Cartilage-Sparing Otoplasty: An Overview of the Mustardé and Furnas Suture Techniques

Otoplasty is commonly used to treat prominauris. Cartilage-sparing techniques for otoplasty are well popularized. The most common cartilage-sparing otoplasty techniques include the Mustardé and Furnas techniques. This article discusses the preparation, surgical steps, postoperative care, and associated complications for Mustardé and Furnas otoplasty in detail.

Office-Based Pediatric Otoplasty Under Local Anesthesia

BACKGROUND

Many parents seek otoplasty for their school age children but fear having to undergo general anesthesia (GA). In our experience, otoplasty can safely be performed in an office-based setting under local anesthesia (LA). There is a gap in the literature regarding pediatric otoplasty under LA.

METHODS

All children aged 5 to 10 who underwent otoplasty between 2017 and 2021 were included in a retrospective review. Demographics, operative techniques, complications, recurrences, and reoperation rates were collected. Surveys were provided 3 months after treatment to assess parental satisfaction and anxiety. Results were compared between patients who received otoplasty under GA and LA.

RESULTS

A total of 13 patients (6 male, 7 female), with a mean age of 7 years (ranging 5-10) underwent otoplasty under LA. Tweleve children (6 male, 6 female), with a mean age of 5 years (ranging 4-7) underwent otoplasty under GA. The only complications seen were 3 minor conchal bowl hematomas that were aspirated, each retrieving <1 mL of blood; no revisions were necessary. The LA subgroup was more likely to repeat otoplasty under identical conditions ( P =0.025). Postoperatively, mean parental anxiety scores between the LA and GA subgroups were significantly different (1.4±1.1 versus 4.8±2.7, P =0.0005). Lastly, the mean satisfaction scores between the LA and GA subgroups were marginally different (3.83±0.58 versus 3.17±1.03, P =0.063).

CONCLUSION

Pediatric otoplasty under LA is a safe and feasible operation for patients between 5 and 10 years of age.

Outcomes and complications of incisionless otoplasty - A retrospective observational study and a review of the literature

INTRODUCTION

Incisionless otoplasty is a more recently described technique to correct prominent ears. It is thought to provide a more natural cosmetic look, easier to perform, and achieve quicker recovery when compared to conventional otoplasty. The safety and efficacy of the procedure is not well characterised as there is limited data on outcomes and complications.

METHODS

This was a retrospective study to evaluate outcomes and complications of incisionless otoplasty. We included all children who underwent incisionless otoplasty by a single surgeon over a 9-year period at a tertiary paediatric ear, nose and throat (ENT) unit.

RESULTS

A total of 32 children were included in this study (62 ears operated on). Using facial dimension measurements to analyse preoperative and postoperative photographs, the proportion of prominent ears reduced from 43/56 (76.8%) to 8/45 (17.8%). The children reported good cosmetic outcomes in 38/40 (95.0%) ears. Assessment of preoperative and postoperative photographs considered 34/39 (87.2%) to have good cosmetic result. The following rates of complications were observed: infection, 6/62 (9.7%); blistering, 14/62 (22.6%); bleeding, 1/62 (1.6%); suture breakage/extrusion, 8/62 (21.9%); skin necrosis, 1/62 (1.6%). Further otoplasty procedures were done on five ears (8.3%).

CONCLUSIONS

Incisionless otoplasty was associated with high success and satisfaction rates. A previously undescribed complication of early postoperative erythema, swelling and blistering may be unique to this technique. This procedure should be further evaluated to identify risk factors and preventative measures to reduce complications.

Aesthetic Otoplasty: Principles, Techniques and an Integrated Approach to Patient-Centric Outcomes

BACKGROUND

Otoplasty is a century-old procedure that, through continued modifications, now has over two hundred different procedures described in the literature. In this article, we seek to describe the anatomy and principles of aesthetic otoplasty, as well as some of the key contributions to aesthetic otoplasty. This article will also outline some of the most commonly used techniques today and associated patient outcomes.

METHODS

We present a review of the literature of relevant anatomy, pathophysiology and common techniques and outcomes. We also provide a discussion of several patients with associated techniques and outcomes.

RESULTS

The treatment of prominent ear has developed through manipulation and experimentation. The outcomes are defined by the native anatomy, the surgical technique and the attention to patient-centered outcomes.

CONCLUSION

Aesthetic otoplasty remains one of the most important surgical techniques and common procedures in plastic surgery. Using an integrated approach guided by known principles as well as patient goals allows for optimal outcome in aesthetic otoplasty.

LEVEL OF EVIDENCE V

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 .

Otoplasty techniques in children: a comparative study of outcomes

BACKGROUND

Numerous otoplasty techniques have been described in the literature to correct prominent ears; however, few have focused on the complication rates. We reviewed our experience aiming to assess peri-operative care requirements and complication rates.

METHOD

We conducted a retrospective review of 207 otoplasty procedures performed in 119 patients over a 5-year period (2009-2014) at the Women's and Children's Hospital, Adelaide. Information pertaining to demographic details, length of stay, otoplasty technique and complications (early and late) were obtained.

RESULTS

In the study period, 97% of the 119 patients had an overnight stay. There was an early complication of 2.2% (return to theatre for bleeding) in the modified Chongchet technique and 0.9% (wound infection) in the Mustarde technique. Late complications included suture extrusion (1.9%) with the Mustarde technique and hypertrophic scarring (2.2%) in the modified Chongchet technique. The recurrence rate requiring revision following modified Chongchet technique was 10% and Mustarde technique was 2.9%. The Mustarde otoplasty technique was associated with a slightly lower antiemetic requirement than the Chongchet technique (3.2 versus 14.3%, P = 0.032). Both techniques had comparable opioid analgesic requirement of 30-35% post-operatively (P = 0.248).

CONCLUSION

Our results are comparable to the huge variation in available literature. We note the higher revision rate following modified Chongchet technique. Both techniques had a low and acceptable rate of post-operative analgesia and antiemetic requirement. We are considering either otoplasty technique as a day surgery procedure within our unit with the provision of adequate patient support as a safe and economical advance.

The Protruding Ear: Cosmetic and Reconstruction

Ear prominence is a relatively common cosmetic deformity with no associated functional deficits, but with profound psychosocial impact, especially in young patients. Protruding ears in children have propagated surgical advances that incorporate reconstructive techniques. Here we outline a systematic framework to evaluate the protruding ear and present various reconstructive surgical options for correction. Both cosmetic and reconstructive perspectives should be entertained when addressing this anatomical deformity.

Optimal Electromechanical Reshaping of the Auricular Ear and Long-term Outcomes in an In Vivo Rabbit Model

IMPORTANCE

The prominent ear is a common external ear anomaly that is usually corrected through surgery. Electromechanical reshaping (EMR) may provide the means to reshape cartilage through the use of direct current (in milliamperes) applied percutaneously with needle electrodes and thus to reduce reliance on open surgery.

OBJECTIVE

To determine the long-term outcomes (shape change, cell viability, and histology) of a more refined EMR voltage and time settings for reshaping rabbit auricle.

DESIGN, SETTING, AND SUBJECTS

The intact ears of 14 New Zealand white rabbits were divided into 2 groups. Group 1 received 4 V for 5 minutes (5 ears), 5 V for 4 minutes (5 ears), or no voltage for 5 minutes (control; 4 ears). Group 2 received an adjusted treatment of 4 V for 4 minutes (7 ears) or 5 V for 3 minutes (7 ears). A custom mold with platinum electrodes was used to bend the pinna and to perform EMR. Pinnae were splinted for 6 months along the region of the bend. Rabbits were killed humanely and the ears were harvested the day after splint removal. Data were collected from March 14, 2013, to July 8, 2014, and analyzed from August 29, 2013, to March 1, 2015.

MAIN OUTCOMES AND MEASURES

Bend angle and mechanical behavior via palpation were recorded through photography and videography. Tissue was sectioned for histologic examination and confocal microscopy to assess changes to microscopic structure and cell viability.

RESULTS

Rabbits ranged in age from 6 to 8 months and weighed 3.8 to 4.0 g. The mean (SD) bend angles were 81° (45°) for the controls and, in the 5 EMR groups, 72° (29°) for 4 V for 4 minutes, 101° (19°) for 4 V for 5 minutes, 78° (18°) for 5 V for 3 minutes, and 126° (21°) for 5 V for 4 minutes. At 5 V, an increase in application time from 3 to 4 minutes provided significant shape change (78° [18°] and 126° [21°], respectively; P = .003). Pinnae stained with hematoxylin-eosin displayed localized areas of cell injury and fibrosis in and around electrode insertion sites. This circumferential zone of injury (range, 1.3-2.1 mm) corresponded to absence of red florescence on the cell viability assay.

CONCLUSIONS AND RELEVANCE

In this in vivo study, EMR produces shape changes in the intact pinnae of rabbits. A short application of 4 V or 5 V can achieve adequate reshaping of the pinnae. Tissue injury around the electrodes is modest in spatial distribution. This study provides a more optimal set of EMR variables and a critical step toward evaluation of EMR in clinical trials.

LEVEL OF EVIDENCE

NA.

Injectable chondroplasty: Enzymatic reshaping of cartilage grafts

OBJECTIVE/HYPOTHESIS

To develop an injection-based enzymatic technique that selectively softens cartilage tissue for reshaping cartilaginous structures in the head and neck.

MATERIALS AND METHODS

Two groups were formed using fresh rabbit ears: (1) whole rabbit ear group; (2) composite graft group (2.5mm×3.0cm specimens sectioned from the central region of the pinna). Subperichondrial injections using three enzymes (hyaluronidase, pronase, and collagenase II) in sequence were performed for the experimental specimens from both groups. In the control specimens, phosphate buffered saline was injected in a similar fashion. The whole ear specimens were then photographed while held upright in the anatomical vertical position to evaluate for buckling, which corresponds to the integrity of the cartilage. In addition, backlight photography was performed for all specimens to further evaluate the effect of the enzymes, such that increased light intensity represents increased cartilage digestion.

RESULTS

The application of the digestive enzymes resulted in marked reduction of cartilage tissue matrix resiliency, while preserving overlying skin layers. Enzymatically treated whole pinnae buckled at the site where enzymes were delivered. Backlit images revealed increased local light intensity at the regions of digestion. There was no obvious destruction of the overlying skin upon visual inspection.

CONCLUSIONS

This study demonstrates the feasibility of injectable chondroplasty as a potential alternative method to conventional surgery for auricular cartilage reshaping. Sequential injection of hyaluronidase, pronase, and collagenase II into the subperichondrial space can be performed to digest and soften cartilage structure with minimal involvement of surrounding tissue. Future studies will need to include chondrocyte viability testing and optimization of delivery techniques.