Incisionless Otoplasty
The aim of incisionless otoplasty technique is to create a cosmetically pleasing pinna. The steps necessary to create a pleasing pinna include percutaneous needle modeling of the cartilage that breaks the cartilage memory spring and establishes a specific
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Michael H. Fritsch
Introduction The aim of incisionless otoplasty technique is to create a cosmetically pleasing pinna. There are two steps necessary to create a pleasing pinna. First, percutaneous needle modeling of the cartilage breaks the cartilage memory spring and establishes a specifically weakened tract in the cartilage which will bend in a certain way so as to create a new pinna form. Secondly, permanent sutures are percutaneously placed in order to hold the cartilage during the scar healing process. Separate incisionless techniques deal with the antihelical fold, lobule, and conchal bowl. Each of these techniques can be used alone or in combination for any specific patient’s ear deformity. Individualization of treatment, effectiveness and reproducibility, and atraumatic techniques leading to a low complication rate make incisionless otoplasty an excellent choice for correction of the lop ear deformity. Using these tried methods, a reliable otoplasty procedure with pleasing results can be accomplished.
M.H. Fritsch, M.D., FACS St Vincent Medical Center, 9002 N. Meridian st., suite 204, Indianapolis, IN 46260, USA e-mail: [email protected]
Technique (Figs. 23.1, 23.2, 23.3, 23.4, 23.5, 23.6, 23.7, 23.8, 23.9, and 23.10) There is a sequence of surgical events that is best suited for successful incisionless otoplasty. Initially, all of the percutaneous needle cartilage modeling work for all of the to-be-corrected areas is performed. The cartilage weakening and breaking is completed before any sutures are placed. The entire cartilage modeling work is completed first in order not to cut any already placed retention sutures. Thereafter, the retention sutures for the conchal bowl, lobule, and then the antihelical fold are placed. The order of conchal bowl, lobule, and antihelical fold suture placement progresses from the conchal foundation to the lowered antihelical shape.
Conchal Bowl Correction In almost all cases of otoplasty, there is a significant abnormality of the conchal bowl. The conchal bowl is the foundation for the otoplasty repair. If the antihelix is corrected without attention to the conchal bowl, then there is often an unnatural appearance to the correction. The main reason for this is that the antihelix will need to be overcorrected to compensate for the conchal bowl problem. The unnatural appearance is best characterized as an “angularity” to the finished otoplasty. Therefore, an overall reduction in conchal bowl prominence translates to a more naturalappearing antihelical correction.
M.A. Shiffman (ed.), Advanced Cosmetic Otoplasty, DOI 10.1007/978-3-642-35431-1_23, © Springer-Verlag Berlin Heidelberg 2013
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Fig. 23.1 To begin an incisionless technique, conchal recession procedure of the left ear, suture anchor points of maximal effectiveness are chosen by using a cotton swab to simulate the correction
Fig. 23.2 Once the points have been found, an ink dot is placed to accurately guide the surgeon’s needle placement
Fig. 23.3 A 3-mm stab opening is created. It almost alway
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