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Purpose - to develop a method of otoplasty in children with underdevelopment of the antihelix. Materials and methods. Otoplasty in our own way in case of underdevelopment of the antihelix was performed in 47 children (30 girls and 17 boys) aged from 6 to 16 years. All patients had bilateral deformity. The postoperative follow-up period was to 5 years. Results. Otoplasty in children with underdevelopment of the antihelix was performed by our own method, which included detachment of the skin on the posterior and anterior surface of the auricle from the cartilage with an anesthetic solution, excision of the skin in the form of an ellipse on the posterior surface of the auricle, cutting the cartilage to the perichondrium along the outer edge of the antihelix, and making staggered notches on the entire thickness of the cartilage, forming the antihelix with U-shaped sutures. The result of the correction was the correction of proportional disorders, ensuring the symmetry of both ears. First of all, the excessive protrusion of the upper part of the auricle was eliminated, since some protrusion of the middle and lower parts may be acceptable. The full-face helix of both auricles was visualized through an antihelix. An even and smooth contour of the antihelix along its entire length was provided. The nuchal recess was not reduced too much, while its shape was not violated. Excessive pressing of the auricle against the head was avoided. Staggered notches help to reduce the excessive pressure on the suture, prevent tension of the ear cartilage and overcorrection during the formation of the antihelix. Conclusions. The proposed method provides minimal trauma, promotes the formation of a natural antihelix shape and provides a good cosmetic result in children with protruding ear with underdeveloped antihelix. The research was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethical Committee of the institution mentioned in the work. Informed consent was obtained from the parents of the children (or their guardians), children. No conflict of interests was declared by the authors., Цель - разработать способ отопластики у детей с недоразвитием противозавитка ушной раковины. Материалы и методы. Отопластика собственным способом при недоразвитии противозавитка выполнена 47 детям (30 девочкам и 17 мальчикам) в возрасте от 6 до 16 лет. Все пациенты имели двустороннюю деформацию. Срок послеоперационного наблюдения составлял до 5 лет. Результаты. Отопластика у детей с недоразвитием противозавитка проводилась собственным способом, который включал отслойку кожи по задней и передней поверхности ушной раковины от хряща раствором анестетика, иссечение участка кожи в виде эллипса по задней поверхности ушной раковины, рассечение хряща до надхрящницы вдоль внешнего края противозавитка и выполнение насечек в шахматном порядке на всю толщу хряща с формированием П-образными швами противозавитка. Результатом выполненной коррекции было исправление нарушений пропорций, обеспечение симметрии обеих ушных раковин. Прежде всего устранялось чрезмерное выступание верхней части ушной раковины, поскольку некоторый выступ средней и нижней частей может быть приемлемым. Анфас завиток обеих ушных раковин визуализировался из-за противозавитка. Был обеспечен ровный и гладкий контур противозавитка по всей его длине. Заушное углубление избыточно не уменьшено, при ненарушенной его форме. Было предупреждено чрезмерное прижатие ушной раковины к голове. Выполняемые в шахматном порядке насечки способствуют уменьшению нагрузки на швы, предупреждают избыточное натяжение ушного хряща и чрезмерную коррекцию при формировании противозавитка. Выводы. Предлагаемый способ обеспечивает минимальную травматизацию, способствует формированию естественной формы противозавитка и дает хороший косметический результат у детей с оттопыренной ушной раковиной при недоразвитом противозавитке. Исследование выполнено в соответствии с принципами Хельсинкской декларации. Протокол исследования одобрен Локальным этическим комитетом указанного в работе учреждения. На проведение исследований получено информированное согласие родителей (или их опекунов), детей. Авторы заявляют об отсутствии конфликта интересов., Мета - розробити спосіб отопластики в дітей з недорозвиненням протизавитка вушної раковини. Матеріали та методи. Отопластику власним способом при недорозвиненні протизавитка виконано 47 дітям (30 дівчаткам і 17 хлопчикам) віком від 6 до 16 років. Усі пацієнти мали двобічну деформацію. Термін післяопераційного спостереження становив до 5 років. Результати. Отопластика в дітей з недорозвиненням протизавитка проводилася власним способом, який включав відшарування шкіри по задній та передній поверхні вушної раковини від хряща розчином анестетика, висічення ділянки шкіри у вигляді еліпса по задній поверхні вушної раковини, розтину хряща до охрястя вздовж зовнішнього краю протизавитка та виконання насічок у шаховому порядку на всю товщу хряща з формуванням П-подібними швами протизавитка. Результатом виконаної корекції було виправлення порушень пропорцій, забезпечення симетрії обох вушних раковин. Насамперед усувався надмірний виступ верхньої частини вушної раковини, оскільки деякий виступ середньої та нижньої частин може бути прийнятним. Анфас завиток обох вушних раковин візуалізувався через протизавиток. Був забезпечений рівний і гладкий контур протизавитка по всій його довжині. Завушне заглиблення занадто не зменшене, при непорушеній його формі. Було забезпечене уникання надмірного притискання вушної раковини до голови. Насічки, що виконуються в шаховому порядку, сприяють зменшенню навантаження на шви, попереджають надлишковий натяг вушного хряща та надмірну корекцію під час формування протизавитка. Висновки. Запропонований спосіб забезпечує мінімальну травматизацію, сприяє формуванню природної форми протизавитка та дає гарний косметичний результат у дітей з відстовбурченою вушною раковиною при недорозвиненому протизавитку. Дослідження виконано відповідно до принципів Гельсінської декларації. Протокол дослідження ухвалено Локальним етичним комітетом зазначеної в роботі установи. На проведення досліджень отримано інформовану згоду батьків (або їхніх опікунів), дітей. Автори заявляють про відсутність конфлікту інтересів.

Background: The auricle constitutes an important part of the face which is a focus of attention and personal interaction. A malformed auricle especially in young school age may result in some kind of psychosocial disturbance. Congenital abnormalities of the auricle have been estimated to occur in 5% of the population. Objective: to demonstrate and evaluate the results of modified mustarde technique used for correction of prominent ear deformity in pediatric. Patients and Methods: The present study included the results of operations in 30 ears concerning 16patients because there were 14 bilateral and 2 unilateral patients with prominent ear deformities, at age between 4-14 years of sexes, (11 males and 5 females). The patients were admitted to Al-azhar University hospitals in Cairo. Results: Our results were discussed in view of one technique, modified mustarde technique for all cases. The aesthetic results were evaluated,during the first 6 months postoperatively, by inspection and continuous measurements of auriculo-mastoid distance. For that purpose, photographs and measurements data taken in the pre- and post-operative periods was compared. In addition, the opinions of the patients and their care givers were taken into consideration. Conclusion: The use of modified mustarde technique not only hides the suture material but also provides a primary otoplasty technique that supports the repair with plication and scoring which gives the opportunity for the new shape to remain consistent in the postoperative period, a natural-looking antihelical fold, no sharp edges was formed and Long-lasting permanent results were aimed We believe that the modified mustarde technique was simple, safe and easy applicable method for protruding ear correction with excellent results.

Background Numerous methods have been developed for the correction of protruding ears. However, the best technique should be the one that is simple, reliable, and reproducible. Our research aimed to compare Mustarde technique and Stenstrom technique used in the correction of prominent ears. We included 20 patients who were randomly assigned to Mustarde or Stenstrom technique. All participants underwent full history collection, general and local examinations, and full investigations. We analyzed the age, sex, surgical technique, follow-up, complications, and results. Aim The aim of this study is to compare between Mustarde and Stenstrom techniques in the correction of prominent ear. Patients and methods This study included 20 patients with prominent ear, comprising 15 males and five females, attending Al-Azhar University hospitals. The patients were divided into two groups, with each group including 10 patients: creation of antihelix was done in all cases, and conchomastoid sutures were used if needed in some cases. Results According to our results, comparison of these two groups showed that patient satisfaction was high in both groups. In our study, hemorrhage, hematomas, keloid formations, suture extrusion, skin and cartilage infection, skin necrosis, and relapse have not occurred in any of the patients of the two groups. Irregularity in the antihelix was not observed in any patients from group A (Mustarde technique) and observed in one (5%) patient from group B (Stenstrom technique). Conclusion Minimizing the gap between the ear and the mastoid is the most significant outcome for patients in considering the operation as a success. Mustarde technique was our favorite technique for correction of protruding ear in children with soft or thin cartilage. We also agree that the technique of Stenstrom was effective in adults with hard or thick cartilage.

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.

(1) Background: Protruding ears are the most common auricular malformation affecting approximately 5% of the population. One common factor leading to auricular protrusion is a deficiency or total absence of the antihelix. A technique first described by Gottfried Lemperle in 2003 attempts cartilage thinning, folding, and fixation by non-absorbable mattress sutures after ventral skin incision along the ventral helical rim. (2) Methods: Retrospective analysis of patient records was performed for otoplasties according to this technique, performed between 1985 and 2014 at Agaplesion Markus Hospital in Frankfurt, Germany. All recorded complications were examined. (3) Results: A total of 912 single otoplasties were performed according to this technique from 1985 to 2014. Overall complications included 26% minor complications not requiring further surgery and 11% major complications leading to revision surgery. Within those requiring revision surgery, the most common reason was recurrence of auricular protrusion (5%), followed by suture granulomas (5%) and hematomas (2%). (4) Conclusions: Lemperle’s otoplasty technique addresses the open thinning and shaping of the antihelix through a ventral incision along the helix to prevent irregularities and possible ridges. Results show a low complication rate comparable to data found in published studies. This technique is easy to perform, safe, and avoids often seen contour irregularities of the antihelix compared to techniques with a posterior approach.

Auricular arteriovenous malformation (AVM) occasionally accompanies macrotia. Here, the authors report a case of AVM with macrotia that was treated with transcatheter arterial embolization, percutaneous sclerotherapy, and subsequent otoplasty following partial resection. A 46-year-old man presented with Schobinger stage III AVM. After transcatheter arterial embolization of the feeding arteries using n-butyl-2-cyanoacrylate, 9 sessions of sclerotherapy were performed using 3% polidocanol foam. Partial resection of the AVM nidus and subsequent otoplasty for ear reduction were performed at the age of 50 years. Two years later, the remnant nidus was resected and the protruding ear was surgically corrected. No recurrence was observed, and the enlarged ear was reduced at follow-up 6 months after the final operation.

Summary Background Prominent ears are by far the most common congenital ear deformity. Many techniques have been described using one or a combination of 3 basic methods: cartilage cutting, cartilage weakening and pure cartilage shaping techniques. The ideal otoplasty technique should yield a natural correction of the deformity, with low recurrence rates and with little risk of complications. Methods A new cartilage shaping technique using closing wedge concentric microchondrectomies through an entirely posterior approach is presented. Between 2006 and 2017, 200 bilateral otoplasties using this ‘WiFi' pattern technique were performed. This technique combined with Mustarde sutures is based on the excision of concentric partial thickness cartilage wedges designed in the pattern of the WiFi symbol. Results There were no major complications such as anterior skin necrosis and no returns to theatre for infections or haematomas. 3 patients (1.5%) had complete recurrence of the deformity and 10 patients (5%) had to undergo a minor revision for recurrence at the upper pole. 5 patients have had exposure of the end of the permanent upper pole scapho-temporal suture more than 3 months after surgery requiring simple outpatient suture trimming/removal without any recurrence of results. Palpable or bridging sutures were present upon clinical examination in 10 patients (5%) but did not require revision surgery. Conclusions Here, we describe a fast, safe and reliable technique for otoplasty with no need for extensive dissection, which is applicable to the full range of deformity.

Objective: This study aimed to get the data of Neonatal auricle for helping pediatricians and obstetricians to make definite diagnosis and individualized treatment for newborn congenital auricular deformities in China. Methods: A total of 1500 newborns' ears were evaluated in this study. Six surface measurements were performed directly on the auricles of the subjects as follows: physiognomic ear length and breadth, morphological ear length and breadth, cephalo-auricular distance, and cephalo otic angle. Results: The incidence of neonatal auricular deformities in the Pearl River Delta area was 57.47% and the self-healing rate was 31.61% by the 30-day follow-up. There were significant differences between different types of auricular deformities (protruding ear, cup ear, lop ear, Stahl's ear, conchal crus, helical rim deformity, and composite deformity) and normal morphological differences of the auricle. Conclusions: Our findings suggested that individual differences in ear morphology are large and there were some differences between measurement data in our study and EarWell. Application of the EarWell system may lead to localized skin excoriations or breakdown as a result of mismatch with the ear. Therefore, early use of personalized ear molds produced by three-dimensional printing to determine if more deformed auricles may be corrected.

Introduction: Protruding ears are a very common esthetical problem, with 5% prevalence. Otoplasty is a universally accepted surgical procedure, taking into account the psychological issues related to this deformity. Materials and methods: A retrospective study of 111 children, who underwent otoplasty to correct protruding ears in a Portuguese Hospital Center, for the last 4 years, was performed. A telephonic questionnaire to assess patients satisfaction related to the procedure and its impact in quality of life was applied to the parents. Results: A population of 75 (68%) male and 36 (32%) female children was analyzed. The procedure was performed, in average, between seven and eight years of age, and 36% were operated in pre-school age. The type of otoplasty was a combined technique, with 98 bilateral cases and 13 unilateral, making a total of 209 corrective otoplasties. Complication rate was low (3.8%). The questionnaire was performed in 98 patients, with a median of 4-5 (scale 1-5) in all items evaluated, reporting an overall satisfaction and positive influence of the procedure in quality of life. Discussion and conclusion: Corrective otoplasty of protruding ears had a direct positive impact in quality of life and self-esteem in patients; this underlies the relevance of referring these children to a specialized surgical center.

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.

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.

Objective The posterior auricular muscle (PAM) functions in ear projection in normal position and is severed during the retroauricular approach, and some patients complain of a protruding ear postoperatively. This study was designed to determine whether suturing of the severed PAM reduces pinna projection after the retroauricular approach. Methods In a prospective controlled study, we enrolled 91 patients with chronic otitis media, all of who underwent canal wall up mastoidectomy with tympanoplasty via retroauricular approach. They were randomly assigned to the PAM-sutured (n = 45) or PAM-non-sutured (n = 46) group. Helical-mastoid distance and concho-mastoid angle were measured serially. Results In both groups, helical-mastoid distance was significantly longer than preoperatively until 1 month postoperatively but was similar to preoperatively by 6 months. Concho-mastoid angle increased significantly until 1 month after surgery in the PAM-non-sutured group but returned to the preoperative value at 6 months postoperatively. In the PAM-sutured group, concho-mastoid angle increased significantly at 3 days postoperatively, was similar to preoperatively at 1 month after surgery, and became narrower than preoperatively at 6 months postoperatively. In both groups, there were significant effects of time on the changes in helical-mastoid distance or concho-mastoid angle. Group assignment did not significantly affect these time-related changes. Conclusion PAM suturing did not affect helical-mastoid distance by 6 months postoperatively, but it did reduce the concho-mastoid angle to below the preoperative value at 6 months. We recommend that PAM be left severed to maintain concho-mastoid angle in the long term when using the retroauricular approach.

Ear prominence is a relatively common cosmetic deformity with no associated functional deficits, but with profound psychosocial impact, especially in young patients. Protruding ears in children have propagated surgical advances that incorporate reconstructive techniques. Here we outline a systematic framework to evaluate the protruding ear and present various reconstructive surgical options for correction. Both cosmetic and reconstructive perspectives should be entertained when addressing this anatomical deformity.

Here we describe a patient who presented with a history of congenital diaphragmatic hernia, inguinal hernia, and recurrent umbilical hernia. She also has joint laxity, hypotonia, and dysmorphic features. A unifying diagnosis was not identified based on her clinical phenotype. As part of her evaluation through the Undiagnosed Diseases Network, trio whole-exome sequencing was performed. Pathogenic variants in FBN1 and TRPS1 were identified as causing two distinct autosomal dominant conditions, each with de novo inheritance. Fibrillin 1 (FBN1) mutations are associated with Marfan syndrome and a spectrum of similar phenotypes. TRPS1 mutations are associated with trichorhinophalangeal syndrome types I and III. Features of both conditions are evident in the patient reported here. Discrepant features of the conditions (e.g., stature) and the young age of the patient may have made a clinical diagnosis more difficult in the absence of exome-wide genetic testing.

Introdução: As orelhas procidentes são um problema estético bastante comum, com uma prevalência de 5% na população. Tendo em conta os problemas psicológicos associados a esta deformidade, a otoplastia é uma correção cirúrgica universalmente aceite. Materiais e Métodos: Foi efetuado um estudo retrospectivo dos processos clínicos de 111 crianças, submetidas a Otoplastia para correção de orelhas aladas num Centro Hospitalar em Portugal, durante os últimos quatro anos. Foi realizado ainda um inquérito telefónico aos pais, para aferição da satisfação dos utentes relativamente ao procedimento efetuado e respetivo impacto na qualidade de vida. Resultados: A população de doentes era constituída por 75 (68%) crianças do sexo masculino e 36 (32%) do sexo feminino. Estas foram intervencionados em média entre os sete e os oito anos de idade, sendo que cerca de 36% foram operadas em idade pre-escolar. O tipo de otoplastia efetuada foi uma técnica combinada, tendo sido bilateral em 98 casos e unilateral nos restantes 13, totalizando 209 otoplastias corretivas. A taxa de complicações foi baixa (3,8%). Foi possível realizar o inquérito telefónico a 98 utentes, observando-se uma mediana de resultados de 4-5 (escala 1-5) em todos os itens avaliados, traduzindo uma satisfação generalizada e influência positiva do procedimento na qualidade de vida. Discussão e conclusão: A Otoplastia corretiva de orelhas procidentes teve um impacto positivo direto na qualidade de vida e auto-estima dos doentes intervencionados. Torna-se assim por demais relevante a referenciação destas crianças a um Centro Cirúrgico especializado., NASCER E CRESCER - BIRTH AND GROWTH MEDICAL JOURNAL, Vol 26, No 4 (2017)

WOS: 000432816200019 Background: A prominent ear is a common disorder which affects the patient's social relations and physiological condition. This deformity can be corrected by using several well-known methods ranging from early splinting to surgery. This study presents yet another new and practical method for protruding ear correction. Patients and method: A total of 40 patients (male, n = 19; female, n = 21) with 76 prominent ears were operated on using the proposed technique. The conchomastoid measure was between 2-4.5 cm with an average of 2.8 cm before the surgery. Being the traditional method, postauricular incision was performed on each ear under local anaesthesia. The process was continued at suprapericondrial plan. By using 4/0 monofilament nonabsorbable suture material, four scaphomastoid sutures were inserted from the posterior aspect of scaphoid fossa to the mastoid periosteum of each prominent ear and tied gently. After control for bleeding, the skin was closed with 5/0 absorbable monofilo'neil suture. Results: Median follow-up was 13.2 months. Complications occurred in both ears. A unilateral haematoma was at one patient's left ear. The haematoma was drained under local anaesthesia and the resuturaing done according to the procedure. A unilateral allergic reaction occurred on the skin sutures of one patient during her first postoperative month and it resolved after taking off the suture material. The mean time of the surgery for each ear was 27.6 minutes (20-40 minutes). The results were satisfactory both for patients and the surgeon. Conclusion: This safe, simple and quick method helps to obtain natural and well-shaped ears. What is more, it does not disturb the external ear canal. No keloid formation and suture exposition were observed with this method, which makes it an effective substitute for other surgical procedures.

Protruding ears represent the main abnormality of the external ear, which has required numerous anatomic and surgical studies. Most studies give attention to the absence of the antihelix as the anatomic defect responsible for the clinical deformity of the lateral aspect of the ear that leads to its anteversion. The reason for this study is the controversial origin of the fold of the antihelix within the auricle framework, a field of interest for aesthetic otoplasty. The current study examined the medial surface of the cartilaginous ear frame from cadaver specimens with right morphology to investigate the starting point of the fold of the antihelix. This allowed for verification of a natural plica at the anatomic base of this antihelical fold, which to date has not had its topography described morphologically. It is acknowledged that relevant literature makes no reference to this innominate natural plica at the origin of the antihelix, whose anatomic and surgical importance is related in this report. This study aimed to show that the existence of a natural plica at the base of the antihelix in ear framing represents a landmark between normal and protruding ear morphology. For 8 years, 118 ears were carefully investigated within rigid ethical principles based on a thorough review of the pertinent literature. The study investigated 16 selected cadaver specimens and 102 protruding ears dissected by the senior author including 49 bilateral cases (26 males and 23 females) and 4 unilateral cases (2 males and 2 females). Bifacial anthropometric measurements by calipers were used for documentation. A natural plica at the base of the antihelix was found in all cadaver ears selected with right morphology, whereas it was totally absent in every surgically treated protruding ear irrespective of color, gender, age, or ethnic origin. Ambilateral measures of the antihelix eminence certify the study object in normal specimens as well as its lack in abnormal ones. Technical and topographic knowledge that a natural plica exists at the anatomic base of the antihelix is a valuable key point in recognizing the normal external ear. In addition, the making of a natural plica is the first and most effective factor in the reconstruction of the antihelical fold and its absolute absence results in the pathologic condition for protruding ears. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the A3 online Instructions to Authors. http://www.springer.com/00266 .

Objective: Although protruding ears are one of the most frequently occurring congenital deformities in the craniofacial area, there is no clear consensus in literature as to the definition. Our aim was to provide a clear delineation for the definition of prominent ears, deduced from the anthropometry of normal (nonprotruding) ears. Methods: We performed a prospective cohort study to assess the anatomy of the normal auricle in children using computer-assisted anthropometry in photographs of 102 children aged 5 to 18 years. We compared the anatomy to retrospectively assess photographs of 44 patients who were listed for prominent ear correction. Results: Our results show that protrusion differs statistically between sexes. In view of these data, an ear could be defined as prominent when the upper protrusion exceeds 21.5 mm or the lower protrusion exceeds 20.0 mm in boys and the upper protrusion exceeds 17.5 mm or the lower protrusion exceeds 15.5 mm in girls. Using these demarcations, 87.5% of our operated prominent ears would qualify as a prominent ear. In addition, we found that prominent ears have larger auricular lengths and consequently larger surface measurements compared with normal ears (P = 0.001). Up to 19.3% of the normal ears showed an asymmetry of more than 3 mm concerning protrusion. Conclusions: Protrusion differs significantly between sexes. This indicates that different criteria should be used to judge protrusion in boys and girls. None of our prominent ears exceeded only the demarcation in the lower protrusion, suggesting that upper protrusion plays a larger role in the perception of prominence than lower protrusion and should therefore be the main objective of corrective otoplasty. Furthermore, the variation of asymmetry of protrusion in the normal population indicates that an often used success criteria in otoplasty of an asymmetry less than 3 mm may be too strict. Copyright

A great number of surgical techniques for the correction of protruding ears have been developed. Their basic concepts originate from Mustarde's suture, the scoring technique described by Chongchet, Stenstrom, and Cricelair, and the combined suture and scoring technique described by Converse. Techniques for cavum rotation and lobuleplasty have also been presented. Indication, diagnostics, selection of method, the operative technique itself, and postoperative care are described. Advantages and risks of each technique are discussed, and a therapy algorithm is proposed.

OBJECTIVE To determine whether a simple, nonsurgical treatment for congenital ear abnormalities (lop-ear, Stahl's ear, protruding ear, cryptotia) improved the appearance of ear abnormalities in newborns at six weeks of age. METHODS This is a descriptive case series. All newborns with identified abnormalities were referred by their family physician to one paediatrician (WGS) in a small level 2 perinatal centre. The ears were waxed and taped in a standard manner within 10 days of birth. Pictures were taken before taping and at the end of taping (one month). All patients and pictures were assessed by one plastic surgeon (JWT) at six weeks of age and scored using a standard scoring system. A telephone survey of the nontreatment group was conducted. RESULTS The total number of ears assessed was 90. Of this total, 69 ears were taped and fully evaluated in the study (77%). The refusal rate was 23%. In the treatment group, 59% had lop-ear, 19% had Stahl's ear, 17% had protruding ear and 3% had cryptotia. Overall correction (excellent/improved) for the treatment group was 90% (100% for lop-ear, 100% for Stahl's ear, 67% for protruding ear and 0% for cryptotia). In the nontreatment (refusal) group, 67% of the ears failed to correct spontaneously. No complications were recognized by the authors or parents by six weeks. The percentage of newborns in one year in the perinatal centre with recognized ear abnormalities was 6% (90 of 1600). CONCLUSIONS A simple, nonsurgical treatment in a Caucasian population appeared to be very effective in correcting congenital ear abnormalities with no complications and high patient/parent satisfaction.

Zur Korrektur abstehender Ohrmuscheln verwendeten wir eine modifizierte Form der 1967 von Kaye veroffentlichten Technik. Unseres Wissens gab es bisher keine Publikation zu Erfahrungen mit einer geschlossenen otoplastischen Technik bei einer groseren Patientenzahl. Von 442 Ohren wurden in 4 1/2 Jahren 385 (200 Patienten, 15 einseitige Korrekturen) mit minimal-invasiver Technik korrigiert. Bei der minimal-invasiven Otoplastik (MIO) wird eine naturlich aussehende Anthelix mittels nicht resorbierbarer Nahte nach schonender Schwachung der Ruckstellkrafte des Knorpels geformt 154 der operierten Patienten (entsprechend 302 Ohren bei 6 einseitigen Korrekturen) konnten wir wenigstens 1/4 Jahr nach Op. nachuntersuchen. An Komplikationen hatten wir Nachkorrekturen wegen partieller Rezidive oder vom Patienten als noch ungenugend empfundener Korrektur (30/302=9,9%), Fadenreaktionen (26/302=9,3%), fruhe Infektionen (2/385=0,7%), langer anhaltende Empfindlichkeit (2/302=0,7%) und eine hypertrophe Lobulusnarbe (1/302=0,3%). Nachblutungen, Hamatome, Hypasthesie, Temperaturempfindlichkeit oder Hautreizungen im Bereich der Ohrmuscheln sahen wir nicht. Mit der MIO kann die Mehrzahl abstehender Ohren korrigiert werden. Sehr fester Knorpel oder eine sehr hohe laterale Kavumwand setzen dem Grenzen. Die kosmetischen Resultate und die Komplikationsrate sind denen offener Techniken vergleichbar; die Akzeptanz dieser Methode scheint hoher.

In 1972, in the search for a method to cope with all deformities in protruding ears and other common minor auricular deformities, Claus Walter published a surgical technique based on various incisions and excisions of the cartilage. The procedure consists of a complete separation of the auricle into two parts, combined with remodeling of antihelical, helical, and lobular structures without use of adjusting sutures. Thus, even in patients with stiff and unyielding cartilage and in revisional surgery, pleasing aesthetic results may be achieved. The recurrence rate has found to be reduced markedly. Considering all pros and cons and optional surgical modifications, the incision-excision technique can be adopted for every protruding ear as well as for lop ears, moderate cup ear deformities, and secondary revisions. Because of the extent of cartilage dissection, this technique is not recommended for beginners but should be restricted to experienced surgeons with profound knowledge of basic remodeling procedures.

The normal auricle has a well-recognized shape, and significant deviation from "normal" is immediately evident. In particular, prominent ears are readily apparent and are a relatively frequent cause of patient concern. Correction of the outstanding ear requires a careful understanding of the discrete elements that compose the normal ear. Careful anatomic analysis to determine the precise cause allows appropriate preoperative planning for the correction of a protruding ear.

Objective: To compare the merits of otoplasty technique with a diverse patient population as experienced spanning a period greater 30 years. Study Design: A review of a series of otoplasty cases that occurred in two distinctly different clinical settings during a 33-year period. Methods: A retrospective analysis of 211 patients undergoing otoplasty from 1969 to 1982 in a military hospital setting was compared with 118 patients receiving otoplasty from 1982 to 2002 in a university/private practice setting. The patient population consisted of 180 adults and 149 children. Results: Otoplasty patients in the military setting were primarily adults, whereas those in the university/private practice setting were primarily children. In the adult population, 98.9% of patients required use of lateral conchal cartilage resection combined with a mattress suture technique. In the pediatric population, all patients required use of a mattress suture technique and in 83.2% of selected cases limited lateral conchal cartilage resection was required. Conclusion: Otoplasty technique involving lateral conchal cartilage resection, mattress suture fixation, or a combination of both is applicable to diverse patient populations.

The goal of otoplasty for correction of prominent ears is normalization of shape and position of both pinnas with a certain symmetry. Recreating the antihelical fold and lowering the auriculocephalic angle are the basic processes for achieving a normal-looking ear. Various methods have been described to recreate the antihelical fold. In addition to anterior scoring or abrasion, many involve placement of permanent or absorbable sutures to reform the cartilage to proper shape to correct the deformity. In this study the use of a custom-made silicone mold was described after anterior scoring to recreate the antihelical fold, without using any suture material. Silicone molds provide good shaping of the antihelical fold, scapha, and helical rim while the tissue is healing. Fourteen patients underwent bilateral otoplasty for prominent ears in our clinic over a four-year period. The anthelical fold was created by anterior scoring and the concha-mastoid angle lowered and sutured. After completing the surgical procedure for both ears, custom-made silicone molds were worn by the patient for the first two weeks to maintain proper position. The third week, the patient wore the mold half a day. A head dressing was used for two days and the ears were subsequently supported using a headband. Follow-up ranged from fourteen months to four years. One patient developed a postoperative hematoma in one ear that resorbed spontaneously. Patient satisfaction with the procedure was generally high. Using a shape mold after a combination of anterior scoring and concha repositioning gives predictable results with a natural-looking ear.

Congenital abnormalities of the auricle span a spectrum of abnormalities from total anotia to slight asymmetries of an otherwise normal appearing ear. This article is dedicated to the management of the prominent, or protruding ear. A number of well-known surgical techniques have been described for the correction of the protruding ear. The ideal set of techniques must accomplish several goals. The desired post-operative results must include (1) a normal appearing auricular contour from both the frontal and lateral views, (2) an absence of unnatural sharp edges in the cartilage framework, and (3) symmetry of both ears. The techniques involved must be relatively easy to learn and must also yield reproducible results.

To investigate health-related quality of life changes that occurred in children with prominent ears applied pre- and postoperatively. A prospective study was performed in 67 consecutive children who underwent otoplasty procedures between April 2008 and July 2010 and followed up for more than 2 years. Evaluations and interviews performed in the pre-and postoperative periods included the patients' history, clinical and routine laboratory examinations. Glasgow children's benefit inventory was the basis of the used inquiry for detecting the changes in health-related quality of life after otoplasty. For the children's cohort, the mean total Glasgow children's benefit inventory score was 23.9 (p < 0.001), indicating a benefit from the operation. All Glasgow children's benefit inventory subscores (emotion, physical health, learning, and vitality) were raised (mean 30.84, 14.98, 18.89, and 23.96, respectively). The health-related quality of life was raised in 63 of 67 children (94.03%). Negative Glasgow children's benefit inventory scores or subscores were not found in a single case. Otoplasty can significantly increase patients' health-related quality of life and leads to a high rate of patient satisfaction in children with prominent ears.

This paper describes the reconstruction techniques I have developed to correct a congenital earlobe defect. My technique was employed in the correction of four auricles in two cases of ear deformity due to a congenital earlobe defect. The first case is a 3-year-old girl with a congenital bilateral earlobe defect, loss of the right superior crus of the antihelix, and a left protruding ear. The second case is a 52-year-old female with a congenital bilateral earlobe defect and bilateral protruding ears. The shape of each reconstructed auricle and earlobe was satisfactory.

In performing otoplasty, the best technique may be the one that is flexible, simple, and versatile. The author discusses the history of otoplasty and describes the technique of Mustarde’s suture cartilage scratching and rasping. The results are reported. Mustarde suture and cartilage softening has been the authors’ preferred method for correcting the protruding ear. Cartilage softening with scratching provides a softer and narrower antihelix fold. With the use of this technique, the anterior skin overlying the concha is left undisturbed. The authors’ use of braided polyester suture prevents loosening of the knots. Polyester is more pliable than nylon, and the color of the suture material is very important because the sutures are close to the skin; they may become visible in time.

There are many types of ear deformities. The one that is most often seen by the surgeon is the protruding ear. These may be unilateral or bilateral. Minor degrees do not need operation but severe forms need done because they are often the source of ridicule and bullying.

Wasp belongs to a group of insect that does not intentionally attack human unless threatened1. It is a member of the Hymenoptera order (which also includes bees and ants). Its consists of various proteins and enzymes. It also contains an acetylcholine-like substance, histamine, serotonin and a kinin (peptides which cause slow muscle contractions and lower the arterial blood pressure)1. In most people the wasp sting causes an initial sharp localized pain followed by swelling and itching of the affected part. We present a case of a seventeen year old male student who presented with persistently protruding ear following a wasp sting on the affected left ear ten years duration. On the protruding ear, fine needle aspiration cytology was done but the result was inconclusive. A skin snip revealed only inflammatory cells with no evidence of microfilaria. A wedged incisional biopsy of the hypertrophied pinna was done under local anaesthesia. Biopsy was taken from anterior helix and the post auricular sulci area. The Histology report revealed inflammatory cell with no evidence of malignancy. Acquired Macrotia may be an unusual presentation in wasp sting, information on bites and stings should be incorporated within injury prevention programs in West Africa such as those developed by Farmsafe Australia. Key words: Macrotia, Otitis externa, wasp, Otorhinolaryngologist

Objectives: More than 200 different otoplasty procedures have been described in the literature to treat patients with prominent ears. However, no simple “best” technique exists. Methods: The Négrevergne otoplasty technique was developed by Michel Négrevergne and adopted in the Georges Portmann Institute in France. The technique includes partial-thickness posterior scoring of the auricular cartilage by use of monopolar cutting diathermy. Results: A telephone survey was designed solely for this study, aimed to give general information about the technique's outcomes. The survey, conducted by the first author among his patients who were followed up for more than 1 year, revealed that most patients (46 of 52) were very to completely satisfied with the appearance and symmetry of their ears. Furthermore, evaluation according to the Global Aesthetic Improvement Scale was performed by a blinded nonparticipating observer using the medical photographs of 48 patients who consented to “medical photography” to evaluate the effect of treatment. All patients were rated as “improved” or better on the Global Aesthetic Improvement Scale at 52 weeks. There were no ratings of “no change” or “worse.” Conclusions: The Négrevergne otoplasty technique is a relatively simple and rapid procedure that maintains the natural contours of the auricle with little morbidity by addressing the poorly developed or absent antihelical fold, an abnormally large concha, and a prominent lobule.