Modified bilateral fasciaperichondrial flap for prominent ear correction

Abstract

Objective: Various techniques have been described in the literature for prominent ear correction. These cartilage-preserving or cartilage-shaping techniques have their own advantages and disadvantages. We aim to achieve aesthetic and stable results with low complication rates using combinations of these methods. Herein, we present our results of prominent ear surgery with a modified bilateral fasciaperichondrial flap in combination with concha-mastoid and concha-scaphal sutures.

Methods: Patients whose surgeries included a modified bilateral fasciaperichondrial flap for prominent ear deformities were included in the study. Patients' demographic data, pre- and postoperative Concha-Mastoid Angle (CMA) and upper-middle Helix-Mastoid Distances (HMD), follow-up time, complications, secondary operations, and postoperative Visual Analogue Scale (VAS) results were evaluated. With a postauricular fish-mouth incision, the bilateral fasciaperichondrial flap was planned into two: proximal- and distal-based. They were then elevated from the cartilage subperichondrially on the proximal side and supraperichondrially on the distal side. Concha-scaphal sutures were used to form an antihelical rim along with concha-mastoid sutures to reduce the concha-mastoid angle. Conchal cartilage resection was done if needed. Then, the bilateral fasciaperichondrial flaps were sutured together to cover the concha-mastoid and concha-scaphal sutures.

Results: Between May 2017 and May 2021, 32 ears of 17 patients were operated on due to prominent ear deformity. No hematoma or infection was observed in any patient, and there were no instances of recurrence, suture exposure, hypertrophic scars, or keloids. The satisfaction level of all patients was 8.2 ± 0.9 points on average according to the VAS. In the anthropometric measurements, a statistically significant difference was found between preoperative and postoperative sixth month CMA and HMD values.

Conclusion: A combination of suture techniques and a modified bilateral fasciaperichondrial flap may be used in prominent ear cases, with low recurrence rates and high patient satisfaction.

Level of evidence: III.

Keywords: Otoplasty; Prominent ear; Surgical techniques.

Figure 1

Skin marking.

Figure 2

Distal and proximal based fasciaperichondrial flap illusturation.

Figure 3

Antihelix creation, Mustardé (horizontal mattress) sutures illusturation.

Figure 4

Conchal cartilage excision illusturation.

Figure 5

Concha-mastoid (Furnas) sutures demonstration illustration.

Figure 6

Flap suturation illustration.

Figure 7

Bilateral prominent ear correction; A 23-year-old female patient. (A), Preoperative anterior view. (B), Preoperatif posterior view. (C), Postoperative anterior view. (D), Postoperative posterior view.