Cosmetic Otoplasty

A Bibliometric Analysis of the 100 Most-Cited Articles on Otoplasty

A bibliometric analysis was conducted in April 2024 to review the current trends in otoplasty. It involved a literature search of the Scopus database for original articles with the query terms "otoplasty" and "pinnaplasty," without restricting publication dates or selecting journals in the database. The top 100 articles with the highest citations were reviewed. Bibliometric analysis was performed with the Scimago journal impact factor. The screening was done following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to extract the top 100 most-cited articles in otoplasty. We excluded articles not focused on otoplasty, those involving other surgical procedures, and non-English articles. With Scopus and manual screening, we performed citation analysis of selected articles. Mean values were calculated for the number of citations and citations per year. Of the 951 studies identified, 100 (10.5%) were analyzed in detail. The studies were published between 1941 and 2024, with a mean of 36 ± 23.7 citations per paper. The journal Plastic and Reconstructive Surgery reported the highest number (23%, n = 23) of articles, followed by the Journal of Plastic, Reconstructive and Aesthetic Surgery with 13% (n = 13) articles. The highest number of articles originated from the United States (38%, n = 38), followed by the United Kingdom (15%, n = 15). Our bibliometric analysis provides a comprehensive overview of the landscape of otoplasty research, highlighting key publications, authors, and journals. This study contributes to the understanding of the evolution and impact of otoplasty literature, laying the groundwork for further research and innovation in this field.

LEVEL OF EVIDENCE: 3

Bat Ear Correction Steps and Outcomes for Better Life Support

An unusually projecting human ear is known as a prominent ear, otapostasis, or bat ear. It might be both bilateral and unilateral. The scapha and antihelix of the big concha are not well formed. It is the outcome of cartilage deformity that occurred during early ear development in utero. After the child reaches five years old, the abnormality can be corrected at any time. In order to prevent psychological suffering, the procedure should ideally be performed as soon as possible. Otoplasty correction is reshaping the ear cartilage to bring the ear closer to the side of the head. The cartilage is reshaped, but the skin is left in place. Hearing remains unaffected by the operation. It is mainly done for aesthetic reasons. Although they are uncommon, the post-operative consequences from the operation include hematoma development, keloid formation, infection, and asymmetry in the ears. Otoplasty is a cosmetic operation that involves permanent sutures to alter the size, shape, or location of the ear. The main purpose of otoplasty is to treat promin auris, or bulging ears. Promin auris, the principal indication for otoplasty, is the subject of this review. The indications, contraindications, and method utilized in otoplasty are reviewed in this exercise, which also emphasizes the need of pre- and post-operative care for patients having this surgery. Otoplasty results are generally lifelong and will improve the self-confidence. The goals of otoplasties are to make the ears appear more natural in comparison to the head and help with the overall contour of the ears. Final ear surgery results will be visible after a two week recovery period, with small improvements appearing for up to 12 months post-procedure. A proper understanding of the diagnosis, indications, and surgical techniques will lead to positive outcomes in otoplasty.

Assessing the Quality and Readability of Web-Based Information on Otoplasty

Introduction: As health care-related internet use expands, parents and patients considering otoplasty frequently turn to online resources for further information to aid their decision making. Objective: In online resources related to otoplasty, what is the quality of the information and how readable is it based on standardized tests? Methods: A web search was performed on the three major search engines, using search terms related to otoplasty. The top 20 results from each search engine were selected. The DISCERN instrument was applied to assess the quality of health information, whereas the Flesch-Kincaid readability tests were used to assess readability. Results: The mean DISCERN score was 28.7 out of a possible score of 80 (poor quality) and commercial bias was common. The Flesch-Kincaid readability test results were significantly higher than the average reading level for adults in the United Kingdom. On the largest search engine, there was a correlation between search engine ranking and both readability and quality. Conclusion: Online patient information resources on otoplasty are generally of poor quality and difficult to read for the average patient.

A Contemporary Review of Trachea, Nose, and Ear Cartilage Bioengineering and Additive Manufacturing

The complex structure, chemical composition, and biomechanical properties of craniofacial cartilaginous structures make them challenging to reconstruct. Autologous grafts have limited tissue availability and can cause significant donor-site morbidity, homologous grafts often require immunosuppression, and alloplastic grafts may have high rates of infection or displacement. Furthermore, all these grafting techniques require a high level of surgical skill to ensure that the reconstruction matches the original structure. Current research indicates that additive manufacturing shows promise in overcoming these limitations. Autologous stem cells have been developed into cartilage when exposed to the appropriate growth factors and culture conditions, such as mechanical stress and oxygen deprivation. Additive manufacturing allows for increased precision when engineering scaffolds for stem cell cultures. Fine control over the porosity and structure of a material ensures adequate cell adhesion and fit between the graft and the defect. Several recent tissue engineering studies have focused on the trachea, nose, and ear, as these structures are often damaged by congenital conditions, trauma, and malignancy. This article reviews the limitations of current reconstructive techniques and the new developments in additive manufacturing for tracheal, nasal, and auricular cartilages.

Open Otoplasty Through Ventral Skin Incision and Abrasion of the Antihelix Under Vision

BACKGROUND

Common otoplasties through incisions behind the ear with blind scoring or scratching the anterior perichondrium often leave an irregular surface of the antihelix.

METHOD

To avoid these tiny side effects, a skin incision along the ventral antihelical fold (scapha) is used to thin and fold the flat antihelix under vision. After local anesthesia of the ventral ear skin, an incision along the scapha allows its blunt lifting toward the concha and to expose the cartilaginous antihelix. Its future shape is marked and the thickness of the cartilage is thinned with a dermabrader by approximately half or until one sees the gray of the inner cartilage. The now missing perichondrium causes the antihelix to fold by itself with an absolute smooth surface and is fixed with three absorbable mattress sutures.

RESULTS

The technique has been developed in 1985 in Frankfurt and has since been performed on over 1000 patients with optimal results and a low complication rate. The skin flap is so well perfused that no skin necrosis and only 5.7% wound healing problems were experienced.

CONCLUSION

This approach from ventral is safe, timesaving, and avoids contour irregularities of the antihelix often seen after traditional techniques. It can be left to beginners in plastic surgery without hesitation. The fear of hypertrophic scars or even keloids can be dispelled with the fact that ear keloids only occur after wound infection.

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.

Seminars in Plastic Surgery: Pediatric Ear Anomalies and Reconstruction

Congenital ear anomalies affect 15 to 20% of neonates and can be categorized as either auricular deformations or malformations. Deformations involve a fully developed, albeit abnormally shaped, chondrocutaneous framework, which makes them amenable to correction with ear molding within the first few months of life. Malformations involve hypoplastic or fully absent auricular structures that require augmentation with alloplastic and/or autogenous reconstruction. The goal of this article is to outline the various auricular deformities and malformations, followed by a description of the latest clinical management options, both nonsurgical and surgical, by auricular anomaly.

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.

Conchal Excision Techniques in Otoplasty: A Literature Review

Prominent ears are a common congenital deformity of the head and neck. Correcting concha hypertrophy is an important step in otoplasty. Despite the risk of postoperative deformity due to the sharp edges created by excision, removing a section of cartilage is sometimes the only method to obtain a satisfying and long-lasting result. Multiple conchal excision techniques have been reported in the literature, with significant differences in approach, outcome evaluation, and complication classification. The objective was to review cartilage excision-based otoplasty procedures to offer plastic surgeons’ insights into current data on outcomes and complications of conchal excision techniques.

Otoplasty: a modified Chong-Chet technique with positive long-term results

BACKGROUND

In the last few decades, many techniques have been developed to correct prominent ear deformities. Modified Chong-Chet otoplasty represents a new and improved classical Chong-Chet procedure for prominent ear surgery. This study evaluates and compares the long-term results of standard Chong-Chet otoplasty with the modified technique.

METHODS

A retrospective study was conducted on patients undergoing otoplasty at the Special Hospital S-tetik Banja Luka between January 17, 2017, and February 5, 2019. The total number of patients undergoing the procedure was 129. The first group (48 patients) underwent otoplasty using the Chong-Chet technique, while the second group (81 patients) underwent a modified Chong-Chet procedure. All patients were randomly selected on the condition that the antihelix was absent.The data were processed and analyzed using the Statistical Package for the Social Sciences version 24 using nonparametric tests (χ2 test, Mann-Whitney U test and Kruskal-Wallis test).

RESULTS

Every second patient was satisfied (19 patients were partially satisfied and five patients were completely satisfied) with the results of the classical Chong-Chet technique. Seven patients were neither satisfied nor dissatisfied, while 17 patients were dissatisfied (11 patients were completely dissatisfied and 6 patients were mostly dissatisfied). As for the modified method, on average, nine out of 10 patients (73 or 90.1%) were satisfied, of which 49 patients (60.5%) were completely satisfied and 24 patients (29.6%) were mostly satisfied.The statistical significance was P < .05.Research results point to the modified Chong-Chet technique being a significant improvement to the classical method.

CONCLUSION

Modified Chong-Chet technique increases the number of positive long-term results and significantly improves the standard method.

Modern Applications of 3D Printing: The Case of an Artificial Ear Splint Model

Three-dimensional (3D) printing is a leading manufacturing technique in the medical field. The constantly improving quality of 3D printers has revolutionized the approach to new challenges in medicine for a wide range of applications including otoplasty, medical devices, and tissue engineering. The aim of this study is to provide a comprehensive overview of an artificial ear splint model applied to the human auricle for the treatment of stick-out protruding ears. The deformity of stick-out protruding ears remains a significant challenge, where the complex and distinctive shape preservation are key factors. To address this challenge, we have developed a protocol that involves photogrammetry techniques, reverse engineering technologies, a smart prototype design, and 3D printing processes. Specifically, we fabricated a 3D printed ear splint model via fused deposition modelling (FDM) technology by testing two materials, a thermoplastic polyester elastomer material (Z-Flex) and polycaprolactone (PCL 100). Our strategy affords a custom-made and patient-specific artificial ear aligner with mechanical properties that ensures sufficient preservation of the auricular shape by applying a force on the helix and antihelix and enables the ears to pin back to the head.

The Educational Reliability and Viewer Interest of YouTube Videos Presenting Otoplasty Procedures

INTRODUCTION

Otoplasty procedures consist of around 30% of facial plastics surgeries in the adult population. In this study, we aimed to assess the reliability of YouTube otoplasty videos based on technical video analysis, usefulness scores, and recommended surgical steps.

METHODS

The present study evaluated 356 videos after a search on YouTube with the keywords "otoplasty, prominent ear, cosmetic otoplasty, and aesthetic ear surgery" during the period from October 2008 to June 2020. The viewer interest parameters such as the total number of views, comments, subscribers, likes, dislikes, source of videos, and video upload date were assessed. Besides, usefulness scores and recommended surgical steps were also analyzed.

RESULTS

Among the 356 videos that were compatible with the keywords of the study, only 122 (34%) of them were in agreement with the inclusion criteria. Group 1 (not useful and slightly useful) comprised 69 (57%) videos, and Group 2 (useful and very useful) consisted of 53 (43%) videos. The mean numbers of views, subscribers, and likes were 20544.65 ± 55235.41, 6718.37 ± 20213.54, and 44.34 ± 121.48, respectively, in Group 1, and 82905.22 ± 292819.49, 18603.57 ± 58007.94, and 1089.09 ± 6991.91, respectively, in Group 2. All 3 parameters were significantly higher in Group 2 than Group 1 (P: 0.02, P: 0.005, P: 0.01, respectively).

CONCLUSIONS

Overall, only 43% of YouTube videos presenting otoplasty procedures were defined as useful or very useful. The interest rates of the viewers are compatible with the usefulness rate of the otoplasty videos.

A Cross-Sectional Analysis of American Insurance Coverage of Prominauris Otoplasty

BACKGROUND

Prominent ears affect up to 5% of the population and can lead to social and psychological concerns at a critical time of social development. It can be addressed with an otoplasty, which is often considered a cosmetic procedure. The authors assessed insurance coverage of all indications of otoplasty and their medical necessity criteria.

METHODS

A cross-sectional analysis was conducted of 58 insurance policies for otoplasty. The insurance companies were selected based on their state enrolment and market share. A web-based search and telephone interviews were utilized to identify the policies. Medically necessary criteria were then abstracted from the publicly available policies.

RESULTS

Of the 58 insurance policies assessed, 25 (43%) provide coverage of otoplasty. There were 2 indications for coverage: hearing loss (n = 20, 80%) and normal approximation (n = 14, 56%), which would encompass prominent ears. Normal approximation was a covered indication for significantly fewer insurers than hearing loss (56% versus 80%, P = 0.0013). Of all the otoplasty policies which covered normal approximation, 21% (n = 3) addressed protruding ears as an etiology. Prominent ears were not included in any policies which covered hearing loss. All policies inclusive of prominent ears required a protrusion of >20 mm from the temporal surface of the head (n = 3, 100%).

CONCLUSIONS

There is a great discrepancy in insurance coverage of otoplasty. A greater proportion of policies cover hearing loss compared to normal approximation. The authors encourage plastic surgeons to advocate for the necessity and coverage of normal approximation by insurers.

A Novel Technique for Reconstruction of a Congenitally Absent Earlobe

OBJECTIVE

Congenital anomalies of the external ear may present a reconstructive challenge, particularly when normal chondrocutaneous components of the auricle fail to develop. Our goal was to develop a novel technique for lobule reconstruction of a congenitally absent earlobe with photographic documentation of the technique.

METHODS

Informed consent for perioperative photography and publication of case details was obtained. A postauricular, turnover flap with ipsilateral conchal cartilage grafting was performed to reconstruct the lobule, and a superiorly based, postauricular, rotation advancement flap was used to close the donor site defect.

RESULTS

Perioperative photographs are included demonstrating technique and cosmetic results.

CONCLUSIONS

Malformations rarely involve the lobule or lower third of the ear primarily. Literature regarding lobule reconstruction for congenital malformations is scarce. We present a novel technique for lobule reconstruction of a congenitally absent earlobe performed in a single stage that avoids a visible neck scar and allows for simultaneous conchal cartilage harvest. The technique demonstrated satisfactory cosmesis regarding contour and overall appearance and these results remained stable at 1-year follow up.

The ideal auricular protrusion - An interactive perceptual pilot study

PURPOSE

Excessive ear protrusion (prominauris) can negatively affect facial appearance. Because the concept of an ideal auriculocephalic angle is controversial, however, it is difficult to define when an obtrusive auricle requires surgical intervention. It is often assumed that angles exceeding 30° require corrective surgery. However, little is known about public perception of ear protrusion. This study aimed to assess perceptions of different degrees of auricular protrusion.

MATERIALS AND METHODS

We conducted an interactive panel survey. Male and female evaluators assessed digitally processed cloned images of a male and female model that depicted various ear protrusions ranging from 0° to 90°. Predictor variables were the sex of the evaluator, the sex of the clone and the extent of auricular protrusion. The outcome variable was the overall attractiveness of auricular appearance.

RESULTS

Forty-four evaluators (students of dental medicine, mean age 25.43 years) participated in the study: 22 women and 22 men. The study results revealed sexual dimorphism, with the attractiveness of corresponding male and female clones rated differently. Male evaluators favoured female ear positions that fitted closer to the head; preferred alignments for female clones were: 18° (Mean) ± 9.38° (SD), p = 0.006; for male clones: 30° ± 7.94°, p = 0.003. Ear protrusion starts to negatively affect aesthetic appearance for male evaluators at positions of 42° ± 4.87° (female clone) and 54° ± 8.22° (male clone), p = 0.001. The panel of evaluators agreed to perceive angles of 21-24° ± 8.10° (female clones), ± 8.33° (male clones), as the ideal degree of protrusion in both sexes (p = 0.158).

CONCLUSION

In this study, perception of ear appearance depended on the sex of both the evaluator and the clone being assessed. Obtrusive ears were more readily accepted in male faces than in female ones. Nevertheless, the overall panel perception shows a preference for rather close fitting, unobtrusive ear alignments. For planning of corrective ear surgery, a target angle of approximately 22° can be considered as a desirable result.

Pediatric Otoplasty: Does Surgical Specialty Training Affect Safety and Rates of Adverse Perioperative Events?

BACKGROUND

Otoplasty remains an overlapping clinical domain of plastic surgery and otolaryngology. The purpose of this study is to objectively analyze the safety of otoplasty and determine if there are any risk factors, such as surgical training, associated with increased patient morbidity.

METHODS

Retrospective cohort study was conducted of otoplasty procedures performed in North America by plastic surgeons and otolaryngologists between 2012 and 2017 using the American College of Surgeons National Surgical Quality Improvement Program Pediatric dataset. Statistical analysis was performed to analyze the relationships between comorbidities, congenital malformations, and postoperative complications.

RESULTS

There were 777 otoplasty procedures performed during the study period. Median age at time of surgery was 8.3 years (95% CI 7.9-8.7 years). Plastic surgeons performed 75.8% (n = 589) procedures and otolaryngologists performed 23.4% (n = 182). No significant (P = 0.952) difference in the occurrence of postoperative complications between surgical specialties was appreciated despite the fact that operative time was significantly longer in procedures performed by otolaryngologists (121 minutes versus 94 minutes, P < 0.001). Overall, 1.3% (n = 10 of 777) children experienced a complication, with the most common complication being superficial surgical site infection, occurring in 0.9% (n = 7 of 777) patients. There was no association of comorbidities (P all > 0.324) or congenital malformations (P all > 0.382) contributing to postoperative complications. Reoperation (0.8%, n = 6 of 777) and readmission (0.4%, n = 3 of 777) were uncommon; nevertheless, these adverse events were significantly associated with multiple inherent patient risk factors on multivariate regression.

CONCLUSIONS

Otoplasty is a relatively safe surgical procedure with similarly low complication and readmission rates when performed by plastic surgeons and otolaryngologists. Surgical site infection remains the most prevalent complication after otoplasty. Readmission and reoperation after otoplasty were significantly correlated to prematurity, structural pulmonary abnormality, alimentary tract disease, and seizure disorder.

[Research progress of clinical therapy for concha-type microtia]

OBJECTIVE

To summarize the current progress of clinical therapy for concha-type microtia.

METHODS

The domestic and overseas literature about the treatment of concha-type microtia was reviewed and the contents of operative timing, operation selection, and complications were analyzed.

RESULTS

The unified therapeutic schedule of the concha-type microtia has not yet been determined due to its complicated various therapeutic methods and unknown etiology. The operation methods commonly used in clinic are partial ear reconstruction with autologous costal cartilage framework and free composite tissue transplantation. The timing of the partial ear reconstruction depends on the development of costal cartilage and children's psychological healthy. The timing of free composite tissue transplantation depends on the severity. It is recommended to perform the operation at about 10 years old for mild patients. For moderate patients, ear cartilage stretching should be performed at 1-2 years old and free composite tissue transplantation would be performed at about 10 years old. The complications of partial ear reconstruction with autologous costal cartilage framework for concha-type microtia mainly include framework exposure, deformation, infection, cartilage absorption, and skin necrosis. The complications of free composite tissue transplantation have not been reported.

CONCLUSION

Etiology and elaborated classifications with individualized treatment are the future research directions.