A Different Approach for Protruding Earlobe Correction-Modified Fish-tail Technique

Abstract

Background: Protruding ears are the most common auricular abnormalities seen in children (1). Protruding ears are a condition that has social and psychological consequences due to its physical appearance and one of the main causes of peer bullying at young ages (2). While various surgical methods exist to address prominent ears, the options for correcting the lobule are relatively scarce. In this study, we are aimed to present the modified fish-tail technique that we have developed and to compare it with other techniques in the literature.

Methods: The patients were selected from the cases that underwent otoplasty for prominent ear correction in our clinic between 2020 and 2022. A total of 21 cases that required protruded lobule correction during otoplasty were included in our study. Keloid and hypertrophic scar formation, wound dehiscence, hematoma, infection and recurrence in the lobule were evaluated. The patients were followed up for at least 1 year for early and late complications.

Results: Each patient in the study underwent bilateral prominent ear correction, including bilateral modified fish-tail technique. All cases were followed for at least 12 months. There was no wound dehiscence, infection, recurrence in lobule prominence or hematoma during the follow-up period. No hypertrophic scar or keloid was observed in any case.

Conclusions: Our method stands out for its ability to achieve both adjustable vertical height and effective lobule correction with a reduced need for skin excision. We recommend the modified fish-tail technique as an alternative technique for prominent lobule surgery.

Level of evidence iv: 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 .

Keywords: Lobuloplasty; Modified fish tail; Otoplasty; Protruded lobule.

Fig. 1

A: Modified fish-tail excision pattern determined after classic otoplasty surgery. B: The skin at the most inferolateral side of the excision border was pulled with forceps toward the skin on the superomedial side of the excision border, and the most accurate suturing point for lobule correction was determined. C Following this, the points to be sutured together were determined with methylene blue, point 1 was sutured to point 1’ and point 2 was sutured to point 2’. D Asymmetric oblique suturation was applied to suture gaps

Fig. 2

A: Preoperative. B Postoperative first year

Fig. 3

A: Preoperative. B: Postoperative first year

Fig. 4

A: Preoperative. B: Postoperative first year

Fig. 5

Wood-Smith suggested a “fish-tail-like” retrolobular skin excision followed by V–Y plasty. This technique allows for the adjustment of the vertical height of the lobule as desired (with suturing “point 4” to a higher point), offering potential permanence by suturing the superior part of the helical tail (point 4) to the conchal cartilage.

Fig. 6

Our modified fish-tail technique offers several advantages, including the ability to achieve adjustable vertical height (Point 3 and yellow arrow) and sufficient correction through asymmetric oblique suturation (purple lines), all with minimal skin excision. Additionally, if vertical height is sufficient, the triangular region at the most inferior of the excision margin can be directly excised for dog-ear correction. (green lines)