Otoplasty

The book discussed otoplastic and other plastic surgery techniques and procedures for correcting, repairing and reconstructing ears, noses, lips, and genitalia that were amputated as criminal, religious, and military punishments.

This otoplasty correction technique proved inadequate, due to the problems inherent to the biochemical breakdown and elimination (resorption) of the cartilage tissue by the patient's body.

The outer framework of the auricle is composed of the rim of the helix, which arises from the front and from below (anteriorly and inferiorly), from a crus (shank) that extends horizontally above the auditory canal.

The abnormal appearance exceeds the normal head-to-ear measures, wherein the external ear is less than 2 cm (0.79 in), and at an angle of less than 25 degrees, from the side of the head.

[medical citation needed] Ear configurations, of distance and angle, that exceed the normal measures, appear prominent when the man or the woman is viewed from either the front or the back perspective.

Similarly, the caudal part of the concha can project disproportionately, and cause a protruding lower auricular pole, therefore, these deformational features require special attention in the operating room.

Moreover, regarding the shape and projection of the ear, the importance of the concha must be considered in relation to the three-tiered configuration of the auricular cartilage framework, because the more delicate antihelix and helical complex are mounted upon the sturdier concha; therefore, changes in conchal size and shape greatly influence the overlying tiers, hence it is rare to see prominence of the ear that does not have a conchal element.

The occurrence of a prominent mastoid process tends to push the concha forward, which extends the auricle (external ear) away from the side of the head.

Hence, in the occurrence of a flattening of the skull (parallelogram deformation of the cranial vault), the side of the head afflicted with occipital plagiocephaly presents a prominent ear.

This effect, of the shape of the patient's head, upon the outward and extended position of the ear is notably indicated in the 1881 illustrations that describe the Ely otoplasty technique.

Moreover, in severe cases of hemifacial microsomia, without the occurrence of microtia (small ears), the normal external ear might appear to have been sheared off the head, because the upper half of the auricle is projecting outwards, and, at the middle point, the lower half of the auricle is canted inwards, towards the hypoplastic, underdeveloped side of the face of the patient.

Such wide-to-narrow skeletal sloping, from the head to the face, might create the bone promontory upon which rests and from which projects the upper anatomy of the auricle, which otherwise is an external ear of normal proportions, size, and contour.

The tail of the helix (cauda helicis), which projects outwards from the concha, carries the earlobe with it, causing it to protrude, which physical condition contributes to prominence of the lower pole of the auricle.

[19] The ear defect or deformity to be corrected determines the otoplasty techniques and procedures to be applied: for example, a torn earlobe can be repaired solely with sutures; a slight damage to the rim of the auricle might be repaired with an autologous skin graft harvested from the scalp; and conversely, a proper ear reconstruction might require several surgeries.

Yet, when done without an incision, the procedure is deemed an 'incisionless otoplasty', wherein the surgeon places a needle through the skin, to model the cartilage and to emplace the retention sutures that will affix the antihelix and conchal bowl areas.

Depending upon the auricular defect, deformity, or reconstruction required, the surgeon applies these three otoplastic techniques, either individually or in combination to achieve an outcome that produces an ear of natural proportions, contour, and appearance: Repositioning the earlobe is the most difficult part of the otoplasty, because when an auricle that has been repositioned in its upper two-thirds, and that yet retains a prominent lobule (earlobe) will appear disproportionate to and malpositioned upon the head — as it did in the original, uncorrected deformity.

Another prominent-earlobe correction technique is suturing the helical-cartilage tail to the concha, yet, because the tail of the helix does not extend much into the lobule, setting it back does not reliably correct the set back of the earlobe proper; other techniques involve skin excision and sutures, between the fibrofatty tissue of the lobule and the tissues of the neck.

Depending upon the pre-surgical degree of prominence of the upper-third of the auricle, the surgical creation of the antihelical fold might be inadequate to fully correct the position of the helical rim, near the root of the helix.

Depending upon the deformity to be corrected, the otoplasty can be performed either as an outpatient surgery or at hospital; while the operating room time varies between 1.5 and 5 hours.

[7] Approximately 20–30 per cent of newborn children are born with deformities of the external ear (auricle) that can occur either in utero (congenitally) or in the birth canal (acquired).

In the early weeks of infancy, the cartilage of the infantile auricle is unusually malleable, because of the remaining maternal estrogens circulating in the organism of the child.

Therapeutically, the splint-and-adhesive-tape treatment regimen is months-long, and continues until achieving the desired outcome, or until there is no further improvement in the contour of the auricle, likewise, with the custom and commercial tissue-molding devices.

[19] The traditional, non-surgical correction of protuberant ears is taping them to the head of the child, in order to "flatten" them into the normal configuration.

The physician effects this immediate correction to take advantage of the maternal estrogen-induced malleability of the infantile ear cartilages during the first 6 weeks of their life.

The German polymath Johann Friedrich Dieffenbach was a pioneer in the fields of plastic surgery. ( c. 1840 )
The auricle is an anatomic structure composed of a cartilage support framework covered with thin, hairless skin.
Prominent ears: the bat-wing type, which extend outwards and to the front, can be corrected with an otopexy procedure.
The angles of the ear determine the surgical anatomy of the auricle, as considered for otoplasty correction.
Auricular prominence: in the occipital area, behind the auricle, a protruding mastoid process is a proximate cause of bat ears.
The soft tissues of the ear: the anatomic location of the posterior muscle of the ear (auricularis posterior) in relation to the auricle.
Otoplasty: The cranial surface cartilage of the right ear; the ponticulus (center right) and the cauda helicis (right) also can be proximate causes of prominent ears.
The soft tissues of the right ear: the three muscles that serve the auricle (external ear) the auricularis posterior (left), the auricularis superior (above), and the auricularis anterior (right) as considered for otoplasty correction.
Ear showing Darwin's tubercle, an evolutionary human-ear vestige in a woman, and the like morphologic feature in a macaque monkey.
Grade III microtia affecting the left ear of a boy.
Non-surgical otoplasty: the therapeutic aspects, before (left), during (center), and after (right), of a tissue-molding procedure performed with an EarWell device.If detected early, Infant’s ear molding can permanently correct ear shape without the need for surgery. However, if ear deformities go unnoticed or untreated during infancy, surgical otoplasty might be considered later in childhood to achieve long-lasting results. [ 26 ]