CC
A 27-year-old male presents to your office because of protruding ears.
HPI
The patient has had protruding ears since he remembers. His parents used pressure bands and hats when he was a child to correct the deformity. It has not helped, and since then he has not done anything else in this regard.
PMHX/PDHX/medications/allergies/SH/FH
The patient is a healthy nonsmoker. (Smoking may increase the risk of skin necrosis and is to be avoided 1 week before surgery.) He has no history of keloid or bad scar formation.
A thorough review of past medical history and physical examination was done to detect any syndromic conditions. In many craniofacial syndromes, ear deformity may be accompanied by a variety of soft and hard tissue anomalies that need a comprehensive treatment plan, and otoplasty alone cannot solve the issues. On the other hand, many craniofacial syndromes may be associated with serious systemic (especially cardiac) malformations, which need to be clarified before any cosmetic and reconstructive surgeries.
Examination
A thorough analysis and diagnosis of each auricle was performed preoperatively. Anatomic compartments were assessed to identify any existing malformations. The cephaloauricular angle and distance of ear to head are two common parameters used to assess protruding ears ( Figs. 87.1 and 87.2 ).
Labs
No laboratory tests are indicated for otoplasty unless dictated by medical history or anesthesia concerns.
Imaging
A series of standard photographs, including full face, lateral, and posterior views, is recommended. These images are used in preoperative planning and consultations and can be repeated with the same standards after 6 months to evaluate and record the results of surgery.
Assessment
A healthy 27-year-old male requests the correction of protruding ears. The patient’s desires are realistic, and he wants only a normal-looking appearance. The clinical examination shows both ears are of normal size; all anatomic components are existing; and the ear-to-cranium distance is only exaggerated in the helical apex, midpoint, and lobule. The cephaloauricular angle is about 35 degrees. (A normal cephaloauricular angle is 15–20 degrees.). On palpation of the ears, the conchal cartilages are very stiff and thick ( Fig. 87.3 ).
Treatment
Otoplasty may be done with different levels of anesthesia from local anesthesia to deep sedation and general anesthesia. Here, the surgery was combined with rhinoplasty. Therefore, general anesthesia was chosen.
Traditional patients are placed in a supine position. This position provides appropriate access to both ears by tilting the head and a complete intraoperative judgment by holding the head upright. The prone position is also frequently reported in the literature.
In the current case, a strong cartilage framework and severely protruding ears were diagnosed, so the combination of cartilage cutting and suture techniques were planned and performed as follows:
- •
General anesthesia
- •
Prep and drape with special attention to keep away hair from the surgical field
- •
5 mL of local anesthesia (lidocaine + 1/200,000 epinephrine)
- •
Skin marking and mapping
- •
Skin resection
- •
Cartilage resection
- •
Sutures
- •
Pressure bandage ( Fig. 87.4 )
