Otoplasty

John S. Rhee

• Surface anatomy
  
  
  
  • The longitudinal axis of the ear should recline 20 degrees from the vertical plane.
    
  • The auricle is normally 5 to 6 cm in length.
    
  • The width of the ear should be 55% of the length.
    
  • The angle of protrusion (auriculomastoid angle) should be 15 to 30 degrees.
    
  • The helical rim is normally 15 to 20 mm from the mastoid scalp.

• These terms are often used synonymously to describe the most common anatomical deformity: the lack of development of the antihelical fold with or without a deep conchal bowl.

• Characterized by a thin, flat ear with the helix acutely folded downward at the superior pole

• Characterized by a smaller than normal ear with weak cartilage, resulting in a cupping or deepening of the conchal bowl.
  
• There is poor development of the superior pole with a short, thickened helix and deformed antihelix.

The surgical considerations and techniques outlined below are more applicable to the more common protruding ear deformity. Correction of other auricle deformities is beyond the scope of this chapter, but certain portions of the outlined techniques can be used for other auricle malformations.

• Optimal age for otoplasty is between 4 and 6 years for the following reasons
  
  
  
  • Auricle is near adult size.
    
  • Psychological distress associated with peer ridicule at school is minimized.
    
  • Child is capable of participating in postoperative care of ear.
    
  • Cartilage is soft and pliable.
  
  
• Features to note on physical examination
  
  
  
  • Antihelical fold absence
    
  • Conchal bowl size and projection
    
  • Lobule size and position
    
  • Right and left ear asymmetries
  
  
• Indications for surgery
  
  
  
  • Absence or poor development of antihelical folds with greater than 20 mm projection of helical rim from mastoid skin
    
  • Deep conchal bowl with auriculomastoid angle greater than 30 degrees
    
  • Asymmetrically projecting ears
    
  • Desire for correction
  
  
• Contraindications for surgery
  
  
  
  • Child under 4 years of age
    
  • History of keloid formation
    
  • Unrealistic expectations
  
  
• Photodocumentation
  
  
  
  • Standard frontal, lateral, and oblique views
    
  • Optional posterior and close-up lateral views