Otoplasty, also known as ear surgery, is a cosmetic surgery that offers both aesthetic and corrective treatment. This cosmetic procedure is performed mostly in children and some adults to improve any ear deformity.
Aside from the physical changes it also helps children avoid the taunting and teasing from others. Using a variety of techniques, the ear can be reshaped to make it more suitable to the patient’s profile.
According to statistics gathered by the American Society for Aesthetic Plastic Surgery (ASAPS), otoplasty is the procedure most often performed to those who are 18 and younger in 2010. In order to cater to these specific cases there is a subspecialty in medicine that focuses on pediatric otolaryngology which treats ear issues in children and infants.
A lot of experts agree that this surgery can affect not only the physical but emotional well being as well. It stops the merciless name calling such as “Mickey Mouse” or “Dumbo”. For older individuals having ears that have overly protruded may look awkward or unsophisticated.
Genetic disorders such as hemifacial microsomia (a congenital disorder where lower half of the face is underdeveloped), microtia (underdeveloped pinna), Stahl’s deformity(pointed malformation of the ears), and Treacher Collins syndrome are the common causes that always lead to corrective procedures.
When it comes to accidents leading to ear surgeries, human and animal bites are the usual culprits that lead to otoplasty.
• To correct the external structure of the ears in children who are born with congenital anomalies such as microtia, anotia (completely undeveloped pinna), Stahl’s deformity, Treacher Collins syndrome, or hemifacial microsomia. It either occurs in one or both ears.
• To correct overly protruding ears to make its distance more appropriate in relation to the head.
• To correct asymmetrical ears with significant differences in either shape and size.
• To treat an ear that is deformed by trauma or injury.
• To improve the appearance of the ears putting a stop to name calling and teasing.
1. Protruding Ears
There are cases where a child is born with ears that protrude significantly. This makes them look awkward which unfortunately could make them the subject of ridicule when they go to school. This is an inherited trait, with 59% of the patients having a family history.
One of the causes for protruded ears is an underdeveloped antihelix. When this outer portion fails to fold into the head, it results to the ear sticking out.
Another reason is the overdeveloped concha. When this structure enlarges in size it also causes the ears to stick out farther.
Ear pinning surgery or setback otoplasty can be done to correct this deformity. For children they can have the surgery once they are four years old, because around this time is when the ears have fully grown. It can also be done on adults without any added risk.
2. Hemifacial microsomia (HFM)
This is a congenital condition where the tissues on one side of the face are underdeveloped. Usually this can affect the lower half including the ears (external or middle portion), mouth, teeth and the mandible.
The goal of treatment for patients with HFM is to balance the facial structures. This requires an interdisciplinary approach which involves the specialties involving orthodontics, ENT, and surgery. For ear reconstruction, this usually involves three to four surgeries which could be started once the patient turns 6-7 years of age. The final decision on the approach to be used will be carried out after extensive evaluation of the child’s specific case is done.
This congenital anomaly occurs when one or both ears fail to develop properly. Hearing in the affected ear is impaired, although in most cases the normal ear may also have problems with hearing due to this condition.
To correct microtia, a series of 3-4 operations would have to be performed separately.
4. Stahl’s deformity
This is a condition where the upper ear has an extra fold of cartilage giving it a pointed appearance. This is also dubbed as Vulcan ear or Spock ear, referring to the famous Star Trek character. If it is diagnosed during the first few days of an infant non-surgical treatment can be done using ear molding techniques. However this should be done within the first two weeks of life. However if surgical treatment is necessary the child should be at least 4-5 years of age.
5. Injuries or Trauma
Emergency doctors state that the common injuries resulting to ear problems include avulsion injurires caused by bites wither by human or animal, and thermal or chemical burns brought about by industrial accidents.
Who is the right candidate for otoplasty?
A person with earlobes that is larger than normal, asymmetrical ears, or those that stick out disproportionately are the right candidates for surgery. But when it comes to age, the minimum 4-5 years old because it is at this time where the ear structures have fully developed.
Since teenagers and young kids are the usual patients in otoplasty, the lower age limit should be 4-5 years old when their ears have already fully developed.
Parents and the patients should be fully aware of the risks and possible outcomes to make sure that they are prepared about what to expect. This means that they not only understand what otoplasty can accomplish but its limitations as well.
As long as there are no bleeding or clotting problems, and the patient is generally healthy then he or she is good to go.
How to choose the right otoplasty surgeon?
If you want the best results you have to be very careful in choosing a surgeon. Below are some of the points that you should take into consideration.
- Proper education and training and certification
- Have specialized training on ear surgeries
- Check the doctor’s credentials. Under state laws physicians can call themselves plastic or cosmetic surgeons even though they are not trained surgically.
- Good work history and patient satisfaction rate
- Have a good amount of experience
- Has a good aftercare plan
How Do You Prepare for Otoplasty?
A shower is important the night before the surgery, and if there is time in the morning another one could be much better. The shower should be at least ten minutes, while concentrating on the area around the ears. Some doctors would require a certain antibacterial soap to be used.
How the Procedure is Done
• For overly protruding ears
After administering anesthesia and once it has taken effect, the surgeon creates an incision at the back of the ears. It is done along the fold of skin where the ears meet the head. The surgeon then exposes the cartilage and reshapes the structure or removes a small piece in what is referred to as a conchal resection. The cartilage is then moved back towards the head and then sutured securely in place using non-removable sutures.
In another approach, the cartilage is spared after skin is removed, and then the cartilage is sutured back on itself. This is called a cartilage-sparing otoplasty.
After the incision is closed it is then covered with sterile dressing.
• For microtia
It requires three separate procedures to correct microtia. The first operation is going to be the most extensive since it would require the removal of a piece of cartilage from the child’s ribs. This is on the side that is opposite the ear that will be operated because this gives the natural curve to shape the ear. Using a template from a photo or a computer generated model, the surgeon shapes the cartilage following this design. After it is created the surgeon arranges the cartilage beneath the skin at the side of the face. In time the skin will simply follow the form of the newly fashioned ear.
The second operation is done to shape the ear lobe, while the last one is to raise the ear to its final position.
• Stahl’s Ear deformity
To correct Stahl’s deformity a piece of cartilage would have to be removed in order to eliminate the pointed appearance of the ear. Using certain techniques and non-removable sutures, the ears are then held in its new shape. The entire procedure can be done as a day or outpatient surgery.
In order to correct ear surgeries that are caused by trauma or injury, a wound debridement should be done first. An antibiotic treatment may have to be even started first and in some cases the surgery postponed for a few days to make sure infection is prevented. The treatment should be done immediately because if prolonged the ears would lose its blood supply.
What to Expect After Surgery
• After surgery or once the dressing is taken off, the ears may appear like it is stuck too near the head. This is only normal and it would simply take its final position after a couple of days. Do not pull your ears out.
• Swelling, bruising and pain are the things that you are going to experience after the surgery. This is going to continue for a week or two with it subsiding over time.
• The head will be wrapped in a dressing for a week or more after surgery. This should not be soaked in water when bathing, but neither should this be removed without the surgeon’s advice.
• If the dressing is too tight or loose, inform your surgeon ahead of time to have it properly fitted.
• A warm compress can be applied gently over the area two to three times a day after the dressing has been removed.
• Follow the surgeon’s instruction in hair washing and drying.
• The head should be raised within 2-3 weeks after surgery to decrease swelling. The affected area should be avoided to prevent putting on too much pressure.
• Activity level should be minimized when recovering. Bending and sports should be avoided. Lifting should only be limited to no more than 10-15 pounds for at least a month.
• The surgical site can be cleansed using soap and water. Make sure that this is kept dry because moisture can create the perfect environment for infection.
• The children can return to work after a few days, given that their playground activity should be minimized while recovering. Adults can already return after two to three days.
• It would be advisable to wear button down shirts instead of those pull-overs. This can avoid dislodging the sutures.
RISKS AND COMPLICATIONS
This risk is true for all patients undergoing surgical procedures. This can result to poor outcome if not prevented through aseptic cleansing techniques and not properly following prophylactic antibiotic treatment.
• Distortion of the ear
This can result due to over-correction, which is why it is important to ensure that a specialized surgeon performs the procedure.
This occurs when blood pools below the skin due to the leakage of blood vessels. Pressure dressing and proper positioning prevents hematoma formation. This could create too much pressure inside which could result to a distorted result. To relieve this, surgical treatment may be needed to drain the blood.
• Abnormal scar formation
Scars can be too large on the area creating a poor result. Surgeons would wait at least six months before a revision has to be done.
When to Contact the Doctor
During the healing period there are some cases where something unusual occurs. You have to call your doctor immediately when you experience the following:
a. A possible sign of infection evidenced by increased pain, swelling, redness, warm to touch, or foul discharges at the surgical site. b. Uncontrollable bleeding. c. Dislodged sutures.
COST AND PAYMENT
Otoplasty is considered to be reconstructive surgery more than a surgical cosmetic procedure which is why this can be covered by insurance. The surgeon’s fee for otoplasty is around $4000 and on top of this are anaesthetic fee and theater fee.
The total cost would depend on the approach needed, the place where it is done, and the surgeon who would perform this.
BEFORE AND AFTER KIDS OTOPLASTY
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