A New Way for Antihelixplasty in Prominent Ear Surgery: Modified Postauricular Fascial Flap

Modified bilateral fasciaperichondrial flap for prominent ear correction

OBJECTIVE

Various techniques have been described in the literature for prominent ear correction. These cartilage-preserving or cartilage-shaping techniques have their own advantages and disadvantages. We aim to achieve aesthetic and stable results with low complication rates using combinations of these methods. Herein, we present our results of prominent ear surgery with a modified bilateral fasciaperichondrial flap in combination with concha-mastoid and concha-scaphal sutures.

METHODS

Patients whose surgeries included a modified bilateral fasciaperichondrial flap for prominent ear deformities were included in the study. Patients' demographic data, pre- and postoperative Concha-Mastoid Angle (CMA) and upper-middle Helix-Mastoid Distances (HMD), follow-up time, complications, secondary operations, and postoperative Visual Analogue Scale (VAS) results were evaluated. With a postauricular fish-mouth incision, the bilateral fasciaperichondrial flap was planned into two: proximal- and distal-based. They were then elevated from the cartilage subperichondrially on the proximal side and supraperichondrially on the distal side. Concha-scaphal sutures were used to form an antihelical rim along with concha-mastoid sutures to reduce the concha-mastoid angle. Conchal cartilage resection was done if needed. Then, the bilateral fasciaperichondrial flaps were sutured together to cover the concha-mastoid and concha-scaphal sutures.

RESULTS

Between May 2017 and May 2021, 32 ears of 17 patients were operated on due to prominent ear deformity. No hematoma or infection was observed in any patient, and there were no instances of recurrence, suture exposure, hypertrophic scars, or keloids. The satisfaction level of all patients was 8.2 ± 0.9 points on average according to the VAS. In the anthropometric measurements, a statistically significant difference was found between preoperative and postoperative sixth month CMA and HMD values.

CONCLUSION

A combination of suture techniques and a modified bilateral fasciaperichondrial flap may be used in prominent ear cases, with low recurrence rates and high patient satisfaction.

LEVEL OF EVIDENCE

III.

Cartilage-Sparing Otoplasty: The Effects of Adipo-Perichondrial Flap-Assisted Posterior Auricular Muscle Complex Flap Technique on the Repair of Prominent Ear Deformities

BACKGROUND

In the repair of prominent ear deformities, the main objectives are to recreate the antihelical fold, reduce projection in patients with a large concha, and normalize the distance between the ear and the cranium. This study evaluated the efficacy of the adipo-perichondrial flap-assisted posterior auricular muscle complex (PAMC) flap technique, which involves a new approach to the repair of prominent ear deformities.

MATERIALS AND METHODS

A medially based PAMC flap and a laterally based adipo-perichondrial flap were elevated in 22 patients with prominent ear deformities. In order to shape the ear, the PAMC flap was sutured to the transition zone between the helix and antihelix, and the adipo-perichondrial flap to the periosteum of the mastoid bone. The ear-cranium distances were measured preoperatively and at postoperative first and sixth months.

RESULTS

Thirteen patients were female and 9 were male. The mean age of the patients was 19.4 years, and the mean follow-up period was 10.6 months. The ear-cranium distance significantly decreased in the postoperative first-month and sixth-month evaluations compared to the preoperative values (P < .05). No relapse, suture exposition, hematoma, keloid scar, or infection was observed.

CONCLUSION

Posterior auricular muscle complex is a strong anatomical structure that includes the trapezius muscle, occipital muscle, extrinsic ear muscles, temporal fascia, and sternocleidomastoid fascia. By elevating this structure as a flap and combining it with an adipo-perichondrial flap, successful results can be achieved in the repair of prominent ear deformities, which prevents relapses and maintains the shape of the ear in the long term.

A Modification of the Posterior Perichondrio-Adipo-Dermal Flap for Protruding Ear Correction: A Customized Technique

Prominent ear deformity is a common congenital deformity of the external ear affecting 5% of the general population. Because of the deformity's displeasing nature, corrective prominent ear surgery is widely common and performed as a prophylactic surgery. More than 200 surgical techniques for the correction of prominent ear deformity have been described to improve the cosmetic outcome and decrease complication rates. The aim of the study was to present a modified post auricular flap technique that increases the control of reshaping the ear cartilages, decreases the operation time, and provides a symmetrical long-lasting cosmetic outcome.One hundred sixty-two patients (141 male and 21 female) had ear correction surgeries performed by the same surgeon using the described technique between January 2015 and January 2018. One hundred sixty patients were gone through bilateral ear correction, whereas only 2 patients had unilateral ear correction procedures. A modified posterior perichondrio-adipo-dermal flap technique for protruding ear correction was applied to all patients.The patients' ages ranged from 18 to 40 years, with a median of 28.3 years. The mean follow-up time was 22.5 months (6-36 months). Total operation time was 35 minutes on average (25-45 minutes). As more experience was gained in flap harvesting, operation time became shorter. The mean preoperative upper third ear proportion-scalp distance was 33.1 mm and the middle third ear proportion-scalp distance was 29.8 mm. At the sixth month of the surgery, the measurements were 9.8 and 11.6 mm.Measuring and adjusting flap's width provided to achieve symmetry in initial technique. Locating the postoperative scar along the posterior surface of the helical groove also provides a natural view. Different from traditional posterior fascial flap, the width of the flap was narrowed to 8 to 10 mm. In the traditional technique, the flap was dissected along the incision margins. Narrowing the width of the flap decreased the operation time. The preserved skin between the helix and the mastoid bone has the same width with perichondrio-adipo-dermal flap. That increases the control over the helix-mastoid distance and posterior auricular fold not to mention provides permanent results. The previously mentioned method can be a simple, useful, and practical technique for protruding ear deformity.

Two Laterally Based Flap Otoplasty for Protruding Ear Correction

: The postauricular fascial flap as supportive or stand-alone technique provides natural, symmetrical-looking ears with minimal complications and recurrence. However, the posterior fascial flap otoplasty is not applicable for all protruding ear deformity types. It is particularly advantageous in terms of anti-helix creation yet does not have a satisfactory effect for correction of conchal hypertrophy. In this paper, it was aimed to describe a new technique, solely focuses on overcoming the conchal hypertrophy problem during protruding ear repair.A total of 12 patients (8 male and 4 female) underwent otoplasty with the same surgeon between May 2017 and May 2018. All otoplasties were performed bilaterally. Patients with conchal hypertrophy and anti-helical effacement were included into this study to evaluate the efficiency of the new technique.A total of 12 patients (8 male and 4 female) underwent otoplasty with described technique. Patients ages ranged from 18 to 30 years, with a median of 27.6 years. None of the patients suffered from early postoperative complications, such as skin necrosis, suture extrusion, hematoma, or wound infection. There was only 1 patient with the complaint of asymmetry at the late postoperative period and unilateral revision otoplasty was performed.In this study it was aimed to demonstrate a new technique which contains one posterior perichondrio-adipo-dermal flap and 1 perichondreal flap. The technique is highly advantageous if the patient suffers from both conchal hypertrophy and anti-helical effacement. It was seen that the described technique is practical and efficient for patients who both has conchal hypertrophy and anti-helical effacement. LEVEL OF EVIDENCE:: III, therapeutic study.

Posterior Perichondrioadipodermal flap: A Versatile Option for Revision Otoplasty

INTRODUCTION

Complications after otoplasty procedure can be divided into early- and late-period complications, with the former occurring up to 14 days postoperatively and the latter occurring after the initial 14-day period. Indications for revision surgery of ear deformations after primary otoplasty are generally related to late complications. The majority of patients demand secondary treatment because of unsatisfactory cosmetic results.

METHODS

A total of 32 patients (18 male and 14 female patients) underwent revision otoplasty with the same surgeon between May 2015 and May 2018. Patient ages ranged from 24 to 70 years. In total, 21 patients underwent bilateral revision otoplasty, whereas 11 patients underwent unilateral revision otoplasty. Patients were also evaluated for complaint and deformity type such as suture extrusion, recurrence, asymmetry, and postauricular area sensitivity or pain. Patients were also evaluated for previously performed primary otoplasty technique.

RESULTS

There were mainly 4 long-term complications for revision otoplasty: suture extrusion, asymmetry, recurrence, and long-term pain and sensitivity in the posterior auricular area. In 12 cases, the complaint was suture extrusion; in 8 cases, patients complained about both suture extrusion and asymmetry. Bilateral recurrence was present in 10 cases, and in 2 cases, revision otoplasty was performed because of long-term pain and sensitivity.

DISCUSSION

In this study, it was aimed to demonstrate that posterior perichondrioadipodermal flap is a safe and simple method for revision otoplasty. The technique is highly advantageous if the primary otoplasty technique is a cartilage-sparing method. However, if the primary otoplasty technique is a cartilage-sculpting method, the efficiency of this technique remains unknown because no patient in this study had cartilage-sculpting otoplasty as primary otoplasty, which is possibly the main drawback of this study.

Two-Flap Otoplasty: A New Technique for Protruding Ear Correction

Prominent ear deformity is a common congenital deformity of the external ear affecting 5% of the general population. Although this is a harmless deformity, several publications demonstrate the psychological distress, emotional trauma, and behavioral problems that this deformity can inflict on children. As a result of these concerns, corrective prominent ear surgery is now widely performed as a prophylactic surgery.A laterally based perichondrioadipodermal flap and a medially based adipoperichondrial flap were elevated. A subdermal pocket was prepared over mastoid bone. Medially based adipoperichondrial flap was fixed to the posterior helical skin; laterally based perichondrioadipodermal flap was fixed to the mastoid bone periosteum. The helix-mastoid distances and concha-mastoid angles of the patients were measured preoperatively and at the sixth month of the surgery as the late postoperative assessment. Patients were also evaluated for suture extrusion, granuloma formation, deformity recurrence, and postauricular area sensitivity.Twenty-two patients with bilateral prominent ear deformities were treated between January 2017 and January 2018. None of the patients suffered from skin necrosis, suture extrusion, hematoma, or wound infection at the early or late postoperative period. Unilateral recurrence was noted in 1 patient, and revision was performed.Preparation of a medially based adipoperichondrial flap and a laterally based perichondrioadipodermal flap and the reposition of these flaps with opposite vectors not only decrease postoperative complication rates but also provide a primary otoplasty technique. The posterior fascia flap is already a well-documented and reliable protruding ear correction method.

Prominent Ear Correction: A Comprehensive Review of Fascial Flaps in Otoplasty

Over the last 100 years, more than 200 different methods have been described to correct prominent ear deformity. These techniques revolved around various combinations of postauricular incision, cartilage scoring, and strategic suture placement to reapproximate the antihelical fold and correct angular deformity. In the last two decades, fascial flap techniques have become prominent in otoplasty. This article gives a comprehensive review of the different surgical techniques employed to construct fascial flaps and their contributions to otoplasty.