Otoplasty
Otoplasty refers to the surgical reshaping of the pinna or outer ear. The aim may be to correct an irregularity or to improve appearance. A person who has sustained damage to their ears or was born with a congenital anomaly may choose to undergo this reconstructive surgery.
The outer ear contributes a lot to a person’s appearance. It also has a minor function in hearing. However, having ears more prominent/ deformed /defective can be bothersome.
The common indications for otoplasty are
- Prominent ears
- Microtia – small/absent ear
- Large ear bore (after wearing earring)
- Ear Keloids
Otoplasty is usually safe and successful, with high satisfaction rates. Otoplasty can change the shape of a person’s ears, which can improve their quality of life. It is important to have realistic expectations about what otoplasty can achieve. It can make the ears look better and create a new auricle, but perfect symmetry is not always possible.
Otoplasty is generally done by plastic surgeons. Before opting for surgery, the person should discuss the pros and cons with his plastic surgeon
Before the procedure, discuss with your surgeon what to expect from the surgery. Your surgeon will review your medical history, and ask about any medical conditions you may have and any medications, supplements or herbs you may be taking.
Your surgeon will recommend that you stop taking certain medications, such as blood thinners or NSAIDs, at least three weeks prior to surgery. You may also need to get certain lab tests before your procedure.
Any ear that is obviously noticeable and projecting out is called a Prominent ear. The ears are usually around 2 centimetres from the side of the head. The outer ear is usually at an angle of about 21–30 degrees to the side of the head. If the angle is more than 30 degrees, the ears will appear to “stick out.”
This can happen if genetic features or health conditions affect cartilage growth, or if an injury affects the shape of the ears Prominent ears may run in families, but they often occur randomly. Any of these factors can affect one or both ears. However, having prominent ears should not affect a person’s hearing.
Around 30% of children with prominent ears have ears that appear normal at birth but then start to change shape in the first 3 months of life.
Treatment of Prominent Ear
Treatment is not always necessary in young infants and young children. Some irregularities will resolve without intervention.
A suitable time to have an otoplasty is when a child is 5–6 years old and 90% of their ears’ growth is complete. This is the earliest recommended age. However, a person can undergo treatment at any age after this. A Person may undergo an otoplasty, a corrective surgery of the ear, to reshape the ear.
Various techniques can reduce the prominence of the ears.
Ear moulding or splinting
A nonsurgical technique known as ear moulding or splinting can be effective if the child starts receiving treatment in the first 2–3 weeks of life. This is a safe, simple procedure that is suitable for infants. This is when the cartilage in the ears is at its softest and malleable. By the time the infant is 6–7 weeks old, the cartilage begins to stiffen.
During this procedure, the surgeon will use a splint to reshape the soft cartilage. The splint supports the ear and keeps it in a new position.
Different types of splints are available. They are made of soft, elastic, mouldable material., Parents and caregivers should leave the splint in place 24 hours per day and take the child to the doctor for regular check-ups. The infant may need to wear the splint for a few weeks to a few months.
After 6 months, the cartilage in the ear will become too hard for remodelling with splints. After this point, surgery will be the only treatment option.
Surgical correction
A plastic surgeon will usually carry out an otoplasty.
The surgeon will use a general anaesthetic for a child and a local anaesthetic for an adult. They will then make an incision behind the ear and apply stitches, which may be permanent, to hold back the outer ear or to create the appropriate grooves in the ear. In some cases of excess cartilage causing the prominent ear, they may remove some cartilage. The procedure will take around 1–2 hours. The incision will leave a thin scar, but this is behind the ear and less noticeable and in most patients fade over time.
This is a deformity of the ear, in which the external ear or the auricle is small deformed and defective. It is problem occurring at birth and in 10 % of children, it could be bilateral. The severity of microtia can vary from a subtle deformity to a minuscule presence in the ear. The external auditory canal (the hole noted inside the external ear) is usually absent or closed. The children usually have a minimal hearing impairment on the affected side. Unless both the ears are affected, the child will be able to hear near normally and generally doesn’t need any hearing aid.
Treatment of Microtia
For minor deformities, usually no treatment is required. But in absent auricle or major deformity, ear reconstruction will be required. This is a medical procedure to build up or repair the outer ear using cartilage from the chest. The procedure is done when the child is 7 to 9 years old when the ear attains about 90% of the adult size but could be done any time after that. The procedure is usually done in 2-4 stages depending upon the method followed by the surgeon. Generally, there is a minimum gap of 3 months between each stage.
The first stage is the most important and longest duration of surgery, where cartilage from the chest (rib) is harvested, carved to the shape of the ear and then placed under the skin in the site of the future ear. This is the foundation surgery and dictates the overall final outcome. the opposite ear is taken as the template for creating the framework. In children with deformities of both the ear, a template is taken from a child of similar age and height. The cartilage gradually becomes stiffer in adults and the carving becomes difficult. In subsequent stages, the ear lobule is transposed, cartilage with skin is elevated, and procedures for the ear grooves and minor revision are done to mimic a normal ear. An ear splint is also given for some time to main the new ear position. Cartilage harvest from the rib/chest wall will not cause any major deformity in the chest wall except for the scar. The surgery is only for appearance and it will not improve the hearing in the ear.
The hole for the earring in the ear lobule becomes bigger in due course of time. This could be due to the weight of the earring, genetically softer ear lobule tissue, longer duration of wearing the earring and even caused due to trauma when the earring is stuck and pulled forcefully. This could cause deformed or larger ear lobule with an unpleasant aesthetic appearance and also difficulty in wearing especially smaller earrings.
The only remedy for correction of large ear lobule is surgical repair. The edges of the large ear bore are freshened and sutured in 2 layers. Generally, the non-absorbable suture material is used and the suture removal is done after 7-10 days. Sometimes glue is used to join the freshened edges and it is called suture less lobuloplasty.
The creation of a new hole in the ear lobule is done generally after 2-3 weeks. This is done using a sterile instrument (Ear Ring Gun) in a relatively painless method. But in certain cases, it is done immediately in a single stage.
This is a condition where there is excess and abnormal proliferation of the scar tissue, usually occurring at the site of the hole made for the earring. This can occur in children and adults. Sometimes the first ear bore may be normal and the keloid occurs when the second ear boring is done.
The exact cause for the keloid is not known but it occurs it has a genetic role and occurs in families. Also, it is common in dark-skinned individuals usually the Asian and African races. The keloid can present as a small nodule or a large mass involving the entire lobule or the auricle.
Keloid is usually managed by a combination of treatments. It includes
Injection Triamcinolone
it’s a steroid injection given into the keloid. It’s an outpatient procedure done once in 3 weeks. A maximum of 3-5 doses of injections are given. Some people respond very well to the injection treatment alone.
Ointments
The ointments have constituents with scar modulating effects. they are usually combined with injection therapy or surgery.
Silicon gel sheet
This is a silicon-based sheet that is applied locally over the keloid area. it has self-adhesive properties or else fixed with tapes or specialised ear studs. It is generally given along with injection therapy or surgery.
Surgical Excision:
The keloid is excised and skin closure is done. Since there is a scar after the excision, there is a high chance of recurrence of the keloid in the scar. Hence surgical excision is always combined with injection therapy and local ointment application. In recurrent keloid and in severe cases, surgery is followed by Local Radiotherapy. Among the treatment modalities, surgery followed by Radiotherapy has the least recurrence rate.
Radiotherapy:
Radiation is given at the site of the keloid. Considering the disadvantages of RT, it is generally not considered as the initial modality or a single modality treatment. Most commonly it is given after surgery. RT is started within 48-72 hours after surgery to get the best result. Compared to cancer treatment, the radiation given for keloid is a very less dose.
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