An alternative approach for correction of Stahl's ear

Stahl's ear correction: synergistic use of cartilage abrading, strategic Mustarde suture placement, and anterior anticonvexity suture

Stahl ear deformity is characterized by a third auricular crus with a horizontal orientation. A diminutive superior crus and prominence of the upper pole of the ear are also generally present. Many acknowledge that Stahl ear is a challenging deformity to correct. In the present report, an effective technique is introduced that uses 3 different, yet synergistic, maneuvers to oblate the third crus, enhance the superior crus, and normalize superior pole projection. The maneuvers are posterior abrading of the third crus, strategic placement of a posterior Mustarde suture, and placement of an anterior anticonvexity suture. Postoperative care involves the use of a custom scaphoid fossa splint and headband.

A new method to correct Stahl's ear

OBJECTIVE

Stahl's ear is a rare congenital auricular malformation in which an abnormal 'third crus' traverses the upper pole of the scapha. A number of different treatment options have been published to correct Stahl's ear deformity; however, none of them corrects all the variations perfectly. In this article, we describe our new method to correct this deformity.

METHODS

To correct Stahl's ear and acquire a natural-looking appearance, a technique of cartilage scoring and a folding cartilage flap was used. The entire layer of the cartilage was cut through and the anterior skin covering the cartilage was dissected to the external border of the desired superior crus and antehelix to form a fan-shape flap. After scoring of the posterior surface of the cartilage, the cartilage flap was folded and sutured to the cartilage below to build the superior crus.

RESULTS

Seventeen patients ranging in age from 9 to 46 years were operated upon using this technique. The ears that were created were of normal size and shape. All patients and their families were satisfied with the final result. There were no complications.

CONCLUSION

We have developed a new method to correct Stahl's ear deformity. Outcomes of this technique on 17 patients suggest that our method is simple, effective and successful.

Posterior Z-plasty and J-Y antihelixplasty for correction of Stahl's ear deformity

The bifurcated Y-shaped antihelix characterises the normal human ear and gives it an aesthetically pleasing appearance. In Stahl's ear congenital anomaly an aberrant crus usually replaces the superior crus, crossing the scaphoid fossa from the site of the normal bifurcation of the antihelix posteriorly towards the helix, giving the antihelix an abnormal J-shape. A technique is described to correct Stahl's ear deformity adding a simple Z-plasty to the incision to lengthen the skin on the posterior surface, together with making use of the aberrant crus to reconstruct the superior crus without reducing the ear size using a modified Mustardé technique. This is achieved by posterior scoring and suturing without any cartilaginous excisions converting the 'J' antihelix into a 'Y'. Out of a series of eight cases examined, four unilateral and one bilateral cases were operated on (six ears). The first two unilateral cases were performed without Z-plasty, which was used in the third case on with very satisfactory results in different types and severities of Stahl's ear deformity. I believe that the technique detailed in this paper fulfils the main principles necessary for correction of Stahl's ear deformity and may be used in cases where the aberrant crus is reducible regardless of its shape.

Stahl syndrome in clinical practice

Stahl syndrome, known also as "Satiro's ear", is a deformation of the auricle described in the nineteeth century by Stahl who included it in a classification of various deformities of ear:-Helix transversus spleniformis-Crus anthelicis trifurcata-Crus superior turgidumAt present Stahl's ear is included in the second group for the abnonnal cartilaginous pleat which extends from the Crus anthelix to the edge of elix deforming in this way the regular curvature of ear and amplifying the triangular hole. It's frequently associated to other aesthetic deformities of the auricle itself and above all among oriental peoples; the pathogenetic origin of this deformation has to be connected with an hereditary, familial character confirmed by the diffusion of this deformation among the members of the same family, reaching its highest expression in identical twins where its manifestation is about at seventy-five percent. Besides the hereditary-familial hypothesis, we find a second hypothesis according to which the cartilaginous deformity is connected with an altered growth of an instrinsic muscle of ear, the transverse muscle [1,4]. The solution of the problem is surgical, through the Chongcet technique [9], modified and applied in the post-operating using particular remedies.