Invited Discussion on: Comparison of Prominent Ear Recurrence in Different Age Groups
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EDITOR’S INVITED COMMENTARY
Invited Discussion on: Comparison of Prominent Ear Recurrence in Different Age Groups Sergey Y. Turin1 • Arun K. Gosain1
Received: 8 May 2020 / Accepted: 25 May 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020
Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. The authors investigate the relationship of patient age and recurrence rate after otoplasty for prominent ear deformity (PED). They present a retrospective series of 380 patients ranging from 6 to 58 years of age, stratified by age group. The techniques used are documented in Table 2, demonstrating that all 380 patients had placement of concha-mastoid (Furnas) sutures to narrow the conchomastoid angle, and the vast majority of patients (355 out of 380) had placement of concha-scaphal (Mustarde) sutures and anterior rasping to create the antihelix. The remaining 25 patients had concha-mastoid sutures placed in isolation without concurrent techniques to create the antihelix. In addition, ten patients had conchal resection, although the authors do not report whether these patients also had recreation of the antihelix. Lobule intervention was done in 23 patients, although the measurements provided to evaluate recurrence do not evaluate potential recurrence in the lobule. Recurrence rates are measured based on linear distance from the helix to the mastoid in the upper, middle, and lower poles and by the cephaloauricular angle measured in the mid-concha (figure 1). Since the crux of the article focuses on measurements characterizing ear position, the technique for measurement
& Arun K. Gosain [email protected] 1
Division of Pediatric Plastic Surgery, Lurie Childrens Hospital, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Box 93, Chicago, IL, USA
is crucial to the paper. The authors describe their measurement apparatus as ‘‘special flexible aluminum apparatus’’ and justify consistency based on agreement between two persons making these measurements. Although this may produce consistent results for one patient at a given time point, one must question how reproducible this technique would be when comparing measurements taken at different time points. Whereas it is easy to divide the helix into upper, middle, and lower poles, slight alteration in the reference point used on the mastoid can have significant impact on the final measurement. In addition, the authors do not demonstrate the special flexible aluminum apparatus used for measurement, making reproducibility of the technique in other centers very difficult. Future studies might incorporate 3D imaging from which measures could be made documented and made more reliably. The authors document the number of recurrences in each age group, but they do not indic
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