CHAPTER 17 Complications After Otoplasty
When otoplasty is performed safely, postoperative complications are rare. Hematomas and chondritis are possible complications, but these are exceedingly uncommon with our technique. Hypertrophic scars or keloids are also frequent complications, but we almost never encounter them despite operating on patients from many ethnic backgrounds.
The only technique-related complication that we encounter occasionally is a relapse of the antihelical posterior root. This usually occurs within the first few weeks after correction and can be easily corrected by reinforcing the sutures in this region using a local anesthetic in the office. We consider this a very minor risk, and it outweighs the downside of an anterior scoring or cartilage-suturing technique, which can cause deformity of the visible surface of the ear cartilage.
Because we have seen a vast array of complications, often bilateral, from this relatively minor procedure over many years, we have developed some experience in the surgical approach to severe complications after otoplasty. We consider the defects to be equivalent to those of posttraumatic cases, and in many patients the only solution to correct the deformity is to perform an ear reconstruction.
Particularly if a complication is bilateral, the surgeon can consider that perhaps it is related to an incorrect technique.
Some of the most self-conscious patients in our practice are those who have had complications after otoplasty. In their mind they had normal ears that simply needed to be set back and have been left in a much worse condition. Reconstructing the ears of these patients requires not only a technical solution but also in many cases a psychological one. We always tell patients that after the reconstruction is finished, they will need to forget about their ears and not continue to be focused on them.
Severe complications after correction of prominent ears are caused by infection or poor technique, leading to abnormal contours. Whatever the circumstances, the surgical approach will be the same as for any acquired partial or subtotal defect.
PARTIAL DEFECT
Infections are rare after otoplasty but may lead to chondritis, resulting in fibrocartilage resorption and skin retraction in a focal area of the cartilaginous framework.
When limited to part of the helix, surgical correction may be performed with a conchal graft to reproduce the normal contours.
COMMANDMENT 4: Conchal cartilage can only be used when the size of the defect is no more than a quarter of the ear and involves no more than two planes; otherwise, costal cartilage must be used.
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