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Surgery to correct protruding ears is referred to as otoplasty. To determine whether this procedure is cosmetic or reconstructive surgery we must ask, “what is the function of the external ear?” The external ear has two major purposes and thus at least two functions. One function is to help direct sound waves to the external auditory canal, thereby impoving our ability to hear. Another important function of a highly visible body part such as the ear is to fall into the normal range of appearance for that part. Ears which protrudes from the head straight out do so because of abnormalities in the development of the cartilage of the ear. Such deformities attract unwanted attention and children with these deformities often are called Dumbo by their peers who have seen the Disney classic. Other remarks such as “ears like a barn door” are not uncommon. While everyone knows someone who by force of personality has overcome such denigrating remarks and attitudes, there are many more children who quietly fade into the background and hide from such attention. The degree of deformity varies from very mild to severe. When does the deviation from normal become severe enough to warrant reconstructive surgery? Perhaps when the protruding ears are the first thing most people notice when they initially meet the child.

Our awareness of body image with regard to facial features is usually apparent by age 5. Children usually begin school around this time and school mates may call attention to ear deformities at this important juncture self image. The ear has completed 85% of its growth by age 3. There is very little ear growth after age 10. Correction of protruding ears is generally carried out from age 4 onward depending on when the patient presents for consideration of surgery.

There are a number of factors in the development of the ear carilage that affect the shape of the ear. In the majority of cases there is a combination of too much cartilage in the central bowl shaped portion of the ear called the shell, and a failure of the natural folds to develop in the portion of the ear known as the antihelix. There are other types of deformity of the cartilage resulting in constriction of the ear as well as more severe failures of intra-uterine development leading to the condition known as microtia which will be covered in a separate site in the near future. The specific maneuvers needed for surgical correction of the more common protruding ears will depend on the degree to which excess conchal cartilage or failure of development antihelical fold predominate in the production of the defect. Some general comments will apply in the majority of cases.

Most Otoplasty procedures can be done on an outpatient basis. Younger patients will require a general anesthetic and older patients may prefer general anesthesia as well. The incisions for this type of surgery can usually be hidden behind the ear or in the folds of the ear. The thrust of the procedure is concerned with alteration of the cartilage framework. Some permanent buried sutures are usually needed to hold the desired shape of the newly molded cartilage. The skin over the cartilage is usually quite thin and even relatively minor irregularities in the cartilage may be visible on close inspection following surgery. These are often not at all apparent to the casual observer however. It is difficult to get the two ears corrected to exactly the same end point though the surgeon always aims for and works hard toward this goal.

The pictures below show the post-operative result in the child pictured above.

before and after otoplasty operation sugery photos

The risks and complications associated with Otoplasty incude those risks associated with any operation involving general anesthesia. Wound infection can occur and is very troublesome if it involves the cartilage. This degree of wound infection is not common but it could result in severe deformity requiring further surgical procedures. A hematoma (collection of blood) between the skin and cartilage can cause loss of skin or disturb the cartilage repair and most surgeons try to prevent this by placement of active drains or special dressings which are sometimes even suture in place. It is possible for the sutures holding the new cartilage shape to pull through the cartilage or to break. Either event might lead to a need for revision of the reconstruction. Post operative care may involve the need to wear special bandages for a period of time.

The majority of patients who have undergone otoplasty are pleased with their result. It is likely that at least one person you are acquainted with has had such surgery during childhood