Chapter 53 - Microtia, Otoplasty

Question 1

6 different methods of otoplasty

Answer 1

Tape, wax reshape neonatal
Incisionless otoplasty if correct with finger pressure
Open otoplasty
graft to cover skin defect, rotational flaps
autologous rib graft
prosthetics, BAHA

Question 2

Indications for otoplasty

Answer 2

Not based on our objective assessment - based on how patient feels about their ears

Question 3

When do ears reach their final shape? Final size?

Answer 3

Shape 1yr

Size 9yr

Question 4

Ear dimensions: Height, width, angle between top and earlobe, ptrotrusion from scalp

Answer 4

H: 55-65mm
W: 30-45mm (50/60% of H)
Top 15-30 deg more posterior than lobe
Midpoint: protrude 18-30mm from scalp, angle <21 (F) <25 (M)

Question 5

How posterior is root of helix to lateral canthus?

Answer 5

60-70mm

Question 6

Protruding ear: measurement, cause, treatment

Answer 6

angle of ear to head >35 deg
Due to lack of antihelical fold development typically
Normal shape with gentle pressure

Question 7

Constricted/Cup/Lop ear

Answer 7

Cannot attain NL shape with gentle finger pressure

Superior helix folded inferiorly

Question 8

Timing of neonatal wax and tape

Answer 8

within first 96 hours

requires at least 2 wk

Question 9

Up to how old can you use splint and double sided tape to reshape ears?

Answer 9

5 y/o

Question 10

At which age is general anesthesia considered safe for elective cases

Answer 10

2 years old

Question 11

At which age is open otoplasty typically performed?

Answer 11

5-6 years old if very motivated
If using rib: as early as 6, but with 3D techniques may need to wait until 10-12
must cooperate with post op course, suture removal

Question 12

Describe incisionless otoplasty for protruding ear

Answer 12

permanent horizontal mattress sutures

Question 13

How long is dressing worn after otoplasty

Answer 13

No dressing needed if incisionless
2 wk if open to let skin flap reattach, cartilage heal, then additional 4-6 wk of elastic headband to prevent forward displacement of ear until fully healed

Question 14

Early complications of otoplasty

Answer 14

hematoma
skin necrosis (dressing pressure)
skin hypersensitivity to pressure/temp
suture spitting/extrusion

Question 15

Telephone ear

Answer 15

due to overcorrection of middle portion, excessive removal of postauricular skin/mastoid soft tissue, or overtightening set-back sutures of the concha to the mastoid

Question 16

How protruding ear tx is different than cup ear

Answer 16

protruding- can try incisionless techniques

cup- enough missing tissue, need new skin/cartilage or advancement of tissue
Release root of helix as V-Y advancement

Question 17

Prosthetics for microtia

Answer 17

silicone attached with skin glue, bone-anchored screw or magnets
prosthetics prone to extrusion, malformation with trauma of sports/play

Question 18

4-stage microtia repair (Brent)

Answer 18

1- portions of 3-4 ribs used to form helical rim, antihelical fold, scapha, fossa triangularis
2- rotate remnant earlobe onto cartilage framework, attach there
3- ear elevation away from head with skin graft
4- create tragus, deepen conchal bowl

Start girls around 6, boys around 10 (for cooperation), whole process takes 9-12 mo.