Protruding Ears & Otoplasty
The treatment of protruding ears, otoplasty, is a very rewarding procedure for both the surgeon and the patient, especially in children. Children with protruding ears are often teased by their peers which can lead to serious body image problems, or in extreme cases, psychological problems. Helping a young person feel better about themselves and improve their self esteem is a true pleasure. Dr. Niamtu will assist selected families that cannot afford the surgery.
The best time to correct protruding ears is before the child enters school. The ear develops to its mature size early in childhood and most children can have corrective surgery between 5-7 years old.
Depending upon the procedure, recovery is usually several days. The patient will wear a tennis type headband for several days and at night for another week. Female patients can hide the ear with long hair and return to work in as little as 48 hours. Generally patients will refrain from strenuous exercise for 2 weeks. Again, depending on the procedure some patients will have sutures that are removed 14 days after surgery.
View Dr. Niamtu‘s video below before considering having otoplasty
How is the Otoplasty procedure performed?
Otoplasty (repair of protruding ears) is a very published procedure with hundreds of variations described by many surgeons over the past 50 years. Unfortunately, many of these procedures are shortcuts and although they may sound quick and easy, the results and longevity are frequently compromised. Like anything else in life, there is a right way and a wrong way and shortcuts frequently lead to poor results. To provide the best and longest lasting procedure, the surgeon must first understand the individual deformities that exist in the patient. Although this sounds very obvious, we frequently see patients presenting to our office that were improperly diagnosed and treated.
What causes protruding ears?
Problem Number 1: Undeveloped Antihelical Fold
Protruding ears are frequently hereditary and are passed down from one generation to the next. There are two main reasons for ear protrusion. The first reason is the lack of a defined antihelical fold on the external ear. In a normal ear, there is a well defined structure known as the anithelical fold which is shown in the picture below. When this normally well defined structure fails to develop normally, the ear protrudes.
This image shows a patient with a normal antihelical fold (A) and a patient without a developed antihelical fold.
Because the ear is not “folded back” in normal position, it protrudes away from the skull and sticks out as shown in the image below.
This patient has a left ear without a developed antihelical fold which makes it protrude from the skull.
To correct this type of problem, a Mustarde’ procedure (pronounced must-ard-y, named after a French surgeon) is performed. This procedure involves making a hidden incision behind the ear and placing specialized sutures to create a new antihelical fold which bends the ear back into its normal position.
This picture taken from a cadaver dissection shows how the specialized sutures fold the ear back. In figure A, the ear is unfurled due to the lack of a fold and in figure B, the ear is set back closer to the skull by the specialized Mustarde’ sutures.
The image below shows an artistic representation drawn by Dr. Niamtu illustrating the placement of the specialized sutures on the back surface of the ear under the skin.
This image shows the approximate placement of the Mustarde’ sutures used to tuck the ear back into normal position.
The above images shows how the Mustarde’ sutures not only create the new antihelical fold, but also reposition the ear to lie back in the proper position. The left image is before and the right image is after.
Problem Number 2: Excess Ear Cartilage
The second and equally important factor in protruding ears is excessive cartilage growth on the back of the ear (posterior wall of the conchal wall). Most patients actually have excess cartilage and an underdeveloped antihelical fold and need both problems treated. As elementary as this may sound, many surgeons do not realize this and do not perform the correct procedures for an aesthetic and lasting result.
The image (A) shows a patient with normal ear cartilage and the bottom image (B) shows a patient with excess cartilage growth contributing to the protruding ears.
If protruding ears from excess cartilage are treated with a procedure designed to create an antihelical fold, failure will result over time because of the effect of cartilage memory. Most patients with protruding ears need some cartilage removed. The most predictable means of doing this is called a Davis procedure and not all surgeons are skilled at this operation. The Davis procedure involves using a hidden incision behind the ear to remove a “kidney bean” shaped wedge of the excess cartilage. This allows the ear to sit further back towards the skull in a natural position. Because many surgeons do not understand this procedure or do not want to take the extra effort and time required to perform it, otoplasty may not be predictable. Instead of removing some excess cartilage (which is the root of the problem), many surgeons will simply suture the ear back to the soft tissues behind the ear which is called a “conchal setback or Furnas procedure. Although this will produce an improved result, the elastic nature of the excess cartilage will sooner or later cause the ears to protrude again, leaving a disappointed patient. Another problem with this type of treatment is that the ear canal becomes distorted and can produce an annoying and unaesthetic result.
The Davis procedure treats the source of the protruding ears by removing a small “kidney bean” shaped wedge of excess cartilage which allows the ear to set back to a normal position and does not rely on sutures to hold the ear back.
Again, 98% of the otoplasties that I perform require treatment of both the under developed antihelical fold and reduction of the excess cartilage. By combining these procedures I have been able to produce very cosmetic results that do not relapse. I have never had an ear re protrude that has been treated with these combination procedures.
This image shows the most common causes for protruding ears. This patient (like most patients with protruding ears) has an under developed antihelical fold (A) and excess cartilage behind the ear. Failure to treat both problems can cause an unaesthetic and unstable result.
When considering otoplasty for protruding ears, do your home work. Find a surgeon like Dr. Niamtu who appreciates the true causes of ear protrusion and can perform the proper procedures that lead to aesthetic and lasting correction.
It is not uncommon for patient of all ages to wear their hair long to hide protruding ears. It is very common for these patients to return to their post op appointment with short hair, often for the first time in their life. The young man shown below is an example of “hair style freedom” after otoplasty by Dr. Niamtu.
Sara is a cutie from out of town. She is shown before and 5 days after surgery (left) and several weeks after surgery (right).
The patients below were treated with dual procedures to reduce the amount of cartilage and to reconstruct the normal ear fold
One of the really rewarding things about otoplasty surgery is meeting really cool children like my buddy Hunter Ford shown below. What a handsome little guy!
The pictures above show my favorite twins. I performed otoplasty on these princesses in 2007 and they are shown in April 2012 in the bottom picture. Their ears still look great, although the surgeon has seemed to age a bit!
The correct surgery and diagnosis equals stable result and longevity
The patient below is shown before surgery (left image), 6 months after surgery (middle image) and 13 years after surgery (right image)