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Otoplasty

Otoplasty

Otoplasty or Ear Tuck surgery has been developed to address irregularities in ear contour that can be aesthetically displeasing or even have psychological effects on children as they are growing up. These irregularities have been defined and include:

  1. Large or asymmetric ears
  2. Protruding ears
  3. Abnormally shaped ears

The specific causes of ear deformity have been defined, and each has specific maneuvers for correction. To begin, let us review the anatomy of the ear.

A protruding ear or dumbo ear is caused by a poor bend of the antihelix such that the helical rim and the scapha protrude out; think of the antihelical fold not being bent back. This will cause the helical rim and scapha to stick out. Another cause of a protruding ear is a prominent lateral conchae as it extends laterally up to the anti-helical fold; When the lateral aspect of the conchae is prominent, this can also lead to a protruding ear. As such, the treatment for a protruding ear is typically a combination of removing excess conchal bowl to allow the ear to set back or bending the antihelical fold so that you have a sharper angle fold so that the helical rim bends back toward the head. In order to create a stronger or more acute fold of the antihelix, the antihelical fold is rasped to soften the cartilage and sutured to maintain the desired fold angle. All incisions are placed on the back of the ear in the posterior auricular sulcus, thus hiding any visual signs of ear corrections hidden. If you are concerned about the shape of your or your child’s ear, please contact Mirzania for a complimentary consultation.

Procedure: Correction of protruding, large, and/or abnormally shaped ears by a) making incisions at the natural fold behind the ears, or at the front of the ears, b) trimming and reshaping the cartilage (supportive tissue of the ears) if necessary, and c) removing excess skin if necessary
Length: On average 1.5 to 2.5 hours, but will vary depending on the complexity of the surgery and if multiple surgeries are required
Anesthesia: Local anesthesia and intravenous sedation or general anesthesia
Place of Treatment: Office-based surgical facility, outpatient surgical facility or a hospital operating room
Side Effects:  a) Numbness/altered sensation: Patients usually experience a temporary loss of sensation around the ears after surgery. It is common for the numbness to last for a few days up to a few months after surgery because the nerves around the ears may take a while to regenerate. In rare cases, the altered/loss of sensation may become permanent.

b) Bruising/Swelling: Most patients experience mild bruising and swelling that lasts for the first few days after surgery. Any related pain is treated with pain medication that is prescribed by your surgeon.

c) Scarring: Scarring usually occurs after ear surgery, but can fade into inconspicuous thin white lines. Furthermore, the incision lines for ear surgery are placed at the natural folds of the ear, which makes any scarring barely visible.

d) Ear asymmetry: An uneven appearance of the ears may result if the ears are asymmetric preoperatively. Although the surgeon makes all attempts to sculpt the ear cartilage intraoperatively to compensate for any asymmetry, patients with significant preoperative asymmetry may demonstrate residual asymmetry. Ear asymmetry may be corrected by additional revision surgery.

Risks: a) Pulmonary embolism: Blood clots may form in leg veins during any surgery when the patient is under general anesthesia. Patients with a leg vein clot will complain postoperatively of pain in their calves. Patients with this complaint should be taken seriously and treated if a vein clot is diagnosed. Early treatment of patients with a deep leg vein will avoid migration of leg vein clot to the heart and lungs causing pulmonary embolism. Even though pulmonary emboli are rare, pulmonary emboli are the leading cause of death after surgery. Pulmonary emboli must be detected early by performing a CT Scan and should be treated urgently.

b) Hematoma: Hematoma refers to the accumulation of blood in the early postoperative period which pools into a pocket. Hematomas provide a perfect medium for harboring growth of bacteria. So if you have an infection anywhere in your body, the bacteria will travel through the bloodstream and grow in the hematoma; this can lead to an infection as well as an open wound. In order to avoid a hematoma, drains are placed in surgery so that any fluid accumulation can be drained. Drains are usually kept in place for 4 to 5 days.

c) Seroma: Seroma formation refers to the accumulation of plasma fluid in pockets created by surgical elevation of the soft tissue and disruption of lymphatic vessels. This fluid accumulates due to a low blood count and protein deficiency both of which may be present in breast lift surgery patients. This fluid can be a nuisance to patients requiring several aspirations in the office prior to their resolution. More importantly, these plasma fluid pockets may harbor bacterial growth and result in a clinical infection. Drains which are placed in surgery are very effective in preventing seroma formation. Consequently, seromas may become apparent following premature removal of drains.

d) Infection: An infection can occur following ear surgery. The infection will disrupt the incision line and may leave the patient with an open wound. Prolonged antibiotics are required to fight the infection and to prevent further extension of the infection. Infections are usually avoided by using drains which will prevent hematoma formation. In addition, infections are less likely in patients who do not smoke cigarettes or in patients who quit smoking for at least 1 month prior to surgery.

e) Skin edge death/open wound: The skin incision can be disrupted if the skin edge dies or if there is local infection. This complication is best avoided by counseling patients on the terrible consequences of nicotine in cigarettes. Nicotine will literally clog all the small vessels found in the skin which are critical for the healing of the skin edge. Ear surgery patients are usually mandated to quit smoking for at least 1 month prior to surgery. In addition, uncontrolled diabetes can lead to the undesired sloughing of the skin. Diabetic patients are urged to be vigilant about controlling their blood sugar levels prior to surgery. If patients develop an open wound, they will require prolonged local wound care with frequent dressing changes. Unfortunately, any delays in healing of the skin edges will compromise your aesthetic outcome.

Recovery: Most patients can resume normal activities within 10 days and return to work between 7 to 10 days after surgery. However, patients should avoid strenuous activities such as bending, straining and heavy lifting for 6 weeks after surgery.
Duration of Results:  Ear surgery offers permanent and almost immediate correction of protruding, large and/or abnormally shaped ears. Most patients are extremely satisfied with their results and enjoy a lifetime of aesthetically pleasing ears.

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PATIENT SPECIFIC QUESTIONS

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