Earfold: A New Technique for Correction of the Shape of the Antihelix

Abstract

An absent or poorly defined antihelix often plays a central role in the perception of the prominent ear. A wide variety of otoplasty techniques have been described over the last 50 years that aim to reshape, create, or enhance the definition of the antihelix, which can, in turn, help to reduce the prominence of an ear. In addition to conventional suture and cartilage-scoring techniques, a permanent implantable clip system (Earfold^® ) has recently become available that is placed using a minimally invasive approach performed under local anesthesia. In this review, we summarize conventional otoplasty techniques to correct the antihelix and compare these with the Earfold implantable clip system. Laryngoscope, 128:2282-2290, 2018.

Keywords: Prominent ear; external ear cartilage; otoplasty; plastic; surgery.

Figure 1

Causes of prominent ears. The thick blue line indicates the profile of the cartilage seen in cross‐section through the middle third of the ear. H‐M = helical‐mastoid.

Figure 2

Cartilage‐sparing methods to create an antihelical fold and reduce ear prominence. The posterior suture method (A) places permanent sutures between the upper scapha and fossa triangularis and between the lower scapha and the concha. With the Earfold^® system (B), a permanent nitinol implant is fixed to the cartilage in the region of the planned antihelix, causing the ear to fold back. The black curved arrow in the center‐left illustration indicates the posterior sutures behind the antihelical fold. H‐M = helical‐mastoid.

Figure 3

Cartilage‐cutting and sculpting methods to create an antihelical fold and reduce ear prominence. (A) The desired outcome is shown. (B) This can be achieved with minimally invasive approaches (inferior or [inset] superior) involving the insertion of a rasp, bent needle, or ophthalmic knife into the anterior, subcutaneous aspect of the pinna, and abrading or cutting the cartilage in the area of the planned antihelix. This causes the cartilage to bend or curl to the opposite side. (C) The conventional approach to the anterior surface of the cartilage involves a postauricular approach through the cartilage, which is dissected away from the anterior skin and then scored. H‐M = helical‐mastoid.

Figure 4

The Earfold^® implant insertion procedure. (A) To insert an Earfold implant, a subperichondrial tunnel is created that extends 2 to 5 mm beyond the area marked for the position of the implant. (B) Multiple through‐and‐through perforations of the cartilage may be necessary to enhance cartilage folding if the cartilage is particularly stiff. (C) Insertion and deployment of the implant using the introducer.

Figure 5

The Earfold^® system. The Earfold implant (A) is preloaded into the introducer (B) to hold the implant in a flattened position before insertion. (C) The Prefold positioner is used to determine the number, position, and orientation of the Earfold implants prior to surgery. Adapted from Kang and Kerstein.18 By permission of the American Society for Aesthetic Plastic Surgery, Inc.

Figure 6

A 45‐year‐old male with bilateral prominent ears and slight lop‐ear deformity of the right ear, with no prior history of prominent ear correction. (A and B) Preoperative ear prominence. (C and D) Three months after treatment with a single Earfold implant inserted into the upper pole of each ear. Images courtesy of Norbert V. Kang.

Figure 7

Combined procedures. Examples of several combination approaches to reducing ear prominence, including (A) conchal cartilage excision and placement of posterior sutures, (B) minimally invasive anterior cartilage scoring paired with posterior concho‐mastoid sutures, and (C) the Earfold^® implant paired with conchal excision. Black curved arrows in the center illustrations indicate the posterior surface of the antihelical fold.