Ear Surgery: Q&A
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Otoplasty: Pros & Cons of Two Approaches
I am planning to undergo otoplasty to reduce the conchal bowl (i.e., to change the orientation of my ears from a prominent angle to one further back). I have consulted two surgeons, who each suggest using different approaches.
One surgeon suggests an approach that involves (among other things) resecting sections of cartilage from the conchal bowl. He suggests that this procedure is likely to be free of re-drift (i.e., ears folding out again), that the ears can be set at a natural angle (e.g., 15-20 degrees), but that there may be some difference in the angle on each side. The other surgeon suggested using permanent sutures (approx. 1 cm from base of ear) to pin the ears to the fascia of the skull. He suggests that this will help prevent re-drift (that he thinks is more likely when using only cartilage resection from the conchal bowl). He also says that using permanent sutures, the ears can only be positioned flat back against the head (rather than a more natural angle).
I respect the advice of both surgeons (who both appear to be competent and honest), but am confused by the conflicting opinions. What are the pros and cons of each approach? For example, how likely will complications (i.e., re-drift and/or asymmetry) using cartilage resection (i.e., without permanent sutures to the cranial fascia) occur? And could the permanent sutures be ripped (e.g., in contact sport etc.) or pulled through over time (e.g., as I age)? Thank you.
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14 Doctor Answers |
Asked by
John_Landar
in Australia
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Which Otoplasty is better? Conchal cartilage excision, or permanent suturing ?
Which otoplasty is better? Conchal cartilage excision, or permanent suturing ?
The answer depends upon what your anatomy is like and upon the preference of your board certified plastic surgeon. either one can give good results, and sometimes both otoplasty techniques can be used together.
I prefer to excise a portion of the conchal cartilage as it is less likely to spring back if a permanent suture breaks or tears through the mastoid fascia.
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Conchal bowl techniques
The question is what is better partial conchal bowl resection/shaving versus suture placement. The answer depends on your anatomy. Conchal bowl resection/shaving and suture placement can be used independently of each other and also can be used at the same time. Each case is individual and depends on factors such as:
size of conchal bowl
stiffness of conchal cartilage
desired aesthetics
As with any procedure, the technique is only as good as...
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Otoplasty
In my opinion, I think it is best to resect a small about of cartilage to help the ears rest in a natural position. By just pinning them back but not resecting the cartilage, there is potential for the cartilage to snap back toward the original position.
Good Luck.
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I prefer to resect cartilage for cup ears and modify cartilage for lop ears
In my experience, cutting cartilage in the antihelical fold can lead to visible ridging so i almost never cut in this area. In the concha, it is seamless and difficult to detect that anything was removed. That being said, I see a slight drift back on occasion with my lop deformities and see almost none with my cup deformities. Removing cartilage in the concha to me is a much more assured method of keeping the ear where I want it without any sizable risk. I think that...
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Suture setback and conchal reduction on otoplasty
I am not sure if anyone can provide you with definitive numbers regarding the recurrence of the prominence "redrift" as you call it. I have performed both and generally prefer the setback sutures over conchal reduction/resection.
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Ear setback during Otoplasty
The ear setback techniques your surgeon's described are valid methods depending on the situation and surgeon preference. Re-drift and or asymmetry are real risks with otoplasty done by any method. Most surgeons will over correct the ears slightly to account for this.
I feel that the long term stability of the new ear position is due to the scar that develops in the area and fixes the ear in place. I often shave the conchal cartilage to thin it out and weaken it. As others have...
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Different approaches for otoplasty
There are multiple approaches for an otoplasty. Each approach addresses a different component of the ear. In our practice, when patients present for an otoplasty, they very rarely have two similar ears. For this reason, the surgery needs to be customized for each ear. Your best bet is to be evaluated by a board-certified plastic surgeon with a great deal of experience in otoplasty. This surgeon will be able to evaluate each ear individually and let you know which techniques will be...
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Otoplasty techniques are customized
There are many techniques used during otoplasty and the question of which technique is best depends on the individual anatomy. In general sutures alone are not strong enough to hold cartilage back long-term without other measures to alter the anatomy.
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Otoplasty Technique
Each patient has unique ears and as such the technique will vary by the individual. The anithelical fold (the fold in your ear that is just inside the outside edge that splits at the top) is often poorly developed and causes a "lop ear". In this area cartilage resection (cut/remove) is not advisable. The cartilage here needs to be rolled, if it is cut there will be very odd unnatural edges. When the cartilage is very stiff, I thin the...
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Incision or suture technique with otoplasty depends on the cartilages
There are two main issues when considering an Otoplasty. 1) Is there an absent anti helical fold? 2) Is there an overly protruding conchal bowl? Either problem can be addressed with cartilage incision or suture techniques.
I generally use incisional techniques and actual cartilage removal if the patient's cartilages are firm and have lots of recoil. This is less likely to have recoil or spring back. In patients with fairly soft cartilages and less intrinsic spring to the cartilages the...
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Every procedure is customized to the patient's anatomy.
Most of us who do otoplasty will combine a variety of techniques and maneuvers to address the specific anatomy of each patients' ears.
Cartilage cutting techniques can sometimes lead to very unnatural curves and edges over time, so I tend to avoid much cartilage cutting.
A deep conchal bowl can often be set back nicely and naturally by resecting the soft tissue behind the ear, creating a so-called conchal nest. This does not create the telephone ear deformity when done correctly. And the...
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Both approaches are popular and are proven
I think when you set back your concha, sometimes you can create tension in the upper and lower parts of the ear and the possibility of a telephone deformity is greater (when the top and bottom of the ears stick out more than the middle portion.) It is effective for mild conchal prominences in my opinion.
If the movement that you are looking for is greater than 4-5 mm, a conchal setback my not be the best option. Greater movement and pinning requires excising parts of the concha. Then the...
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Setback Otoplasty
Both of the techniques you described work, but the indications differ. If you concha is really in excess (too much cartilage), then the resection technique is more appropriate. When you leave the cartilage intact and only use a suture to "tighten" the bowel back, the change you get in ear prominence is minor (you often have to remove some excess soft tissue behind the ear when using this technique.) The suture technique is normally used when the conchal bowl is not the main...
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Otoplasty- a great procedure - not discussed enough
Dear John,
Why not perform both procedures at once? It sounds like you have only one of the two concerns for prominent ears - the large conchal bowl. For those uneducated like yourself -- the conchal bowl is that part of the ear that surrounds the ear canal and is shaped like a bowl. The best treatment is to remove some excess cartilage and then stitch the remainder of the bowl to the tissue on top of the bone behind the ear. For some children, sutures alone are adequate, but as we get older...
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