Separating the helix from the antihelix: a new concept in prominent ear correction

Abstract

Background: For over a century, various otoplasty techniques for correction of the prominent ear have been attempted. Nevertheless, cartilage memory strength, mainly in the thick cartilage (and consequently the recurrence of the prominence), still remains a problem. An additional difficulty relates to the antihelix irregularities caused by attempts to weaken the cartilage spring, which are time-consuming and in some cases lead to an unnatural-looking result.

Objective: The technique reported in this article represents a new approach to otoplasty that deconstructs the auricular pavilion with a single full incision in the antihelix. This approach makes it easier to rebuild the antihelical fold with dissolving sutures and allows repositioning of the helix and earlobe with a posterior bielliptical incision and a narrow bridge skin resection.

Methods: Between 1999 and 2009, the author performed otoplasty for correction of the prominent ear in 60 patients, including 32 men (53.3%) and 28 women (46.7%). A single incision was made in the superior and lateral borders of the antihelix from the triangular fossa down to the tail of the helix, to completely separate the antihelix from the helix. Three postauricular sutures were applied with nonpermanent side-to-side mattress sutures, with a fourth suture placed to reposition the tail of the helix. A posterior bielliptical incision with a narrow bridge skin resection was performed.

Results: Complications occurred in six of the 60 patients (10%) who underwent bilateral otoplasty. A discrete recurrence occurred in the superior pole in six patients (10%) and was unilateral in all cases. Follow-up ranged from three months to 10 years. There were no major recurrences in this series. The satisfaction rate was 98.3%. The antihelix looked smooth, without marks or irregularities; the helix seemed straight and well placed. The posterior scar was inconspicuous.

Conclusions: The present technique introduces a new concept in otoplasty that avoids handling the antihelix cartilage. A single incision of the antihelix breaks the cartilage spring memory completely and allows rebuilding of the antihelical fold without resorting to techniques such as rasping, drilling, excision, or complete incision, all of which are time-consuming and may result in irregularities. Sutures are placed to create the new antihelix in the desired shape easily and without tension. The helix and earlobe are repositioned with a specific posterior skin resection and with the tail of the helix's replacement.