Complications after prominent ear correction: A systematic review of the literature

A Retrospective Analysis of Pinnaplasty Outcomes: The Welsh Experience

Prominent ears (PEs) are the most frequent congenital external ear deformity, occurring in ∼5% of the population. Although the deformity does not usually cause functional difficulties, it can significantly affect the patient's psychological and social health. The authors aim to present the Welsh experience of pinnaplasty, reviewing our outcomes and complications. A retrospective cross-sectional study was performed of all patients undergoing pinnaplasty in Morriston Hospital, Swansea, Wales. We represent the tertiary plastic surgery referral unit across Wales. We included all patients undergoing pinnaplasty between 2015 and 2022 inclusive. We excluded patients undergoing revision procedures or those who had no follow-up. Over the 7-year period, 236 pinnaplasties were performed and 203 were included in the analysis. Ninety-six percent of cases were performed using a cartilage-sparing approach, which represents the mainstay in our unit. The mean follow-up length for our cases was 12 months. Revision procedures were required in 4% of cases. Three hematomas (1.5%) and one (0.5%) wound dehiscence due to infection were recorded and required a return to the operating room. Suture extrusion was noted in 5% of cases (10 patients); 4.5% (9) cases were affected by either hypertrophic or keloid scarring. Across the United Kingdom, cosmetic procedures have come under scrutiny, namely, because of a difficult economic climate. In the era of tight fiscal control in health care, it is pertinent to analyze the outcomes and performance metrics of our operations regularly, thus aiding in the development of an established evidence base to advocate for our respective patients.

Modified Valente Technique for Cauliflower Ear: Outcomes in Children at Two-Year Follow-Up : New Surgical Technique for Cauliflower Ear

BACKGROUND

Cauliflower ear deformity, a common sequela of auricular trauma, presents an esthetic and reconstructive challenge. Existing surgical techniques have limitations, including complexity, donor site morbidity, and variable long-term outcomes.

MATERIALS AND METHODS

In this case series, we present a novel and minimally invasive surgical approach for the correction of cauliflower ear deformity that adapts the Valente otoplasty technique; it combines cartilage debulking with helical rim release and Mustardé mattress stitches to restore ear contour and reduce the risk of recurrence. The procedural steps include bielliptic post-auricular skin and soft tissue incision, release of the cartilaginous spring, removal of excess fibrocartilaginous tissue, cartilage reshaping with suture to restore contour, and tissue redistribution to promote adherence of skin to the cartilage framework.

RESULTS

Outcomes were evaluated in 7 patients (9 ears) with cauliflower ear deformity, assessing surgical duration, complications, patient satisfaction, and esthetic outcomes at two years after surgery. The mean surgical duration per patient was 52 ± 17 minutes, including 2 bilateral procedures. Follow-up at 24 months showed favorable esthetic outcome in all patients with sustained improvements in auricular contour and symmetry with neither loss of the shape nor recurrence of deformity. Patients reported high satisfaction and improved quality of life, with mean Glasgow Children Benefit Questionnaire scores of 99.3 ± 6.3.

CONCLUSIONS

This technique thus demonstrated lasting correction of cauliflower ear with favorable cosmetic outcomes, low risk of complications, and high patient satisfaction. Further investigations and longer-term follow-up are warranted to validate the technique's durability and expand its application to older and more diverse patient populations.

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 .

Results of Modified Stenströms Technique Otoplasty and Patients' Satisfaction at King Fahad Armed Forces Hospital (KFAFH)

Background Globally, the prevalence of protruding ears is relatively frequent. Ear deformities manifest due to underdevelopment of the antihelical fold, conchal hypertrophy, and/or an obtuse conchoscaphal angle. The availability of multiple approaches proves that there isn't a single optimal accepted procedure. The Modified Stenström otoplasty technique supports the surgeon in the management of underdeveloped antihelix fold, conchal hypertrophy, and obtuse conchoscaphal angle among other deformities. We are the first to evaluate the clinical effects and measure the satisfaction rate post-otoplasty using the modified Stenström technique with a case series study. Methods Six patients were included in the study with a total of 12 ears operated on between February 2021 and July 2022. Utilizing the modified Stenström technique for bilateral protruding ears. All patients had six postoperative follow-up visits with fixed intervals; one week, three weeks, six weeks, three months, six months, and one year. During their one-year postoperative follow-up appointment, all patients completed the satisfaction survey questions. Results Six individuals were studied, three males and three females with a mean age of 23.1 (range, 7-53 years old). There were no complications or recurrences observed. Based on the responses we collected, all patients reported a high satisfaction rate at one-year postoperative follow-up. Conclusion The modified Stenström technique yields good naturally appearing ears. It is an easy and safe technique to apply. It has a short recovery period, and no hospital stay is required. All contribute to a high satisfaction rate among studied patients.

Complications of Cartilage Sparing Otoplasty: A Systematic Review and Meta-Analysis

OBJECTIVE

To study the prevalence of complications in patients who have undergone cartilage sparing otoplasty.

METHODS

On December 26, 2021, the authors searched 8 databases using the search term "(otoplasty) AND (cartilage sparing OR cartilage sparing)" for collecting the most appropriate studies. The authors used R software version 4.1.2 for conducting the meta-analysis.

RESULTS

Of the 414 records screened, the authors included 14 studies. Recurrence/reoperation was the most common reported complication with a prevalence of 4.27% (95% CI: 2.93-6.22), followed by suture erosion 2.46% (95% CI: 0.86-7.07) and hematoma/hemorrhage 1.34% (95% CI: 0.79-2.27). The authors did not find any significant difference between cartilage sparing and cartilage scoring in terms of recurrence/reoperation [odds ratio (OR): 0.92; 95% CI: 0.53-1.60; P = 0.766], hematoma/hemorrhage (OR: 1.39; 95% CI: 0.28-7.01; P = 0.688), and wound infection (OR: 0.37; 95% CI: 0.06-2.24; P = 0.279).

CONCLUSION

Various complications have been reported, including recurrence and reoperation, hematoma, wound infections, suture erosions, keloid formation, and skin necrosis. However, the prevalence of these events is not high, although significant heterogeneity was reported for some outcomes. Therefore, it can be concluded that cartilage sparing otoplasty is a safe and reproducible technique.

Cartilage-Sparing Otoplasty: A New Approach

SUMMARY

Ear protrusion is the primary indication for otoplasty. Many methods have been developed for addressing this defect, based on cartilage-scoring and excision and suture-fixation techniques. Disadvantages include irreversible distortion of the anatomy, irregularities, or overcorrection, or forward bulging of the conchal bowl. One of the most common long-term sequelae of otoplasty is an unsatisfactory result. A novel, cartilage-sparing, suture-based technique has been developed that aims to minimize the risk of complications and provide a natural-appearing aesthetic result. The method is based on two to three key sutures that shape the concha into the desired natural appearance while preventing a conchal bulge, which otherwise could appear if no cartilage is removed. Furthermore, these sutures support the neo-antihelix created by four further sutures anchored to the mastoid fascia, thus achieving the two main goals of otoplasty. The sparing of cartilaginous tissue means that the procedure is reversible if needed. In addition, permanent postoperative stigmata, pathologic scarring, and anatomical deformity can be avoided. This technique was used on 91 ears in 2020 and 2021, with only one ear (1.1%) requiring revision. Rates of complications or recurrence were low. The presented technique appears to be a rapid and safe method for treating the prominent ear deformity, providing aesthetically pleasing results.

Vertical mattress suture applied as "Tension band fixation" for the antihelix creation and prominent ear treatment: 104 case reports

BACKGROUND

Prominent ears were the most common auricular deformity. Different surgical techniques, such as cartilage-cutting techniques and suturing techniques, are available for treatment. The horizontal mattress suture technique, represented by the Mustard technique, is widely accepted, while the vertical mattress suture technique is rarely discussed in otoplasty.

METHOD

A total of 104 cases of prominent ear deformities were treated from January 2017 to December 2020. Several hypothetical "tension bands" perpendicular to the natural curvature of the antihelix were introduced for the surgical design and determination of the position of the antihelix fixation, and vertical mattress sutures were placed accordingly for the auricular cartilage fixation.

RESULT

Follow-up ranged from 3 months to 2 years. No complications, such as hematoma, infection, or poor wound healing, were observed. Three patients had recurrence within two months post operation, and one complained about the overfolded antihelix. Three cases had suture exposure, but the shape of the auricle was not affected after suture removal. The surgical result was evaluated according to the overall shape of the auricle, including the shape of the antihelix, the improvement of the prominent, the surgical marks, and the bilateral symmetry. A total of 98 patients (94.23%) rated the results as "very satisfactory" or "satisfactory".

CONCLUSION

The vertical mattress suture applied as "tension band fixation" could provide stable cartilage fixation with the natural appearance of the antihelix formation. In addition, the technique could fit a wide range of indications with a low risk of complication and reoccurrence.

Development of a High-Fidelity, 3D Printed Otoplasty Surgical Simulator

IMPORTANCE

Prominotia has functional and esthetic impact for the child and family and proficiency in otoplasty requires experiential rehearsal.

OBJECTIVES

To design and validate an anatomically accurate, 3D printed prominotia simulator for rehearsal of otoplasties.

METHODS

A 3D prominotia model was designed from a computed tomographic (CT) scan and edited in 3-matic software. Negative molds were 3D printed and filled with silicone. Expert surgeons performed an otoplasty procedure on these simulators and provided Likert-based feedback.

RESULTS

Six expert surgeons with a mean of 14.3 years of practice evaluated physical qualities, realism, performance, and value of the simulator. The simulator was rated on a scale of 1 (no value) to 5 (great value) and scored 3.83 as a training tool, 3.83 as a competency evaluation tool, and 4 as a rehearsal tool.

CONCLUSIONS

Expert validation rated the otoplasty simulator highly in physical qualities, realism, performance, and value. With minor modifications, this model demonstrates valuable educational potential.

Prominent Ear Correction Using Full-Thickness Cartilage Strip: An Incomplete Cutting Technique

BACKGROUND

Prominent ears are one of the most well-known facial disfigurements influencing youngsters. Approximately 5% of the population suffers from some degree of ear prominence. More than 200 techniques have been used for the surgical correction of prominent ears, referring that no single "best" method exists and that techniques and modifications will continue to appear.

OBJECTIVES

In this work, we are going to evaluate the results of using a full-thickness cartilage strip, an incomplete cutting technique for the correction of various degrees of the prominent ear.

PATIENTS AND METHODS

This prospective controlled clinical trial was carried out on a sum of 63 patients, who presented with prominent ear deformity, in the period between March 2014 and January 2020 at the plastic and reconstructive surgery department, Tanta University Hospitals, and private clinic.

RESULTS

Sixty-three patients were operated upon, 46 were males and 17 were females, their age ranged between 4 and 23 years, and their mean age was 9.7 years. Clinical results showed excellent results in 37 patients (58.7%), good results in 18 patients (28. 6%), fair results in 8 patients (12.7%), and no poor results. Patient satisfaction showed excellent results in 32 patients (50.8%), good results in 22 patients (34.9%), fair results in 9 patients (14.3%), and no poor results.

CONCLUSIONS

Prominent ear correction using full-thickness cartilage strip, an incomplete cutting technique, is a good technique. It can be used in the correction of different varieties of prominent ears. It has a very low incidence of complications. No hypertrophic or keloidal scars have been reported.

Complication Rates From Otoplasty at a Tertiary Facial Plastic Surgery Center: A Retrospective Analysis

Prominent ears are considered the most common congenital external ear deformity among Caucasians. Affecting approximately 5% of the population, it runs in families and exhibits equal sex incidence. This study aimed to determine the complication rate from otoplasty in a tertiary facial plastic surgery center. This retrospective cross-sectional study included all patients with prominent ears deformities who underwent otoplasty at King Abdul-Aziz University Hospital between January 2019 and June 2021. The records of 116 patients who underwent otoplasty during the study period were examined and only 44 matched the inclusion and exclusion criteria. The total of 85 operated ears from 44 patients were included. Of these, 17 were pediatric patients and 25 were male patients. Forty-one patients underwent bilateral otoplasty and 3 underwent unilateral otoplasty. Complications occurred in 17/85 (20%) patients and the complications included recurrence 4 (4.70%), hypertrophic scar 3 (3.52%), keloid 2 (2.35), granuloma 2 (2.35%), infection 2 (2.35%), discomfort 1 (1.17%), wound dehiscence 1 (1.17%), hematoma 1 (1.17%), and retracted ear 1 (1.17%). The overall patient satisfaction was 38/44 (86.36%). Our study is first study conducted in middle east about otoplasty complications. It showed that the complications from otoplasty surgery varied from severe to mild, with acceptable overall satisfactory results. The most common complication was recurrence. Fortunately, serious complications, such as wound dehiscence and hematoma, were rare. However, our study’s small sample size remains a major limitation.

Outcomes and Complications of the Mustardé Otoplasty: A "Good-Fast-Cheap" Technique for the Prominent Ear Deformity

Background:

The Mustardé otoplasty is a commonly used procedure for the correction of the prominent ear deformity. Complication rates related to suture extrusion and long-term outcomes are variable in the literature. The study’s purpose was to examine the efficacy and safety of the Mustardé otoplasty and its resource utilization, using an “iron triangle” methodology incorporating quality, time, and cost.

Methods:

Retrospective data were collected on patients under 18 years who underwent primary Mustardé otoplasty between 2009 and 2018. Patient demographics, intraoperative details, complications, follow-up, and satisfaction were collected and analyzed.

Results:

There were 119 Mustardé otoplasties performed on 68 patients, with a median follow-up of 72 weeks (24–476 weeks). In total, 51 of the 68 patients underwent bilateral procedures. The median operative time was 95 minutes (31–133 minutes), translating to a facility case cost of $2046. A total of 24 complications were reported in 17 patients. Minor complications included the following: suture extrusion (n = 20), hematoma (n = 1), and suture abscess (n = 1). Major complications included reoperation (n = 2). The series had a revision rate of 1.7% (n = 2). No additional procedures were documented at other hospitals in the province. The majority (97%) of ear outcomes demonstrated both patient and surgeon satisfaction.

Conclusions:

The Mustardé otoplasty demonstrated a high efficacy in the correction of the prominent ear, with low reoperation rates and high patient and surgeon satisfaction. The procedure demonstrated intriguing results in resource utilization, with brief operative times, a “knife and fork” supply chain, and minimal overall case costs. This technique qualifies as a good, fast, and cheap outpatient otoplasty option.

A retrospective analysis of complications and surgical outcome of 1380 ears: Experience review of paediatric otoplasty

AIM OF THE STUDY

The psychological benefits of successful surgery for prominent ears have been emphasised. However, there are few comprehensive reports in the literature on the incidence of complications. The aim of this retrospective study is to present the postoperative outcome and possible recurrence of prominent ears after otoplasty in a University Hospital Center.

METHODS

A total of 705 patients were followed after otoplasty. We carried out a retrospective review of the file that included all children who had been treated for prominent ears following the same surgical technique from January 01, 1993 to December 31, 2017, and made a descriptive analysis of the data.

MAIN RESULTS

Our study confirmed the prevalence of females in operative treatment of PE, as well as the predominance of the bilateral form of this anomaly. Postoperative complications were recorded in 3.7% of the children (n = 26). 16 patients (2.2%) developed hypertrophic scar complications that required surgical revision in all cases, classifying them as 3b according to the Clavien-Dindo classification. Nine patients (1.3%) required surgical revision for recurrence (Clavien-Dindo 3b). Recurrence, unlike scarring complications, seems to be dependent on the surgeon's experience. A family history was noted in 20% of cases.

CONCLUSIONS

The otoplasty technique showed here is safe and has a low rate of the complications commonly described in the literature. A prospective study with a survey of complications and degree of satisfaction with the results will follow.

Minimally Invasive Technique for Correction of Prominent Ear

OBJECTIVES

Prominent ear is not an uncommon deformity with 5% prevalence in population worldwide. Although there is no physiological handicap in this deformity, it affects the psychology and social integration, especially in children. Many surgical techniques are performed to correct this deformity. In this study, we illustrate a minimally invasive technique in cases of prominent ear and evaluate its efficacy.

MATERIALS AND METHODS

A total of 16 patients were operated by incisionless otoplasty in both ears simultaneously. Therefore, 32 ears were included in the study. Postoperative follow-up was carried out for 6 months to determine the efficacy of this technique, complications, and recurrence of the abnormal shape.

RESULTS

Two ears (2/32) were presented with slight protrusion three months postoperatively Three ears had postoperatively exposed sutures that needed to be embedded again under local anesthesia. The satisfaction rate was found to be 88% by the visual analog scale. No perichondritis or other complications occurred postoperatively. The technique results in correction of the deformity without any visible evidence of surgery.

CONCLUSION

This technique is effective and safe for correction of prominent ear with negligible rate of complications and rapid recovery time.

Anterior versus Posterior Scoring of Cartilage in Otoplasty: A Retrospective Patient-related Outcome Measurement Study

Background:

Various surgical techniques are applied to correct prominent ears. However, there are limited data on the effect of otoplasty on patient-related outcome measures, such as cold ears and cold intolerance. This retrospective cohort study describes the occurrence of cold intolerance in 98 patients, with a total of 196 ears in a single center during 6 years (2011–2017).

Methods:

In this study, 3 groups were identified: group I, anterior scoring of the cartilage (ie, Chong Chet); group II, posterior scoring of the cartilage and suture reposition of the cartilage; and group III, posterior approach without scoring (ie, Furnas and Mustardé). Parents of patients filled in a questionnaire with 40 questions to criticize the effect of surgery.

Results:

Symptoms of cold intolerance and pain were reported in 44.4% (n = 16) in the anterior scoring group, 48.1% (n = 26) in the posterior scoring group, and 62.5% (n = 5) in the posterior approach group without scoring of the cartilage (P = 0.68). The satisfaction rate was significantly lower in the posterior group without scoring (Likert scale of 17.44 ± 22.01 anterior scoring, 16.02 ± 18.13 posterior scoring, and 11.13 ± 25.87 posterior approach without scoring; P = 0.02).

Conclusions:

This study underscores the fact that a great part of patients after otoplasty report symptoms of cold intolerance; however, these most often resolve and did not differ between different groups. Patients should be informed about this sequela. Furthermore, overall satisfaction rate was significantly lower in the posterior group without scoring.

Facial surgery for cosmetic purposes: Practice guidelines

OBJECTIVES

Facial surgery for cosmetic purposes aims to improve the physical appearance and self-image of normal individuals. The aim of the guidelines is to answer questions related to legislation, patient evaluation and motivations, relevance and risk assessment, patient information and patient follow-up.

METHODOLOGY

Analysis and synthesis of the medical literature through research of bibliographic databases in French and English from 2000 to 2017. Research and use of guidelines from evaluation agencies and academic societies. Drafting of guidelines with indications on levels of evidence.

RESULTS

24 guidelines with levels of evidence B (scientific presumption), C (low level of evidence) or EO (expert opinion) were selected to answer the questions. Cosmetic facial surgery must be performed by certified, qualified professionals in authorized structures. It must follow certain specific rules as well as a charter and code of ethics so as to enforce the rules of practice.