A new technique for the surgical repair of double cleft earlobe: modified Millard’s rotation–advancement flap

Abstract

The double cleft earlobe is a rare earlobe deformation. The most common causes of cleft earlobe are earring or piercing tear injuries and trauma. In this study, the cases of five patients (all women) attending the clinic between 2010 and 2013 suffering from a unilateral traumatic complete double earlobe cleft as a result of an earring injury were evaluated. The principles of Millard’s cleft lip repair were applied during the repair of these double cleft earlobe deformities. This adaptation of Millard’s technique to repair double earlobe clefts with a non-straight closure appears to give satisfactory results.

The double cleft earlobe is a rare earlobe deformation. The most common causes of cleft earlobe are earring or piercing tear injuries and trauma. Recurrence of the cleft, bulging of the earlobe, an abnormal contour, and scarring are some of the most frequently encountered problems challenging plastic surgeons involved in the correction of cleft earlobe.

Millard’s rotation–advancement flap technique has been used widely worldwide for more than 50 years in cleft lip closure. We present an adaptation of this well-known technique for the repair of double cleft earlobe.

Materials and methods

The cases of five patients (all women) attending the clinic between 2010 and 2013 suffering from a unilateral traumatic complete double earlobe cleft as a result of an earring injury were evaluated. These patients ranged in age from 39 to 56 years (mean 46.2 years). The injury affected the left side in four patients and the right side in one.

Local anesthetic with 2% lidocaine and epinephrine (1:100,000) was injected until the lobe became firm and pale. Prior to the administration of local anesthetic, the rotation–advancement flap was designed and preoperative markings made. The principles of Millard’s cleft lip repair were applied during the assignment of the points and flap design. In accordance with these principles, a full thickness C flap was designed between the medial and lateral splits. The lobule segment medial to the C flap was named the M flap, and the segment lateral to the C flap was named the L flap ( Figs. 1–4 ).