There are
many techniques described for the surgical correction of protruding ears and
quite a few are variations of two main techniques namely scoring and sutures.
The suture technique comprises of permanent suture use such as Mustarde’s mattress sutures
or Furna’sconchamastoid sutures and they include any kind of fixating sutures
for rectifying the deformities whereas in scoring technique incisions are made
into the ear cartilage.
In the Mustarde technique which was first established in
the year 1963 the aim was to form an anti-helical fold in children with soft or
very thin cartilage. In the procedure, an incision is made in the retro-auricular
skin 8-10 mm below and at a level parallel to the helical rim. The skin
covering the cartilage is made mobile caudally up to the mastoid and with
respect to the helical rim, it is made mobile cranially. To prevent any kind of
post-operative skin distortions the mobilization must not be extended beyond
the helical rim. The auricular cartilage and the perichondrium remain intact. A needle having methylene blue is used for puncturing the new anti-helical fold
ventrally and if required it is marked retro-auricularly too. On the
corresponding markers, the non-absorbable mattress sutures which are transparent
or white in the material is placed making use of retro-auricular access through the
perichondrium and the auricular cartilage without penetrating the ventral skin.
The knots of the mattress sutures can be further everted towards the interior for
the prevention of later extrusion of the sutures. The main advantage of this
technique is that it leaves the auricular cartilage intact. Also, perichondral hematoma risks are low but then it is
only suitable for children who are of the age of 10 and not more than that.
Since if the cartilage grows firm then there is an increased rise factor for
the ear to get back to its original shape and the risk of the suture tearing
out. There is also an additional risk of suture granuloma.
Furna’s technique is used for correcting excessive
conchal cartilage. This procedure can be performed along with Mustarde’s
technique. The skin exposure is made to reveal the auricularis posterior muscle
and detach its insertion from the conchal cartilage. The muscle and the neighboring musculoareolar
tissue attached with the medial skin flap are not touched. Along with the
auricularis posterior muscle the skin is also elevated and the soft tissues adjacent to it are moved forward as a
musculocutaneous flap. Now the plane of the mastoid fascia is exposed quite
well enough for providing a nest for the concha. After this the concha-mastoid
sutures are placed.
Cartilage
scoring: This
technique was the first to elaborate anterior scoring of the cartilage for the
purpose of prominent ear correction. The helix is first of all pushed into its
normal position which will allow the anti-helical fold to appear. With the
appearance, the fold is quickly marked. With lidocaine and adrenaline, the skin
must be infiltrated so to help in the dissection of the skin from the tissues. Thereafter
the postauricular skin is removed between the border of the cephalon-auricular
angle and the helix and this shall run along the entire length of the ear. Once
the antihelix is marked the incision is made through the thickness of the
cartilage. This incision is made distal to the mark made. A curl of cartilage
can be seen once the skin overlying the anterior cartilage is cut and made
free. Whilst the cartilage is held the parallel incisions are made through the
cartilage and perichondrium. This technique is called the anterior scoring. By
doing this a smooth area of cartilage for the antihelix is produced. To hold
the fold of cartilage a stitch is required and once that is completed the
sutures can be placed along the edge of the skin and the antihelix is achieved
by suture overlapping.
Combined techniques: There are procedures that make use of suturing,
cartilage scoring and excision. The advantage of the combined technique ensures
that the risks and disadvantages associated with any one technique being
performed separately are avoided. Like sharp edges can arise as a result of
anterior scoring which can be avoided when scoring and excision is performed
along with it to give the final shape and position of the ear. A procedure was
introduced that made use of anterior cartilage scoring with posterior mattress
sutures which are placed along the anti-helical folds by trimming the tail of
the helix and thinning of the antitragus. Finally, it is ended with excision
along the posterior medial surface of the skin.
In
another technique skin excision, cartilage transaction along with anterior skin the elevation is employed and cartilage scoring and mattress suturing is done to
ensure that the angle of conchosphagal angle can be anchored in the right
place. Variable amounts of cartilage rotation and excision is required in this
case.
Combination
pinnaplasty can be performed endoscopically which will involve sclaphal and
mastoid suturing and posterior cartilage scoring as well. The post auricular the incision can be eliminated with this thus reducing the risk of hypertrophic
scar formation.