Otoplasty

Editors-In-Chief: Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [mailto:Newmanm@ccf.org]; Michel C. Samson, M.D., FRCSC, FACS [mailto:SAMSONM1@ccf.org]

Overview
Otoplasty, is a cosmetic surgery to change the appearance of a person's external ears. Otoplasty can take many forms, such as bringing the ears closer to the head (often called ear pinning), reducing the size of very big ears, or reshaping various bends in the cartilage. Other reconstructive procedures deal with the deformed, or abscent-microtic ears. Otoplasty surgery can involve a combination of moving, reshaping, adding, or removing structural ear elements. This procedure is usually performed by either an oral and maxillofacial surgeon, plastic surgeon, or ENT surgeon.

The external ear is made of a thin structural cartilage cover over with thin skin. Each of the various folds and structures of the pinna (external ear) is named. Ear deformity results from distorted, damaged, or missing ear elements. Many otoplasties are performed not because of actual deformity, but because the individual is displeased with the shape of their ears.

History
Otoplasty was first developed by Sushruta, a physician often regarded as the "father of surgery". He lived in ancient India circa 600 BC, which he first described in his text Susrutha Samhita. He and his later students and disciples used otoplasty to reconstruct ears that were amputated as a punishment for crimes. The techniques of otoplasty he developed form the basis of surgical procedures that are practiced to this day. This knowledge of plastic surgery existed in India up to the late 18th century.

How otoplasty ear surgery is performed
Anesthetic options depend on the problem to be treated and ability of the patient to cooperate and can include local anesthesia alone, local anesthesia with sedation, and under general anesthesia (which is generally the case for children). Most otoplasty surgery is performed as a outpatient surgery, some requires a hospital stay. The procedure can take from two to five hours depending on the problem.

Incising one side of a flat cartilage piece leaves unopposed elastic forces on the other side and permits the shape to evolve over time. Thus, incising one side of the lop-ear cartilage along the new anti-helical fold may be one element of the surgery. This can be done through a small incision, or without an incision: an "Incisionless Otoplasty," where a needle is placed through the skin to model the cartilage and also to place the retention sutures.

For many ear operations, one or more incisions give access to the structures to be sculpted. The main, and often only incision, is behind the ear. Other possible incisions depend on what needs to be done. Through the incision behind the ear, the concha bowl can be moved closer to the head, a small tunnel created along the front of a poorly folded antihelix to weaken this cartilage, sutures placed to reshape the anti-helix fold, and to balance the ear lobe with the rest of the ear.

Ear reduction otoplasty may involve reducing one or more components of the ear. Incisions are typically hidden near folds in the front when a part of this surgery.

Addressing Microtia (small ear deformity) or Anotia (missing ear deformity) involve augmentation or adding elements to replace deformed or missing structures. Cartilage from the ear or rib are the most common for these more extensive reconstructions. Other ear shapes may be changed through moving, adding, and weakening ear structures.

Internal sutures often are permanent. The wound(s) are then closed with either dissolvable sutures or ones that are removed by a doctor after the wounds have healed. A bulky ear dressing protects the ear after surgery.