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Facial Plast Surg
DOI: 10.1055/a-2447-8589
Original Article

Double Triangular Cartilage Excision in Otoplasty Revisited

Alessandro Gualdi
1   Department of Plastic Surgery, Milan Face Institute, Milan, Italy
2   Department of Plastic Surgery, University Vita-Salute San Raffaele, Milan, Italy
,
Janos Cambiaso-Daniel
1   Department of Plastic Surgery, Milan Face Institute, Milan, Italy
3   Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
,
Filippo Contessi Negrini
4   Department of Plastic Surgery, Santa Maria della Misericordia Hospital, University of Udine, Udine, Italy
,
Salvatore Giordano 
1   Department of Plastic Surgery, Milan Face Institute, Milan, Italy
5   Division of Plastic Surgery, Department of Surgery, Satakunta Wellbeing Services County, Pori, Turku, Finland
6   University of Turku, Turku, Finland
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Abstract

Background Prominent ears negatively impact the psychological and social health of individuals. Despite the availability of different surgical correction methods for this congenital condition, many of these techniques might result in significant risks of complications and the condition often reappears. Herein, we present log-term outcomes of our suture-free method that employs various strategies to reduce these risks and prevent recurrences.

Methods We analyzed the results of patients who had a bilateral double triangular cartilage excision otoplasty as an outpatient procedure. This previously described technique is designed to correct prominent ears by precisely removing sections of cartilage to reshape the ear mechanically without the need for sutures through the cartilage. We documented any complications after surgery and gathered feedback from patients over an extended follow-up period.

Results A total of 146 patients (292 ears) met the inclusion criteria. The mean age was 23.2 ± 5.3 years. The mean follow-up period was 22 months. Complications were as follows: 3 ears (1.02%) showed superficial skin tissue necrosis at the front of the ear and 17 ears (5.8%) needed further surgery due to unsatisfactory ear rotation. Additionally, 2.73% experienced wound dehiscence, 0.68% had hematomas, 1.02% had external ear infections that were treated with local and systemic antibiotics, 4.1% developed hypertrophic scars, and 8.2% experienced temporary paresthesias. Patients reported being satisfied with the final outcomes at follow-up.

Conclusion Double triangular cartilage excision otoplasty is a safe procedure with few complications, low recurrence rates, and good patients' satisfaction at long-term follow-up. This sutureless technique should be included as an alternative to the existing surgical techniques and added to the skill set of surgeons.

Level of Evidence IV.

Keywords

otoplasty - prominent ears - conchal hypertrophy - antihelix - complications - patient-reported outcomes


Publication History

Article published online:
24 November 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Janz BA, Cole P, Hollier Jr LH, Stal S. Treatment of prominent and constricted ear anomalies. Plast Reconstr Surg 2009; 124 (01) 27e-37e
    CrossrefPubMedSearch in Google Scholar
  • 2 Siegert R, Magritz R. Otoplasty and auricular reconstruction. Facial Plast Surg 2019; 35 (04) 377-386
    Thieme ConnectPubMedSearch in Google Scholar
  • 3 Jones ES, Gibson JAG, Dobbs TD, Whitaker IS. The psychological, social and educational impact of prominent ears: a systematic review. J Plast Reconstr Aesthet Surg 2020; 73 (12) 2111-2120
    CrossrefPubMedSearch in Google Scholar
  • 4 Driessen JP, Borgstein JA, Vuyk HD. Defining the protruding ear. J Craniofac Surg 2011; 22 (06) 2102-2108
    CrossrefPubMedSearch in Google Scholar
  • 5 Ersen B. A modification of the posterior perichondrio-adipo-dermal flap for protruding ear correction: a customized technique. Ann Plast Surg 2019; 83 (05) 500-506
    CrossrefPubMedSearch in Google Scholar
  • 6 Hoehn JG, Ashruf S. Otoplasty: sequencing the operation for improved results. Plast Reconstr Surg 2005; 115 (01) 5e-16e
    CrossrefPubMedSearch in Google Scholar
  • 7 Hendrickx BIMM, Hamdi M, Zeltzer A, Greensmith A. The 'WiFi' otoplasty: combined concentric posterior microchondrectomies and sutures for correction of prominent ears. J Plast Reconstr Aesthet Surg 2018; 71 (06) 900-905
    CrossrefPubMedSearch in Google Scholar
  • 8 Mogl AG, Palackic A, Cambiaso-Daniel J. et al. Conchal excision techniques in otoplasty: a literature review. Plast Reconstr Surg Glob Open 2022; 10 (06) e4381
    CrossrefPubMedSearch in Google Scholar
  • 9 Converse JM, Nigro A, Wilson FA, Johnson N. A technique for surgical correction of lop ears. Plast Reconstr Surg 1955; 15 (05) 411-418
    CrossrefPubMedSearch in Google Scholar
  • 10 Stenstroem SJA. “Natural” technique for correction of congenitally prominent ears. Plast Reconstr Surg 1963; 32: 509-518
    CrossrefPubMedSearch in Google Scholar
  • 11 Mustardé JC. The treatment of prominent ears by buried mattress sutures: a ten-year survey. Plast Reconstr Surg 1967; 39 (04) 382-386
    CrossrefPubMedSearch in Google Scholar
  • 12 Gualdi A, Cambiaso-Daniel J, Gatti J. et al. Double triangular cartilage excision otoplasty. Plast Reconstr Surg 2018; 141 (03) 348e-356e
    CrossrefPubMedSearch in Google Scholar
  • 13 Strychowsky JE, Moitri M, Gupta MK, Sommer DD. Incisionless otoplasty: a retrospective review and outcomes analysis. Int J Pediatr Otorhinolaryngol 2013; 77 (07) 1123-1127
    CrossrefPubMedSearch in Google Scholar
  • 14 Kühn S, Wöhler N, Wehle A. et al. Otoplasty through ventral skin incision and shaping of the antihelix by abrasion-a retrospective study. J Clin Med 2021; 10 (16) 3713
    CrossrefPubMedSearch in Google Scholar
  • 15 Ersen B. Posterior perichondrioadipodermal flap: a versatile option for revision otoplasty. Ann Plast Surg 2020; 84 (01) 20-23
    CrossrefPubMedSearch in Google Scholar
  • 16 Janis JE, Rohrich RJ, Gutowski KA. Otoplasty. Plast Reconstr Surg 2005; 115 (04) 60e-72e
    CrossrefPubMedSearch in Google Scholar
  • 17 Marino H, Aldogandolfo E. Surgical considerations on treatment of the protruding ear. Prensa Med Argent 1964; 51: 797-801
    PubMedSearch in Google Scholar
  • 18 Mandour YM, Abdelmofeed AM. Benefits of medially based perichondrio-adipo-dermal flap in cartilage sparing prominent ear surgery. Acta Otorrinolaringol Esp (Engl Ed) 2023; 74 (02) 69-78
    CrossrefPubMedSearch in Google Scholar
  • 19 Luckett WH. A new operation for prominent ears based on the anatomy of the deformity. Surg Gynecol Obstet 1910; 10: 635-637
    PubMedSearch in Google Scholar
  • 20 Mustarde JC. Correction of prominent ears using buried mattress sutures. Clin Plast Surg 1978; 5 (03) 459-464
    CrossrefPubMedSearch in Google Scholar
  • 21 Horlock N, Misra A, Gault DT. The postauricular fascial flap as an adjunct to Mustardé and Furnas type otoplasty. Plast Reconstr Surg 2001; 108 (06) 1487-1490 , discussion 1491
    CrossrefPubMedSearch in Google Scholar
  • 22 Hassanpour SE, Moosavizadeh SM. Posterior scoring of the scapha as a refinement in aesthetic otoplasty. J Plast Reconstr Aesthet Surg 2010; 63 (01) 78-86
    CrossrefPubMedSearch in Google Scholar
  • 23 Limandjaja GC, Breugem CC, Mink van der Molen AB, Kon M. Complications of otoplasty: a literature review. J Plast Reconstr Aesthet Surg 2009; 62 (01) 19-27
    CrossrefPubMedSearch in Google Scholar
  • 24 Alanazi H. Complications of cartilage sparing otoplasty: a systematic review and meta-analysis. J Craniofac Surg 2024; 35 (03) 874-878
    PubMedSearch in Google Scholar
  • 25 Hoshal SG, Morisada MV, Tollefson TT. Reducing surgical risks for otoplasty. Facial Plast Surg Clin North Am 2023; 31 (02) 253-261
    CrossrefPubMedSearch in Google Scholar
  • 26 Ozturan O, Dogan R, Ozucer B, Yildirim YS, Meric A. Dynamometric analysis of normative auricular stiffness and comparison with operated prominent ears. J Craniofac Surg 2015; 26 (07) 2155-2159
    CrossrefPubMedSearch in Google Scholar
  • 27 Nunes D, Haubner F, Kuehnel T, Gassner HG. Safety approach to otoplasty: a surgical algorithm. Facial Plast Surg 2015; 31 (03) 308-314
    Thieme ConnectPubMedSearch in Google Scholar
  • 28 Kompatscher P, Schuler CH, Clemens S, Seifert B, Beer GM. The cartilage-sparing versus the cartilage-cutting technique: a retrospective quality control comparison of the Francesconi and Converse otoplasties. Aesthetic Plast Surg 2003; 27 (06) 446-453
    CrossrefPubMedSearch in Google Scholar
  • 29 Taboada-Suárez A, Brea-García B, Couto-González I, Vila-Moriente JL. Correction of protruding ears (Weerda grade I deformity) using knotless bidirectional barbed absorbable sutures. Otolaryngol Head Neck Surg 2014; 151 (06) 939-944
    CrossrefPubMedSearch in Google Scholar
  • 30 Ozturan O, Dogan R, Eren SB, Aksoy F, Veyseller B. Cartilage-sparing techniques versus percutaneous adjustable closed otoplasty for prominent ear deformity. J Craniofac Surg 2014; 25 (03) 752-757
    CrossrefPubMedSearch in Google Scholar
  • 31 Ozturan O, Dogan R, Eren SB, Aksoy F, Veyseller B. Percutaneous adjustable closed otoplasty for prominent ear deformity. J Craniofac Surg 2013; 24 (02) 398-404
    CrossrefPubMedSearch in Google Scholar
  • 32 Cihandide E, Kayiran O, Aydin EE, Uzunismail A. A new approach for the correction of prominent ear deformity: the distally based perichondrio-adipo-dermal flap technique. J Craniofac Surg 2016; 27 (04) 892-897
    CrossrefPubMedSearch in Google Scholar