4 months ago I had a bilateral Otoplasty to correct my prominent ears. My surgeon used the Mustarde technique with dissolvable sutures. My ears initially healed well, but several months on, both ears relapsed to their pre-op state. My surgeon says that as the sutures dissolved, the ears have subsequently relapsed. He has suggested a revision using permanent sutures. There seems to be some debate over the use of permanent vs dissolvable sutures? What are the risks/benefits for each?...
Otoplasty - Dissolvable Vs Permanent Sutures
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Recurrance of prominent ears after otoplasty
Dear Otoplasty patient from Sydney,
One the most common complications associated with Otoplasty in adults is recurrence of the prominent ears. It also depends if any conchal cartilage was reseceted or not. I personally use permanent sutures and remove conchal cartilage for adults to prevent recurrence.
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Structural Sutures with Otoplasty Surgery
A variety of surgical techniques are utilized to correct prominent ears. Many of these techniques utilize structural sutures to maintain the shape of the newly formed ear.
When structural sutures are utilized, they must provide stability until the wounds have healed adequately. This may take several months because the ear cartilage has memory and wants to return to its original position. For this reason, recurrence of prominent ears is a major complication of setback otoplasty.
The procedure can be performed with permanent or absorbable sutures, but because of the potential for recurrence, we always use non absorbable permanent sutures.
Otoplasty suture material
Generally I think it is a good idea to use permanent suture suture performing otoplasty surgery. Otherwise, I think you're risking an increased chance of recurrence of the prominent ears. The potential downsides of permanent suture ( including palpability, infection, extrusion and potential need for removal) are outweighed by the advantages of a permanent setback of the ears.
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Otoplasty; recurrence four months after procedure
I am sorry you are having trouble with your ears after your surgery.
As the other surgeons have said, I routinely use permanent sutures for otoplasty. I am concerned that dissolvable suture would not hold over time.
I also usually score the anterior aspect of the cartilage. this weakens the front side of the cartilage allowing it to curl backwards to a more natural position. With the use of permanent sutures and anterior scoring, my recurrence rate is low, but not zero. I also usually instruct on the wearing of a head band for about 4 weeks postop. I think this also helps prevent recurrence.
I assume your surgeon is not charging you a fee for his services, but you may get a charge from anesthesia and the OR.
Permanent sutures for otoplasty
I always use permanent sutures for otoplasty. Yes, they may become infected, but this is not common if done properly. In some cases the cartilage may be weakened at the time of surgery and you might get lucky with resorbable sutures, but I would not want to take a chance. Donald R Nunn MD, DDS Plastic Surgeon
Recurrence of prominent ears at 4 months following an otoplasty
Total recurrence of your ear deformities, on both sides and in 4 months is not acceptable and may very well be related to the usage of absorbable sutures and even which type was used as some will not last nearly as long as others.
My recommendation is for permanent sutures as other plastic surgeons have stated. This largely precludes the situation that you are dealing with now.
Otoplasty is a procedure to correct deformities of the ear. Most of the time, otoplasty is done to make the ears less protruding. The two most common maneuvers for this are Mustarde sutures and conchal setback, and there are several more as well. The effect of Mustarde sutures are to recreate a fold in the ear that is normally there. In performing this procedure 2 mistakes are commonly made:
(1) Ear cartilage has memory--it wants to keep its shape. In order to make a fold in the cartilage, the cartilage needs to be bent. To allow the cartilage to bend, the cartilage is "scored," meaning it is weakened with a series of small scrapes. This takes out some of the memory of the cartilage. However, if the scoring is too aggressive, the cartilage becomes too weak and will buckle, making an unnatural appearing sharp fold. For this reason, many surgeons are too conservative with scoring, and the cartilage will bounce back to its original shape with time.
(2) If placed correctly, permanent sutures are perfectly safe. The typical suture used is a clear, fine, nonabsorbable suture (nylon). Resorbable sutures are not necessary and do not prevent complications. Rather, they provide an opportunity for the cartilage to bounce back once the suture has dissolved.
Otoplasty (Ear Pinning) Surgery - Dissolvable Vs Permanent Sutures
Regarding : "Otoplasty - Dissolvable Vs Permanent Sutures
4 months ago I had a bilateral Otoplasty to correct my prominent ears. My surgeon used the Mustarde technique with dissolvable sutures. My ears initially healed well, but several months on, both ears relapsed to their pre-op state. My surgeon says that as the sutures dissolved, the ears have subsequently relapsed. He has suggested a revision using permanent sutures. There seems to be some debate over the use of permanent vs dissolvable sutures? What are the risks/benefits for each?..."
Although ears share the same common characteristics they are actually different and differ not only from side to side but much more widely between different people. There are several Ear Pinning (Otoplasty) techniques each named after a known ear surgeon who described it (Senstrom, Mustarde, Davis, Furnas) etc. Most of us combine and modify techniques, as needed, for each patient's particular needs.
I prefer using clear permanent stitches. Unless the spring of the cartilage is weakened (with a modified Senstrom for example), using dissolving stitches to shape the cartilage is essentially betting that the scar tissue that forms after surgery is strong enough to splint and resist the cartilage forces which want to assume the former more open less curved shape. I prefer more "insurance". I accept the very low risk of clear nylon sutures of becoming infected or being extruded to 100% certainty that dissolving sutures would be gone and that my ear correction would be solely dependent on surrounding scar tissue. Therefore in MY opinion, mild weakening of the cartilage springiness (?verb) by careful anterior weakening supplemented by a Mustarde technique with permanent stitches has worked very well.
Dr. Peter Aldea
Ottoplasty Involves many steps, weakening the cartilage(aberading). sutures and some times removal of an elipse of conchal caretillage.
Both permanent and absorbable sutures are used. I use permanent sutures to prevent recurrence.
In my opinion the chances of recurrence are high in adults irrespective of type of suture material. The cartilage has memory and tends to unfurl back unless the cartilage is incised and rolled over to form a stable antihelical fold. In my experience this has reduced the chances of recurrence.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.