Otoplasty (Ear Plastic Surgery)
One of Dr. Sherman’s particular interests is the correction of prominent ears (otoplasty). Historically, there have been many techniques described for the repair of this congenital problem. They have evolved from cartilage cutting to cartilage folding and suturing to create the normal ear. Dr. Sherman has created a video that is available on YouTube. Part one describes the anatomy of the prominent ear, part two describes the surgery and shows it in detail, and part three shows the final end result. This set of video instruction has served as a teaching tool for residents and plastic surgeons alike. They have been seen over 100,000 times on YouTube. The past year, according to the statistics of the American Society of Plastic Surgeons over 35,000 otoplasty’s were performed. Of course is a small percentage of cosmetic cases performed by a board-certified plastic surgeons. However, it is one of the most common operations performed in our office. Dr. Sherman has been featured in magazines for the correction of prominent ears in children, and has performed the procedure on the Today Show. Dr. Sherman is also the inventor of an instrument that helps in the correction of prominent ears.
The prominent ear is the most prevalent deformity of the ear, and occurs in roughly 5% of children. You may notice that multiple members of your family have this condition. Several factors may contribute to the development of prominent ears, but its inheritance as an autosomal dominant trait is probably the most important. The condition may be bilateral (both ears) or unilateral (one ear).
In children, the prominent the ear that is noticeable is often the source of teasing by of the children. Unfortunately, nicknames are assigned to children with this problem, such as “Dumbo ears.”
What Causes the Condition?
There are several anatomical features that cause the protrusion of the ear. They are the lack of development or partial development of the antihelix, or a deep concha (cup) of the external ear. Other variables include the size of the concha (cup), the angle of the concha with the head, and the angle of the ear cartilage fold. In most patients there is a combination of all of these features that may need to be adjusted during the otoplasty procedure.
These problems will emphasize the protrusion of the ear, which is the distance from the edge of the helix (the ear rim) to the mastoid (the skull behind the ear). The normal distance of this measurement should be about 2 cm.
If you notice that your child has prominent ear shortly after birth, there is a remedy that is effective. A silicone device may be placed on the ear that will mold the prominent ear over 3 weeks. The problem is that many doctors will tell their patients that the child will grow into the ear or that it will acquire the proper folding. For maximal benefit, the device should be placed on the ear within the first 2 or three days.
Timing of Surgery
The surgery is usually planned before the socialization process and after major ear growth (around four to five years old). The correction may be performed anytime during childhood. This certainly permits less social trauma to the child, softer ears to sculpt, and full (or almost full) ear growth before treatment. Most otoplasty surgery for children is done between the ages of four and fourteen. Surgery performed on children is performed in the hospital (New York Presbyterian) under general anesthesia.
The vast majority of our patients are adolescents or adults. They are often our most motivated patients. One advantage is that the surgery can be performed under a total local anesthesia. With this method, the entire ear is blocked with anesthetic, and the patient may be awake. Most patients choose sedation anesthesia similar to a colonoscopy, administered by a board-certified anesthesiologist.
Because of his individual interest in ear correction, Dr. Sherman has produced several videos that are on available on his YouTube channel. These Clips show the individual anatomy of the operation, the operation itself, and the postoperative result. The videos have been viewed over 100,000 times and we encourage you to visit these sites, they are quite informative
Otoplasty overview by John E. Sherman, MD, FACS New York Plastic Surgeon
The nature of otoplasty procedure varies, depending on the problems that must be corrected. These problems, as noted above, include: a deep cup of the ear (concha), a lack of development of the fold in the ear, and various cartilage abnormalities. All of these will be corrected during surgery.
The top left illustration shows the anatomy of a normal ear with the proper development of the inferior and superior crus, and normal contour. The upper right illustration shows a normal folding of the cartilage that must be replicated during surgery.
The lower left illustration shows the flattening of the scaffold without formation of the superior crus of the antihelix. Note on the cross-section the lack of folding.
These illustrations show the sequence of the repair. The entire repair may be performed either from behind the ear (posterior) or in some examples from the front. An ellipse of skin is removed from behind the ear allowing access to both the concha and the area of the folds that must be re-created. The second illustration on top shows removal of the concha which reduces the size of the concha and allows access to the front of the ear for recreation of the folds. The lower row of illustrations show the sequential placement of internal sutures (Mustarde) that re-creates the folds, and additional sutures to reduce the size of the concha.
This last panel shows the preoperative ear with lack of folding, and the placement of the sutures that re-create the fold and reduce the size of the scapha.
What to Expect in the Operating Room
If the patient is a young child, he or she may be apprehensive in the operating room. This is normal and to be expected. Dr. Sherman recommends that otoplasty on children be performed under general anesthesia at the hospital. During the induction of anesthesia, one parent is allowed in the room until the child is asleep. This is assuring and comforting for the child as well as the parents.
If otoplasty is performed for the adolescent or adult, it can be performed under intravenous sedation in our fully accredited outpatient facility. Our anesthesiologists are fully trained and board-certified and experienced.
Recovering from Ear Surgery
At the termination of the operation, Dr. Sherman will administer a long acting anesthetic thereby minimizing pain for 3 to 5 hours. Pain medication is prescribed and should be used as needed. There is minimal pain after the first day, however the bulky dressing which must be left on for 3 days is often a source of annoyance. This keeps the gentle compression intact. We do recommend that you wear a ski band to sleep for 1-2 months after surgery to avoid folding of the ear. Discoloration and bruising is usually gone by ten days. For an adult, you may return to work usually after one week.
The incidence of complications stemming from otoplasty are remarkably low. Occasionally correction of the otoplasty may be needed, since the shape of the ear in the original surgery may not hold and recurrence of the original protrusion can occur. The younger the patient, less the chance of recurrence because the cartilage is less developed. A second ear surgery may be needed in order to repair or correct the procedure at a later time. Dr. Sherman is an expert at correcting previously performed otoplasties. Sometimes, your procedure may not have been properly done at another plastic surgeon.
A Note on Ear Surgery Insurance
If you have health insurance, you should check with your policy provider to see if ear surgery is covered. There are some insurance policies that reimburse the cost of the otoplasty operation if performed in the early childhood years. This is not a common occurrence, but we offer financing options for our patients. Our office staff will help you contact your carrier to see if this may apply for you. Schedule a consultation at our office today for more information.