Abnormalities of the ears are relatively common. Dr Anton Potgieter looks at the various irregularities and provides a basic outline on how to correct them…
Abnormalities usually arise early on – in utero – during the development and “folding” of the very early embryonic tissue in an area of the face called the first branchial arch. It’s a rather elaborate and aesthetically pleasing process, wherein six “hillocks” of mesenchymal tissue form on either side of a groove in the face.
These hillocks ultimately develop into an ear, and small differences will be present between the ears of any particular individual.
However, if something goes wrong during the process with the skin, cartilage, bone, etc., an unusually shaped ear may develop. These possible anomalies include:
- an absent ear – anotia
- an incompletely formed ear – microtia
- anomalies of the tissues manifesting as unusual shapes – cryptotia, constricted ear, Stahl’s ear, etc.
- prominent ears – optapostatis; “unfolded landmarks” causing bat ears.
When looking at an ear, it is important to consider certain characteristics. These include the overall appearance, shape, irregularities and unusual features.
Surgical planning is more detailed and involves looking at specific components:
- the landmarks (vs normal) or lack thereof
- the choncho-mastoid angle (between the ear and the mastoid; the skull bone behind the ear)
- the height of the ear (distance from the mastoid)
- the length of the ear, its position on the head and angle of inclination (which usually follows the profile of the face)
- the “folding” of the cartilage: specifically, the antihelix (the inner prominent fold running parallel to the edge), which is an aesthetic “crease” that contributes greatly to the harmony of the middle and superior thirds of the ear.
Who has corrective ear surgery?
There are two main peaks in patient numbers: the first is in childhood, before school going age, and the second is among young adults who decide to correct their ears because they never had the opportunity to do so when they were younger.
How to surgically change the ear’s appearance
The surgical approach is usually from behind the ear, utilising the crease in the fold at the back. Certain types of repairs use anterior approaches from the front, but care must be taken to make sure that the scars are hidden as well as possible.
Once the skin is cut, the first step is to expose the cartilage. Care is taken to not damage the perichondrium (the membrane around the cartilage). Shifting the ear closer to the mastoid bone of the skull is accomplished by first clearing out the remnant of the posterior auricular muscle from behind the ear and stitching the bowl of the ear to the periosteum (the membrane of the bones) of the mastoid, thereby narrowing the choncho-mastoid angle and “pulling” the ear back.
If the height of the ear needs correction, an ellipse of cartilage is removed from the bowl to “lower” the ear. It is held in place, at its new height, with clear, permanent stitches. If cartilage is in the wrong location (such as with Stahl’s ear), it can be excised, relocated and held with stitches.
A very powerful technique is used to change the folding of the antihelical fold. By accentuating and shaping this fold, the whole ear changes. This is very valuable, particularly with prominent ear corrections.
Another technique to change the shape is cartilage scoring. This procedure involves the use of an otoabrader to disrupt the attachments within the ear cartilage, and thereby allow it to warp and adopt a different shape (convex or concave, as desired).
Upon completion of the work on the deeper structures, the skin is closed over, usually with absorbable sutures hidden in the grooves of the ear.
Looking after the result
Dressing an ear postoperatively is very important to the eventual outcome, since any swelling takes a long time to subside and any blood over the cartilage can distort the overall result.
A good example of how a haematoma affects the outcome is a cauliflower ear, which is caused by a traumatic blood clot.
Surgical manoeuvres like cartilage scoring carry a high risk of bleeding. The contours and shape of the ear are protected with moulded pieces of cotton wool soaked with antiseptic. These are held in the ear by a circumferential headband over foam compression pads. The entire dressing can resemble a crash helmet when applied to children. Adults are more compliant, and a headband (much like the ones tennis players once wore) or a broad, comfortable Alice band is sufficient.
Complications aren’t nice to talk about, but they can occur. In ear surgery, they are rare. If something does go wrong, it usually involves swelling, bleeding and distortion of the final result.
Infection is uncommon, but can be troublesome if it involves the cartilage (which has poor healing potential).
In rare instances, an ear may require complete reconstruction. This is accomplished by sculpting an entirely new framework using rib cartilage and inserting it under the skin of the ear.
All ear surgery is very rewarding and the results are very pleasing when planned and executed correctly.
A2 Disclaimer: This article is published for information purposes only, and should therefore not be taken as an endorsement or advertisement for any product or medical treatment – nor should it be regarded as a replacement for sound medical advice.
This article was written by Dr Anton Potgieter and edited by the A2 team EXCLUSIVELY for the A2 Aesthetic & Anti-Ageing Magazine September Spring 2016 Edition (Issue 19).
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