Otoplasty
Among the numerous anomalies which can occur in the head and neck region, protruding ears are certainly one of the most common. The two most frequent causes of this condition are a disproportionately shaped cavity of concha and an underdeveloped anthelica
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6 Otoplasty Mang Procedure: Combination of the Stenström and Converse Procedures 䊏
Introduction 228
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Anatomical Overview 229
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Instruments and Medication 230
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Photographic Documentation 232
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Preliminary Examination of the Ear 232
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Surgical Planning 233
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Disinfection 233
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Preliminary Marking of Incision Lines 234
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Local Anesthesia 234
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Incision 236
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Skin Resection 238
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Exposure of the Dorsal Surface of the Auricular Cartilage 240
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Preparation of the Auricular Concha 242 1. Marking with Fine Needles 242 2. Marking of Incision Lines 242 3. Incision of Conchal Cartilage 244 4. Blunt Cartilage Dissection 244
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Resection of the Concha 246
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Reshaping the Anthelix 248
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Cartilage Sutures 254
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Wound Closure 256
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Identical Approach on the Contralateral Side 256
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Dressing 258
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Postoperative Treatment and Precautions 258
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Results 259
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Tips and Tricks 261 The symbol
indicates parts of the procedures shown in the video
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6 Otoplasty
Introduction Among the numerous anomalies which can occur in the head and neck region, protruding ears are certainly one of the most common. The two most frequent causes of this condition are a disproportionately shaped cavity of concha and an underdeveloped anthelical fold. The standard operations for otoplasty make use of the techniques developed by Pitanguy, Converse, Stenvers, Stenström, and Mustarde, among others. Our own procedure is a combination of the surgical procedures developed by Stenvers and Stenström. The aim of otoplasty is to reduce the angle between the ear and the head to 25°–30°. The incision is placed on the dorsal side of the auricle to ensure that the operation leaves no visible scars. By the end of the operation the auricle should have assumed its final desired position without any tension. The belief that the aesthetic outcome can be influenced by the application of corrective dressings is fallacious. The modified technique described in this chapter will substantially lower the recurrence rate. In the hands of a competent surgeon, otoplasty is an uncomplicated procedure within the field of aesthetic facial surgery. For patients with deformities of the ears (e.g., protruding ears), it can be recommended from ages 5–6 onward.
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6 Otoplasty
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Anatomical Overview (Fig. 6.1) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.
Temporoparietal muscle Crura of anthelix Greater muscle of helix Cymba Anterior incisure of the ear Lesser muscle of helix Crus of helix Bony external acoustic meatus Muscle of tragus Tragus Antitragus Intertragic incisure
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Antitragohelicine fissure Auricular lobe Helix Antitragus muscle Cavity of concha Posterior auricular muscle Concha of auricle Auricular tubercle Anthelix Scapha Triangular fossa
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6 Otoplasty
Instruments and Medication (Fig. 6.2) 1 2 3 4 5 6 7 8 ) ) ) ) ) ) ) ) ) ) ) )
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Delicate long single-pronged wound retractor Delicate long two-pronged wound retractor
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