tape for fixation, and dental compound for molding and shaping. The mold and fixation must be secured for six weeks and worn constantly. It generally necessitates a change every two weeks. A review of our results with ear molds shows an overall success of approximately 85%. In those who require revisional surgery, the deformity and the surgery is far less extensive. With early diagnosis of auricular deformities and the application of ear molds, a significant cost savings to parents in a highly successful non surgical outcome can be achieved. We strongly recommend this protocol to you and your patients
Microtia
Reconstruction of microtia is deferred until five to seven years of age, at which time the opposite normal ear can be used as an adult-sized pattern for reconstruction of the abnormal side. At this age also, the rib cartilages have attained enough dimension to serve as a graft source and template for reconstruction of the ear framework.
Reconstruction typically involves three stages. While surgical preferences influence the exact steps within this sequence, my preference is for an initial stage involving the reconstruction and transplant of the ear cartilage framework to its desired location on the affected side.
The second stage involves transposition and positioning of the earlobe and reconstruction of the tragus with deepening of the conchal hollow. A final stage involves elevation of the ear from the scalp. A child's particular deformity may impose variation on these routines.
Since microtia occurs in approximately one in eight thousand births and is associated with some failure of development in the first and second branchial arch (see Craniofacial Microsomia), the treatment of these children is generally best carried out under the guidance of Team Centers, where a large volume of children similarly affected are seen.
Anotia
Reconstruction follows the same course and guidelines as described for microtia but necessitates additional cartilage to shape the likeness of the ear lobule. In addition, grafts and flaps are frequently required over the anterior surface of the reconstructed ear to add the missing skin cover and eliminate the presence of hair-bearing scalp over the framework.
