CHAPTER 16 Prominent Ears
Prominent ears are not a congenital anomaly, and this must be clearly communicated to patients. Prominent ears are an aesthetic variation, which tend to be poorly accepted in Western cultures. In many Asian cultures, prominent ears are considered a desirable facial feature.
The parents usually decide whether their child will undergo setback otoplasty to correct prominent ears, because they want to reduce the amount of psychosocial harm to the child from bullying or teasing during the school-age years. The parents may also make this decision, because they have prominent ears or had setback otoplasty in the past.
Generally, we do not think that it is advisable to operate on aesthetic variations of prominent ears in very young children. We prefer to wait until children can express a desire to change their appearance, and we can personally assess their motivation. This may occur in children as young as 7 years old, which is the youngest age we will consider performing otoplasty.
ANALYSIS OF THE PROMINENT EAR
During the initial consultation, the various features of the prominent ear deformity should be examined. We consider four factors in this assessment, each of which will be explained in detail:
Unfolding of the posterior root of the antihelix
Valgus of the concha
Hypertrophy of the concha
Prominent lobule
These factors are often interrelated and should be corrected simultaneously in most cases.
Posterior Root of the Antihelix
Unfolding of the antihelical fold is commonly considered a hallmark feature of prominent ears.
The surgeon must assess which part of the antihelix has unfolded and the degree to which it has unfolded. The most frequently unfolded part is the posterior root of the antihelix, but it may be the whole antihelix.
Examples of Different Degrees of Unfolding
Valgus of the Concha
Some patients have a condition that we call valgus of the concha. In normal ears, the floor of the conchal bowl is almost in direct contact with the mastoid. Prominent ears typically have a valgus between the floor of the conchal bowl and the mastoid process.
As a result of this valgus, the conchal bowl appears excessive from the frontal view. After the conchal bowl is correctly repositioned posteriorly, it is usually of normal size; thus the enlargement was not a true hypertrophy of the concha. The surgeon must check from the posterior view the angle made by the floor of the concha with the mastoid.
“True” Hypertrophy of the Posterior Wall of the Concha
Although the height of the posterior wall of the concha can be true excess (or conchal hypertrophy), we think this is far more rare than others may think. This should be checked from the posterior view.
Conchal hypertrophy should be assessed after the valgus of the conchal bowl has been corrected. If conchal excess is present, the surgeon must decide exactly where the conchal bowl is most pronounced and judiciously remove only the smallest amount possible to achieve the desired reduction.
We perform a maneuver at the start of the operation (which can also be done in the consultation) showing that if we correct only the valgus of the concha, the antihelix may appear very prominent from the frontal view.
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