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In cosmetic pinnaplasty, an underdeveloped or absent antihelical fold and a hypertrophic concha are the most frequent defects requiring surgical consultation. With this study, the authors intend to describe a technique consisting of an anterior para-helical incision to approach the antihelix, with no posterior approach. Advantages of this surgical approach are described. All patients consecutively operated in the period 2016–2019 by the senior author (FB) with the anterior incision technique were retrospectively included in the study. Demographic and comorbidities were sought. Postoperative patient’s reported pain and satisfaction were determined. Early and late complications were also mentioned. Forty-five Caucasian patients were included, of whom 23 were women and 22 were men. Mean age was 25 years old (range 14 to 52). Follow-up was from a minimum of 12 months to a maximum of 36 months. All complications were managed with an office-based approach. Patient’s satisfaction was rated as very good in most cases (25 patients, 56%), excellent in 9 cases (20%), good in 7 (16%) and fair in 4 (9%), and no one expressed poor satisfaction. The most common postoperative pain was mild. The parahelical anterior incision has proven to be a safe and effective technique for antihelical open sculpting. The scar tends to fade nicely and remain well hidden under the helical fold. The proposed technique allows an open approach to the antihelix and a surgical moulding under direct view, in addition to a limited risk of complications and an optimal balance compromising operative efficiency-efficacy and risks, patient’s and surgeon’s intraoperative comfort, appearance of the scar and duration of the result. Level of evidence: IV, therapeutic study

The base frame provides a stable support for the helix, antihelix, and tragus–antitragus complex in microtia reconstruction, and this support is vital to attain a highly defined outline for a reconstructed auricle. The success of base frame sculpting depends on appropriate treatment of the cartilage, mainly the sixth and seventh costal cartilages, which may have different characteristics. The aim of this study was to demonstrate the relevant details for base frame fabrication under various scenarios. Between 2016 and 2019, a total of 352 patients with microtia underwent autologous auricular reconstruction. Concerning the different sizes and characteristics of the costal cartilage used for the base frame reconstruction, we describe the related methods for fabrication and introduce corresponding strategies for proper management. We found that 90% of the patients responded at follow-up, and 76% of them were satisfied with the cosmetically refined auricle with harmonious integrity. The elaborate design and appropriate utilization of costal cartilage for base frame sculpting is one of the most significant and fundamental processes in microtia reconstruction. It contributes to achieving a clearly defined outline of the auricle with harmonious integrity, which is as important as the other projected subunits.

Background Multiple techniques have been advocated over the years for correction of the prominent ear. The basic techniques used to correct prominent ears with a missing antihelix depends on incision, scoring, bending and reposition of the auricular cartilages. This study was undertaken to correct prominent ears using cartilage incision and vertical mattress sutures to define antihelix. Patients and Methods This study was carried out on 13 patients (25 ears) in the period between February 2014 and June 2017, twelve patients of them were presented with bilateral prominent ears and one patient was presented with unilateral prominent (bat) ear. This series comprised 8 males and 5 females. Their ages ranged between 7 to 33 years. In this technique 2 parallel incision in auricular cartilage, definition of antihelix with vertical mattress sutures and ellipse of skin was removed. Results Satisfactory results were obtained in all patients. Complications occurred in 2 patients only: one of them had mild protrusion of upper third of auricle and the other had keloid. Conclusion Our technique produces natural-looking of the operated ears with low complication rates.

The authors propose a novel surgical technique for reconstruction of full-thickness defects of the middle portion of the auricle including the helix and the antihelix up to the neighboring portion of the concha and sparing the whole of the ear lobe. It is a single-stage procedure that is indicated when a large, redundant, and pendulous earlobe exists as typically occurs in the elderly patient. The earlobe is rotated into the full-thickness ear defect and fits as an inlay between two cartilaginous stumps. The ear lobe presents two anatomical patterns: the pendulous or free one, with the ear lobe lying free from the cheek, and the non-pendulous or attached one, where the ear lobe is attached to the cheek. Donor site deformity is therefore limited to the conversion of a pendulous ear lobe pattern into an attached one. Surgery may be scheduled in an outpatient basis as the procedure is easy to plan, is fast to perform, and is carried out under local anesthesia. Level of Evidence: Level IV, therapeutic study.

Background: Prominent ear is the most common deformity of the external ear. Although hundreds of surgical otoplasty techniques have been described, none of them has proved enough advantage over others to become the gold standard in this field. In this study, we evaluated the results of a cohort of 188 patients operated with two different cartilagesparing otoplasty techniques. Patients and methods: A total of 356 otoplasties were performed in 188 patients, between January 2012 and November 2016. Two different techniques were utilized in two different groups: a modified-Mustarde otoplasty and a modified-Furnas technique. Postoperative follow-ups were performed at week 1, and at 1 and 6 months and at 1 year. Complications were recorded and compared between both techniques. The success rate was measured according to McDowells’ criteria. Results: A total of 356 ears were operated in 188 patients (85 men; 103 women; mean age 9.97; range: 6–15 years). In all, 105 patients underwent modified-Mustarde otoplasty, and 83 were operated utilizing a modified-Furnas technique. Success rates ranged from 90 to 100% depending on the technique utilized. No significative differences were observed in the incidence of complications and success rates. Conclusion: None of the compared otoplasty techniques showed better results than the other. Notwithstanding, otoplasty shows to be an effective treatment with high success rates (independent of the technique utilized) for patients with prominent ears. Keywords: antihelix, concha, Furnas, Mustarde, otoplasty, prominent ears

Currently, autologous cartilage provides the gold standard for auricular reconstruction. However, synthetic biomaterials offer a number of advantages for ear reconstruction including decreased donor site morbidity and earlier surgery. Critical to implant success is the material’s mechanical properties as this affects biocompatibility and extrusion. The aim of this study was to determine the biomechanical properties of human auricular cartilage. Auricular cartilage from fifteen cadavers was indented with displacement of 1 mm/s and load of 300 g to obtain a Young’s modulus in compression. Histological analysis of the auricle was conducted according to glycoprotein, collagen, and elastin content. The compression modulus was calculated for each part of the auricle with the tragus at 1.67 ± 0.61 MPa, antitragus 1.79 ± 0.56 MPa, concha 2.08 ± 0.70 MPa, antihelix 1.71 ± 0.63 MPa, and helix 1.41 ± 0.67 MPa. The concha showed to have a significantly greater Young’s Elastic Modulus than the helix in compression (p

Otoplasty for the correction of protruding ears is characterized by various techniques and a common and popular cosmetic procedure. For the surgeon, whether beginner or advanced, it is essential to understand the principles and master techniques for standard auricular deformities before applying further sophisticated methods, because a lot of complications and failures are caused by wrong indication and incorrect surgical techniques. The different surgical steps are best learned from teaching models. Therefore, we developed two different silicone models of protruding ears with moderate auricular deformities: one with conchal hyperplasia for the training of conchal resection, and one without antihelix for creating an antihelical fold by suturing technique, based on computed tomography scans of patients. The silicone ear models were evaluated during four standardized surgery courses for residents in otorhinolaryngology by 91 participants using specially designed questionnaires. Nearly all participants rated the training on the auricular models as very helpful (n = 51) or good (n = 31); the scores for the different techniques and properties of the models ranged from 2.0 to 2.6 in a range from 1 (very good) to 4 (inadequate). The good results demonstrate the possibility for learning different surgical otoplasty techniques with this newly designed teaching tool.

Question mark ear deformity or Cosman ear is a very uncommon congenital alteration. The deformity includes a cleft between the posterior helix and the lobule, an increase in anterior projection, an abnormal superior third that modifies the superior crura and the scaphoid fossa, partial or complete absence of the antihelix, transposition of the lobule and antihelix (severe cases), and postauricular tags. The authors present a case of moderate question mark ear deformity treated using Mustarde sutures and two cartilage grafts to correct the support and the contour defect. Adequate correction of the deformity and symmetry was achieved for both ears. The technique described in this report is suitable for minimal to moderate defects.

Various methods for correcting prominent ears have been reported. Although anterior cartilage antihelix abrasion combined with posterior retention sutures is a conventional procedure, it does not include anterior conchal cartilage abrasion and thus allows easier reduction of the condromastoid angle. A simple and effective technique is described that involves using a rasp to score the whole anterior surface of the auricular cartilage, including the concha, in combination with Mustarde-type conchal-antihelical and conchal-mastoid retention sutures. This method was applied to 342 patients (675 ears) over 23 years, who were followed up for periods varying from 18 to 24 months. Good results were obtained for all patients with minimal complications.

Question mark ear (Cosman ear) deformity, a rare congenital malformation, is characterized by a cleft between the helix and the ear lobe and marked prominence of the auricles. Although the features of question mark ear deformity are well described in the literature, there is no definitive surgical technique for repair of this deformity, Several surgical methods have been introduced for the correction of the deformity. These techniques mainly provide for repair of the cleft between the helix and ear lobe. However, marked prominence of the upper auricle usually is also present with the cleft. We modified the surgical technique to correct the cleft and the upper prominence at the same time. With this procedure, the cleft is exposed by raising a vertical cutaneous flap based on the cleft on the posterior side of the ear, After anterior scoring to form the antihelix and cleft repair using an ipsilateral conchal cartilage graft, the cutaneous flap is used to cover the cartilage graft and the flap donor site is closed primarily to facilitate restoration of the antihelix. The authors report on a patient with Cosman ear and introduce their modified technique that can be used for repair of the cleft between the helix and ear lobe and the prominence of the upper helix in the same procedure.

Many congenital ear deformities involve abnormal plical folding, most commonly affecting the helix and the antihelix. Non-hypoplastic auricular deformities can be corrected by appropriate splinting in the early neonatal period without anaesthetic and with minimal cost. At this time, oestrogen activity is increased and the ear cartilage is very malleable. The splinting therapy, devised and popularized in Japan, has not been widely used in Europe. A series of 26 patients having various ear deformities treated by splintage in the early neonate period is presented. Excellent results were achieved in 82% of the splinted ears. In the other 18% results were satisfactory or good. No complications occurred in the series. In conclusion, ear splintage is an effective technique that should be more frequently offered to parents of affected neonates.

Prominent ears is the most common congenital malformation in the head and neck region, and over 200 different correction techniques have been published. This demonstrates both the substantial effort devoted to ensuring an harmonious, natural, stable result and the lack of agreement over the approaches to achieve this goal. We present our experience in 42 patients using a combined technique that includes: (a) a large cutaneous excision in the upper part of the helix and in the lobule area to make the ear lie closer to the head, instead of the conventional elliptical excision, (b) closed anterior scoring, according to Stenstrom's technique, to reconstruct the antihelix, possibly combined with Mustarde sutures, (c) removal of the posterior auricular muscle to make the concha fit to the mastoid in a stable way, and (d) a semilunar excision of conchal cartilage by Mustarde's technique if the concha does not fit satisfactorily. This technique has proven to be safe, not particularly difficult to perform, with few complications, and can be used even for very prominent ears with good, stable long-term results.

Wir berichten uber einen Patienten, der sich mit einer unklaren malignen mesenchymalen Raumforderung der Anthelix in unserer Therapie befand. Das histologische Ergebnis zeigte ein myofibroblastisches Sarkom. Myofibroblastische Sarkome sind sehr seltene Tumoren, deren genaue Zuordnung im Rahmen proliferativer Erkrankungen schwierig ist. Differenzialdiagnostisch kommen sowohl benigne als auch maligne mesenchymale Veranderungen in Betracht. Therapeutisch ist eine vollstandige Resektion anzustreben, gegebenenfalls eine Kombination aus Chirurgie und Strahlentherapie.

Over the past five years we have successfully performed what we call a minimally invasive technique. The objectives of this technique are minimal incisions, limited dissection, and absence of internal permanent sutures for antihelix definition. In this article, we describe the surgical technique and analyze its advantages. There has been a reduction in complications and other problems associated with the conventional techniques.

Trisomy 4p syndrome is a distinct clinical entity which was noted almost a quarter century ago by Wilson et al. [71] and later was delineated by Gonzalez and colleagues [29]. The variation in the length of duplicated segment usually associated with monosomy of other genetic material which has resulted in confusion and as a result a so-called 4p syndrome could not be recognized without cytogenetic analysis. We wish to draw the attention of clinicians to this subject by presenting the description of over 75 cases including one from our clinic and stress the point that molecular approaches are imperative to characterize this anomaly. After extensive review, it appears that patients retaining at least the distal two-thirds to the entire short arm share an overlapping phenotypic expression that constitutes pure trisomy 4p syndrome which includes prominent glabella, bulbous nose with flat or depressed nasal bridge, retrognathia, pointed chin, short neck with low hairline, enlarged ears with abnormal helix and antihelix, rocker-bottom feet with prominent heel. Arachnodactyly and camptodactyly. Molecular characterization of 4p is imperative. We have also included an extensive bibliography for clinicians who may find it useful as a single reference source for evaluating their future cases.The 4p-syndrome is a distinct entity but without cytogenetic evaluation, the syndrome can not be recognized.

Various techniques have been used to correct prominent ears. This deformity is caused by the lack of formation of the natural fold along the antihelix, a hypertrophied concha or a combination of both. The authors present a simplified method of auriculo-plasty. The key point of the operation described in this paper is an incision on the upper part of the tail to the lower end of the antitragus in order to break the strongest point where the helix, antihelix and antitragus join [9]; also, anterior scratching of the ear cartilage along the line of the future antihelix and superior crus, as suggested by Stenstrom [12]. Only a single Vicryl stitch is used to transfix the fold at the antihelix tail, bending the scapha over the conchal cartilage to make the lobule fall into place. The results are satisfactory, with a normal looking antihelical fold. The ears should also feel normal and should not appear to have been operated on.

There are many surgical treatments for lower lid ectropion, but very few are effective for lower eyelid retraction with ectropion because of the influence of gravity on the flap transferred to the cheek. In two cases, we have successfully treated lower lid ectropion by suspending the lower lid with the ear cartilage taken from the antihelix. We believe that ear cartilage taken from the antihelix is a suitable material to suspend the lower eyelid for correction of lower eyelid retraction with ectropion due to gravity acting on the flap.

To reconstruct a major middle third auricular defect, a two-stage operation is usual, using a skin flap with cartilage support. In this paper, a one-stage operation for an acquired ear defect using an auricular cartilage sling and temporal fascial flap with skin grafting is reported. The auricular cartilage graft was harvested along the antihelix and used for the reconstruction of the helical rim. This is a simple, easy, and safe method of one-stage reconstruction for an acquired ear defect in properly selected patients.

Our technique for the correction of the protruding ear deformity has been successfully used in 275 patients. It gives a natural look of the auricle, symmetrical results, and a decreased number of secondary surgical procedures. This technique is based on a careful planning of the operation and measurement of the auricle, a large posterior skin excision proportional to the protrusion, breaking of the keystone of the auricular cartilage (horizontal cut of the cartilage between the antitragus and antihelix for 10–12 mm), superficial scratching of the periochondrium of the antihelix, and deep scratching of the cartilage laterally and medially to the antihelix. The dressing remains on for only 24 hours.

In performing otoplasty for correction of prominent ears, the aesthetic plastic surgeon may be faced with the existence of two antihelical folds especially if the conchal wall is too high. Thinning of the cartilage opposite and in between these two folds transforms them into a gently curved single fold that leads to a good aesthetic result.

A 5-cm incision and an elliptical skin excision are part of almost all surgical techniques designed to correct prominent ears. It is proposed that two 0.5-cm incisions be used that give access to the lateral surface of the auricular cartilage, which is thinned with a rasp along the antihelix and concha. The skin is not removed at all. Results obtained with this technique are presented.

In 10 consecutive otoplasties, conchal floor cartilage was excised to facilitate rotating prominent ears back against the head. The procedure is most effective in aural prominence due to deep conchae. Cosmetic improvement is as good as that achieved by excision of posterior wall cartilage, and recontouring of the antihelix fold is needed less often. The amount of cartilage to remove is easily determined, matching of asymmetrically prominent ears is simplified, and concha-mastoid sutures can be placed without tension. The corrections have been followed 1-2 years without recurrence of the deformity.