Are growth alterations a consequence of surgery for prominent ears?

Anthropometric assessment of human auricle in North Indian population

Introduction:

Morphometric studies of the auricle find its place in many areas, such as esthetics, forensic medicine, biology, anthropology, mythology, arts, and acupuncture.

Aims and Objective:

This study aims at establishing the anatomical variations in the auricular dimensions in North Indian population. The objectives of this study were to measure auricle height in males and females, to measure auricle width in both sexes, to measure lobular height (LH) in both sexes, to measure lobular width (LW) in both sexes, to calculate the auricle index in both sexes, and to calculate lobular index in both sexes.

Materials and Methods:

This study was conducted on 130 subjects (78 males and 52 females), in the age group of 18–25 years, without history of genetic disorders, injuries, or any disease of the auricle.

Results:

The average length of the auricle was 6.28 cm (right) and 6.23 cm (left), and the average width was 3.21 cm (right) and 3.28 cm (left). The average height of the lobule was 1.76 cm and 1.77 cm on the right and left sides, respectively, while the lobule width was 1.90 cm on the right side and 2.01 cm on the left side.

Conclusion:

Total right auricle height and total auricle width of both the right and left ears are more in males as compared to females, and the difference between both the sides was significant. Both right- and left-side LH and LW were higher in males as compared to females.

Aerospace and Ergonomic Methods for Ear Anthropometry Supported by Bulgarian Research

Translation into English has recently been completed for excerpts on ear and craniofacial anthropometry from an innovative, unpublished Bulgarian-language doctoral thesis written in 1986 by a plastic surgeon, M. M. Madzharov, MD-PhD; MD-SC. Most remarkable among the many benefits of the translation was revelation of heretofore unavailable text descriptions for 49 dimensions. Of these, 43 explain the titles and abbreviations with summary statistical data on ear measurements for young adults that were published in 1989 in the English language. Especially valuable among these data were four new and unique, long-axial ear lengths, all measured from a common ear landmark. These could locate “station planes” for cross-section views of human ears, similar to those for 3-D coordinate systems in aircraft and spacecraft fuselage engineering. Examples explaining the concepts and values of such a new approach to ear anthropometry are herein introduced, described and illustrated, together with previously recommended improvements in ear anthropometry notation and illustration, a virtual Ear Primary View Plane, a section plane through the ear long axis, newly introduced “semi-width” measurements extending perpendicular to the aforementioned section plane, new concepts of “view depths,” which are measured perpendicularly from the Ear Primary View Plane toward ear surfaces and a previously described three-axis aircraft motion analogy for defining static ear orientation. These innovative approaches are advocated for adoption by future researchers, designers of related hardware, modelers and standards developers.

Fixing Flaws in Engineering Anthropometry, Ears and All

This document reports on four years of work on improvements in documentation of anthropometry involving human ears and the whole body. The results have led to several new concepts for enhancing dimension titles, titles and abbreviations for landmarks and other origins and terminations and codes for constraints of paths between them. Included are recommendations for improved text descriptions, new formats, labels and view planes for illustrations and improved data tables. These approaches are intended to fix frequently found errors and vaguely defined aspects of anthropometry as previously practiced for developing engineering design requirements and for planning plastic surgery. The goal has been to create crisply clear, accurate documents. The fixes are based on ergonomic principles and successful methods from aerospace engineering, chemistry and business accounting, combined into an integrated system. Development of the system is traced through a series of documents, including bibliographies, guidelines for recommended common terminology and illustration formats, illustrated dictionaries, translations, trial applications, and a history of errors and other problems uncovered in surveys spanning more than a hundred years. The process has inspired breakthrough concepts for ear anthropometry reference planes and for extensions of concepts for point landmarks into formal titles and abbreviations for reference planes and surfaces. The system will be exemplified in two statistical databases now in work that will demonstrate many improvements applicable to whole-body anthropometry, though they are focused on human ear dimensions. These data bases were compiled from reports on surveys of more national populations than have previously been available in one document. One will be limited to as-published documents related primarily to plastic surgery planning and client consultation. The other will include many newly derived and estimated dimensions to benefit digital modeling and ergonomic design of ear-related devices.

Otoplasty for Prominent Ears: A Versatile Combined Technique to Master the Shape of the Ear

OBJECTIVE: We present our experience with an otoplasty technique that combines “closed” anterior scoring using the Stenström otoabrader with mattress sutures to the posterior cartilage.

STUDY DESIGN AND SETTING: In a retrospective study, we report our experience with 135 patients operated on in the last 12 years. Some surgical principles make our procedure different from previous combination techniques: the posterior access incision is linear without skin excision; anterior scoring is performed along the entire antihelix and scapha, with care to score toward the concha at the tail of the antihelix to bring the ear lobe nearer to the mastoid; Mustarde's mattress sutures are used to stabilize the result.

RESULTS: There were no major complications and few minor complications. The aesthetic results were graded as very good or good in 95% of the cases; the rest were graded as satisfactory.

CONCLUSIONS: Our technique is versatile, gives pleasant, natural-looking results, and has a low complication rate. It is a simple, reliable, reproducible, and easily mastered method.

Comparison of two incisionless otoplasty techniques for prominent ears in children

OBJECTIVES

In the present study, we applied two incisionless suture techniques for otoplasty: Haytoglu et al.'s modification of incisionless otoplasty technique and Fritsch's incisionless otoplasty technique for correction of prominent ears.

METHODS

In this prospective study, 60 patients with prominent ears were included in the study. In Group 1, 55 ears of 30 patients (25 bilateral and 5 unilateral) were operated with Haytoglu et al.'s modification of incisionless otoplasty technique. In Group 2, 57 ears of 30 patients (27 bilateral and 3 unilateral) were operated with Fritsch's incisionless otoplasty technique. For comparison of two methods, auriculocephalic distances were measured at three levels which were level 1 (the most superior point of the auricle), level 2 (the midpoint of the auricle) and level 3 (level of the lobule) pre-operatively (preop); and measurements were repeated at the end of the surgery (PO(0-day)), 1st month (PO(1-Mo)) and 6th month (PO(6-Mo)) after the surgery, in both groups. Patient satisfaction was evaluated using a visual analog scale (VAS). Moreover, Global Aesthetic Improvement Scale (GAIS) was rated by an independent, non-participating plastic surgeon at 6 months after the surgery.

RESULTS

Operation time was 15.9±5.6min in Group 1 (Haytoglu et al.'s) and 19±4.7min in Group 2 (Fritsch). Hematoma, infection, bleeding, keloid scar formation, sharp edges or irregularities of the cartilage were not observed in any group. Suture extrusion was detected in 14.03% of Group 1 and 16.1% of Group 2. No statistically significant difference was observed between auriculocephalic distances at levels 1-3 of groups at preop, PO(0-day), PO(1-Mo) and PO(6-Mo) separately. Similarly, difference in auriculocephalic distances (preop values-PO(6-Mo) values) was not detected as statistically significant in Groups 1 and 2 at three levels. In both techniques, No statistically significant difference was observed in patient satisfaction at 6th months after the operation which was measured using Visual Analogue Scale (VAS) on 0 to 100 scales. According to GAIS, the patients were rated as 92.9% "improved" and 7.1% "no change" in Group 1; as 94.6% "improved" and 5.4% "no change" in Group 2.

CONCLUSIONS

Due to the similar results, Haytoglu et al.'s and Fritsch's incisionless otoplasty techniques are good options in the treatment of prominent ears, especially in pediatric patients with isolated inadequate development of antihelical ridge, and with soft auricular cartilage.

In vivo electromechanical reshaping of ear cartilage in a rabbit model: a minimally invasive approach for otoplasty

OBJECTIVE

To report the first successful study to date of in vivo electromechanical reshaping of ear cartilage in a rabbit model.

METHODS

Ears of New Zealand white rabbits were reshaped using percutaneous needle electrode electromechanical reshaping (5 V for 4 minutes) and were then bolstered for 4 weeks. Ten ears were treated, with 2 undergoing sham procedures and serving as controls. The treatment was performed using a platinum array of electrodes consisting of 4 parallel rows of needles inserted across the region of flexures in the ear. After 4 weeks, the animals were killed, and the ears were photographed and sectioned for conventional light microscopy and confocal microscopy (live-dead fluorescent assays).

RESULTS

Significant shape change was noted in all the treated ears (mean, 102.4°; range, 87°-122°). Control ears showed minimal shape retention (mean, 14.5°; range, 4°-25°). Epidermis and adnexal structures were preserved in reshaped ears, and neochondrogenesis was noted in all the specimens. Confocal microscopy demonstrated a localized zone of nonviable chondrocytes (<2.0 mm in diameter) surrounding needle sites in all the treated ears.

CONCLUSIONS

Electromechanical reshaping can alter the shape of the rabbit auricle, providing good creation and retention of shape, with limited skin and cartilage injury. Needle electrode electromechanical reshaping is a viable technique for minimally invasive tissue reshaping, with potential applications in otoplasty, septoplasty, and rhinoplasty. Further studies to refine dosimetry parameters will be required before clinical trials.

[Otoplasty without cartilage section using the Mustardé technique. Presentation of our experience]

BACKGROUND

Some loop ear surgical procedures include cartilage section or abrasion, while others involve antihelix folding by simple suture.

METHODS

Our results with the Mustardé technique are presented. This procedure avoids an aggressive action on the ear cartilage and makes antihelix folding easier.

RESULTS

Good aesthetic results were obtained in all our patients, with a low complication rate.

CONCLUSIONS

We conclude this cartilage technical procedure has an advantage over the aggressive ones, with a low complication rate.

Morphometry of the external ear in our adult population

This study aimed to determine the mean values of the different morphometric measurements from right and left ears. These measurements were taken from 341 healthy young adults (150 women and 191 men) ages 18 to 25 years using an electronic digital caliper. The results showed the mean values for total ear height, lobular height and width, distances from tragus to antihelix and to helix, and ear projection and width to be, respectively, 59.7 +/- 3 mm, 17.5 +/- 1.4 mm, 18.5 +/- 2.2 mm, 16.6 +/- 1.7 mm, 25.1 +/- 2 mm, 16.6 +/- 2 mm, and 31.3 +/- 2.2 mm for the left ear, and 59.5 +/- 3.1 mm, 17.9 +/- 1.5 mm, 18.9 +/- 2 mm, 16.5 +/- 1.8 mm, 25.2 +/- 1.9 mm, 17 +/- 1.9 mm, and 31.2 +/- 2.2 mm for the right ear in the young women. However, in the young men, these values were, respectively, 63.1 +/- 3.6 mm, 18.3 +/- 1.7 mm, 19.4 +/- 2 mm, 17.2 +/- 1.8 mm, 26.3 +/- 1.9 mm, 17 +/- 2.3 mm, and 33.3 +/- 2.2 mm for the left ear, and 62.9 +/- 3.5 mm, 18.4 +/- 1.7 mm, 19.8 +/- 1.9 mm, 17.2 +/- 1.8 mm, 26.6 +/- 1.9 mm, 17.6 +/- 2.1 mm, and 33.1 +/- 2.1 mm for the right ear.

Otoplasty

BACKGROUND

Auricular deformities, specifically, prominent ears, are relatively frequent. Although the physiologic consequences are negligible, the aesthetic and psychological effects on the patient can be substantial.

METHODS

Otoplasty techniques are used to correct many auricular deformities, including the prominent ear, the constricted ear, Stahl's deformity, and cryptotia. Various treatments and techniques have been developed for the correction of these deformities, including methods that excise, bend, suture, scratch, or reposition the auricular cartilage.

RESULTS

The multitude of different approaches indicates that there is not one clearly definitive technique for correcting these problems.

CONCLUSIONS

This article reviews the history of otoplasty, its anatomical basis and a method for evaluation, techniques for the correction of the deformity, and potential complications of the procedure.

Otoplasty using a spherical metal head dermabrador to form a retroauricular furrow: five-year results

Since 1987 we have performed more than 300 otoplasties using a combined technique, i.e., furrowing the cartilage retroauricularly with the dermabrasion tool with a spherical metal head, followed by vertical mattress sutures. To undertake a retrospective study (subjective results), we sent a questionnaire to 267 patients (100%) who underwent surgery a minimum of one year prior (average 2.53 years). One hundred sixty-seven forms were returned (63%) and the case sheets of these patients were collected. To objectify the results, 102 patients (38.6%) were drafted and 38 (14.3%) could be controlled. By reviewing the literature, where only a few long-term surveys could be found, an analysis of long-term results was performed. Both the subjective findings and the objective results showed a successful operative outcome and proved that by using this combined technique a far better result can be obtained than with most other techniques.