EAR SURGERY - OTOPLASTY

COSMETIC EAR SURGERY FOR PROTRUDING EARS

Protruding or prominent earlobes are congenital malformation that is visible right after birth. Parents usually recognize this deformity very early and very often (especially mothers) believe that the reason is child sleeping on the ear, so they try to fix it with band-aid. As you would expect – without success.

EAR SURGERY CANDIDATES

Protruding ears correction is performed after six years of age. Ears are usually subject of other kids teasing and giving various nicknames to the child (Dumbo, Flappy Ears). Later in life it can lead to low self-esteem. That is why plastic surgeons mostly recommend that this surgery should be performed before the school starts. In spite of that recommendation, according to statistics, patients most often decide for this type of surgery between age 10 and 18, and naturally there are many older patients. Women can hide moderate degree of ear deformity with their hair. If the ears are very prominent, practically no hairstyle can hide them.

Small children between ages six and ten are very motivated for this form of surgery. Usually children do not like much to go to doctors and they are scared on the very thought of injection. We who are dealing with these issues, in our experience have seen many children that climb on surgical table themselves and show excellent cooperation (apart from few exceptions) during this surgical procedure, most likely happy to end their friends' teasing.

Very important factors for positive selection of patients are emotional stability and realistic expectations.

PREOPERATIVE TREATMENT

Ear can be protruding on one side or on both sides. In addition, both ears can be protruding symmetrically or asymmetrically. In patients with protruding ears there are often present other earlobe deformities.

We say that the ear is protruding when the angle between backside of the ear and the head is larger than 30 degrees. There are other angles and parameters that are considered (e.g. conchoscaphoid, etc.). That will be determined by the plastic surgeon during the first examination if you decide to go through the surgery. Whether the ear is protruding can depend on its sizes. Small ear may look completely normal even if the conchoscaphoid angle is wide, while big ear with massive antihelix bend may look protruding. Children that undergo surgery for protruding ears mostly do not know how their ears should look like. They just want to end their friends' teasing. The older patients usually have clear vision how their ears should look like. During the first examination you’ll be asked to show exactly how you would like your ears to look like, which will help Dr. Milan Jovanovic to understand your expectations.

EAR SURGERY OBJECTIVE

Aim of the ear surgery is to correct prominence, to reach natural shape of the ear and remove psychological load on the patient. That can be accomplished by correction of upper ear end, by maintaining original smooth and regular helix line and by reduction of postauricular sulcus angle etc. depending on the shape of the ear, i.e. to form completely natural form of the ear.

EAR SURGERY PROCEDURE

First surgical techniques for correcting prominent ears were described back in 1845. Dieffenbach and later Monks were first who described this operation that was based only on skin excision. Of course, these techniques had been rejected long ago. Cornerstones of today's techniques were set by Luckett, later Pierce, Convers etc. These techniques for prominent ear correction are based on ear cartilage modeling. For the patient is not necessary to know which techniques are being used, but it is important to know that the most important part of procedure is cartilage modeling (which depends on method being used) mostly based on sawing of cartilage and bending it (Mustarde), thinning of the cartilage (Pierce), grinding, scarification (Stenstrom, Chongchet), crushing, cartilage abrasion from its front and rear side and different techniques of cartilage excision.

Prof. Dr. Milan Jovanovic has earlier used abovementioned techniques. Since he has seen many faults of these techniques he uses his own technique for more than ten years. With his own techniques he achieves impressive results, which he has published many times. He uses this technique depending on the shape of the ear, which he assesses before the operation in consultation with the patient.

Postoperative incision is not visible postoperatively, it is positioned behind the ear, hidden on the back of earlobe.

Ear surgery takes about one to two hours. With smaller children it is performed in general or local anesthesia with supporting analgosedation. With older children and adults it is performed in local anesthesia.

POSTOPERATIVE COMPLICATIONS

Complications that can appear just after the surgery are called acute complications. Ones that can appear later are chronic complications.

The most common of acute complications is hematoma (accumulation of blood between skin and cartilage). The most common of chronic complications are hypertrophic scar, rarely keloid, numbness that is temporary. If the ear surgery is performed correctly, complications occur rarely.

POSTOPERATIVE TREATMENT

After a few hours spent in hospital, the patient can be discharged. Depending on the technique used, bandages are kept for three to seven days. Sutures are removed after two weeks. It is advised to avoid strenuous activities and contact sports for a month or two. Postoperatively the patient need to go to regular check-ups agreed with his surgeon. At the check-ups, control photographing, results comparison and analysis is done.