Prominent Ear Correction “Otoplasty”

My dearest patient,

In this leaflet I aim to explain your chosen procedure in a simple understandable way.

An Otoplasty is a surgical procedure by which we correct prominent ears. Prominent ears are described as: “ears that, regardless of their size, protrude from the sides of the head.”

The first report of the correction of prominent ears was in described in 1845 by a surgeon named Dr Johann Friederich Dieffenbach. Since then the basic surgical principles of the correction of prominent ears remains the same namely:

Remove the problematic excess cartilage from the back of the ear

Fixing the newly shaped ear in position by deep stiches.

Causes of prominent ears

Prominent ears develop due to an overgrowth or undergrowth of parts of, or the entire ear.

The exact cause of the growth abnormality is not known. Most cases of prominent ears occurs as part of familial trait and is often inherited from one generation to the next. It is not uncommon to see a group of siblings all with prominent ears.

Prominent ears may also occur as features of genetic syndromes which would have been diagnosed in the first year or so of life. These conditions are managed using specific protocols by cranio-fascial surgeons.

Most of the prominent ear corrections I perform in my practice correct the cosmetic appearance and avoid the social stigma that goes with prominent ears. Luckily modernization has allowed the correction of prominent ears to be an acceptable procedure and thus the procedure is performed commonly.

Timing of the procedure

Generally the procedure should be performed once most of the ear development has been completed and prior to school-going age to avoid teasing and embarrassment at school.

The timing of the operation may also be determined by the severity of the prominent ears. In children with extremely prominent ears, 4-years of age is a reasonable age to correct the ears.

Goal of surgery

The corrective goal of otoplasty is to set back the ears so that they appear naturally proportionate and contoured, with a scars hidden at the back of the ear.

It is important to realize that the left and the right ears are not naturally the same size, shape and position and will not be exactly the same after the procedure. Due to genetic dominance the left and the right side of our bodies are not the same.

It may also be that the prominence of the ears reoccurs and an additional operation may be needed. As one ages the ears tend to continue to grow which may necessitate a second procedure. Patients with a very severe prominent ear deformity may require multiple procedures.

Surgical Procedure

I prefer to perform the procedure under general anaesthesia in theatre. A completely still patient provides the cosmetic outcome to be far superior to a moving patient.

In an older cooperative patient it may be possible to correct the ears under local anaesthetise with sedation. Depending on the deformity to be corrected the procedure will either be performed as a day procedure or the patient will stay in hospital for one day. The procedure takes anything from 1 hour to 3 hours depending on the severity of the deformity.

A small cut is made at the back of the ear in the natural fold of the ear so that the scar may be hidden and not obvious. In very rare cases a small cut may be made in the front in the deep cartilage bowl this is however only needed in severe cases.

After the operation the patient will have large bulky dressing that looks like massive ear phones with a helmet which need to be worn for 10 days. The elaborate dressings allows for protection while the ears “set and settle” in its new position. Trauma or premature removal of these dressings may result in the ears returning to the original position and another operation will be needed.

Post – Surgical Recovery

After the removal of the dressing a protective headband may be worn while sleeping for a period of 3-6 weeks. The headband should be snug, not tight, because its purpose is preventing the corrected ears from being pulled forward, while the sleeping patient moves. In some cases a headband will not be needed but a decision will be made at the time of the procedure.

The patient will be discharged on analgesia and antibiotics and perhaps something to sleep.

It is mandatory that I see the patient in the dressing’s clinic once a week until all the wounds are healed, this may take anything from 2 to 6 weeks. The wounds should only be opened by our wound care specialist or myself to avoid any infections.

The scar protocol is to be initiated 3 weeks after the operation and a course of laser treatment will also greatly improve the scarring

Complications

Please contact me if the patient complains of a severe increase in pain or any obvious bleeding from the wound.

Complications

-Haematoma formation (Bleeding)

-Infections

-Stich related complications, protrusion of a suture or spontaneous rupture of a suture

-Delayed wound healing

-Infections

-Sensory changes, loss of feeling in the areas of the operation, behind and around the ear

-Over correction and unnatural contour of the ears.

-Significant asymmetry between the left and the right ears

-Poor scaring, especially of concern in a patients whom themselves or family members are prone to keloid or hypertrophic scarring

It is important to consider the complications. Although I have been lucky with a low complication rate I cannot predict which patient will develop a complication. I think that it is important that if you open yourself to an operation you also open yourself to the possibility of compilations. It is important to evaluate the complications and consider your course of action should you develop a complication.

Thank you for reading this pamphlet. I can assure you that the correction of prominent ears is a definite life changing operation.