Prominent Ear Surgery

Prominent Ears are the most common congenital ear deformity; approximately with 5% prevalence. It is genetically inherited.

Average height of the ear ranges between 60 and 65 mm and the width ranges between 25 and 35 mm. Angle of the ear and the head is known as the cephalo-auricular angle and ranges between 20 and 30 degrees. Ear curve is called anthelix. Indentation of the cartilage is called concha. This particular deformity, which is called prominent ears, results from increased angle of the ears with the head, straightened ear curve or deeper concha either all in combination or in several at different degrees. The actual problem of deformity is determined before surgery and the applicable surgical operation is determined.

Prominent ear is a deformation that is a reason for mockery amongst school children, and that, in turn, results in psychological disorders. Studies demonstrate that ears take the final shape when we are 6-7 years old; it is therefore recommended that prominent ear surgery is performed in preschool period when the child is 6 years old. Since the ear cartilage is softer then, the surgery is much easier and yields much better results.

If the child was born with prominent ears, the ear cartilage can be corrected non-operatively with the help of headband and mould applications in the first 3 months of delivery as it is extremely soft due to maternal oestrogen hormone. For this reason, awareness should be raised between families so that they notice it at an early phase, preventing mockery or any potential psychological disorder in the future. This is also particularly important for raising self-confident individuals.

 

I would also like to mention threaded or non-operative ear aesthetics, which were quite popular some time ago and are still preferred by some colleagues today. The technique involves permanent threads placed behind the ears with no incisions. Applied in office environment under local anaesthesia, the technique partially appeals to brides that will tie the hair up for the wedding ceremony. People that need urgent results and somehow could not find the time for a surgical operation show interest in it. I have however learned from my personal experience and also from the publications released by surgeons around the world that problems occurred in almost all of the resultant ears. Nearly 50% of the patients complained that threads were extruded and nearly 50% of them complained about angular wide-apart of the ears. Most of my colleagues in the rest of the world, including myself, no longer resort to this technique as majority of patients complained for hypersensitivity behind the ears, extreme pain and infection – the latter being rarely though. I strongly recommend against this method even though I am aware that advertisements promising against prominent ears only in 10 to 15 minutes without incision or a surgical operation are appealing.

As a surgeon, who has applied all surgical techniques known in prominent ear operations, I have observed and pointed out to a set of problems occurring after surgery depending on the method used. These problems can be divided into 2, including early complications and late complications. Early complications are bleeding, hematoma, skin necrosis, wound dehiscence, and wound infection. Late complications are pain and hypersensitivity when touching the ears, irregularity and asymmetry, scarring, suture extrusion, and unsatisfactory aesthetic results such as telephone ear, and overcorrection etc. Of course, not all patients undergo these complications. I have preoccupied myself to come up with an excellent technique to eradicate these complications, and finally discovered a technique (A New Technique of Antihelixplasty: Proximal Based Dermo-Facioperichondral Flap), for which, I was awarded with a prize in a contest organised by the Turkish Society of Plastic, Reconstructive and Aesthetic Surgery. Also made into a scientific journal format, the technique generates an excellent solution for all problems encountered in any other techniques. I still use this particular technique and I have never been reported a complication. The flap technique has become popular in the rest of the world and is commonly in use.

 

Advantages of the technique are as listed below:

  • As I use absorbable sutures, suture extrusion after surgery or even after 1-2 years is out of question.
  • As I flatten the ears backwards with the flap tissue, dehiscence and relapses after surgery are out of question,
  • I avoid overcorrection at the back of the ear, which is likely to prevent wearing glasses, and results in an unnatural look,
  • As I do not intervene in the cartilage, no deformation occurs there.
  • As I place splints inside the ear, there is no need to wear a head band after the operation.
  • I do not intervene in the frontal side of the ears, so puffiness, bruises, hematom, circulation complications are not seen.
  • The technique can be applied under local anaesthesia
  • No keloid or hypertrophic scarring appears on the ears as the technique is applied behind the ears without removal of skin.
  • As it causes no trauma in the ear, the patient can turn back to his or her routine next day.
  • I call all my patients for a control examination and make measurements in Month 1, Month 6, Month 12 and Year 2 following the operation. I have noticed no dehiscence so far, and the technique is statistically proven as a permanent and durable one.

I perform surgeries under local anaesthesia. If the patient is 6 to 10 years of age, I recommend general anaesthesia as a child’s cooperation might not always be in full. The operation takes 45 minutes to 1 hour. The patient is discharged from the hospital the same day and can take a shower provided no water contacts the ears. Contact with water is allowed after 48 hours of surgery. Bandage is removed next day of the operation. No head band is necessary. The patient should be careful and take good care of the ears and not lie on them while sleeping. He or she can turn back to his or her social or professional life one day after the operation. Sutures behind the ears are removed in 1 week to 10 days following the operation.

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