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Posts Tagged ‘macrotia’

Case Study – Macrotia Ear Reduction

Sunday, December 6th, 2015

 

Background: The embryology and development of the human ear is a marvel in not only its complexity but how well it works most of the time. It is created by the merging of six separate tissue segments (hillocks) in utero that create the recognizable ear that is a collection of various ridges and valleys. But due to its complex shape the ear is prone to a wide variety of congenital anomalies of which microtia is the most severe.

macrotiaThe opposite of microtia is macrotia where the ear is abnormally large. Unlike microtia where various parts of the ear are either missing or deformed, in macrotia the ear components are normal but bigger than desired. The ear is usually felt to be large primarily because it is vertically long. Various parts of the ear may be bigger than normal but usually the upper and lower thirds of the ear are what is too long.

The average height of the ear, as measured from the bottom of the lobule to the top of the upper helix, is in the range of 60 to 65mms. (average of 63mms) While they are some slight differences in these measurements between men and women, they are not all that different. (around 5% or less) The average length of the earlobe is around 18mms or about 1/3 of the total ear height.The average height of the pinna or cartilaginous portion of the ear, calculated by subtracting the earlobe height from the total ear height, was around 45mms.

Case Study: This 27 year male had ears that he felt were too big (long) as well as stuck out. He had seen other plastic surgeons but they only wanted to fix the protruding aspect of them. His total ear height was 76mms with an earlobe length of 24mms.

Vertical Ear Reduction result intraop Dr Barry Eppley IndianapolisUnder local anesthesia with infiltration around the base of his ear, three specific ear reshaping procedures were done. The earlobe was vertically reduced by 6mms with a helical rim excision technique. The upper third of the ear was reduced by 7mms using  scaphal excision of cartilage and outer skin with a helical rim reduction. (scapha-helical rim flap) Lastly ear was set back with concha-mastoid sutures from a postauricular incision. At the end of the procedure the total ear height was 65mms.

Macrotia ear reduction is done by reducing the height of the ear from the top (scapha-helical reduction) and bottom (earlobe reduction) simultaneously. Correction of any ear protrusion can be safely done during macrotia reduction surgery.

Highlights:

  1. Macrotia is an aesthetically abnormal enlargement of the ear that is most manifest in the vertical dimension.
  2. Macrotia ears usually have a combined increased height of the upper ear and longer earlobe.

3) Macrotia ear reduction surgery is done by an upper ear scapha-helical reduction flap and a helical rim earlobe reduction.

Dr. Barry Eppley

Indianapolis, Indiana

Otoplasty in the Long Ear (Macrotia)

Friday, May 15th, 2015

 

Prominent ears are the most common reason for an aesthetic otoplasty correction. There are numerous reasons that one has ears that stick out too far from the absence of the antihelical fold, a large concha or combinations thereof. The surgical techniques used to treat prominent ears are based on creating a more defined antihelical fold, reducing the size of the concha and/or reducing the concha-scapha angle. Generally the size of the ear is usually not of significance as the vertical height of the ear is normal.

In the May 2015 issue of the journal Plastic and Reconstructive Surgery, an article as published entitled ‘Precision in Otoplasty: Combining Reduction Otoplasty with Traditional Otoplasty’. In this paper the authors looked at a series of otoplasty patients who also had some degree of macrotia (long ears in addition to protruding ears) Over a three year period the authors reviewed over 80 otoplasty patients of which 30 had some scaphal reduction at the same time. (36%) The scapha reduction was performed from a lateral incision inside the helical rim. The helical rim was reduced to accomodate the reduced scapha. Earlobe reduction was performed at the same time in five patients. (6%) Almost 25% of the treated patients were revisions of a prior otoplasty of which they were dissatisfied. The results from 6 to 12 months after surgery had a 100% high satisfaction rate with no significant complications. (tissue loss, infection or shape recurrence) The only visible scar was on the helical rim with some slight notching.

Otoplasty with Earlobe Reduction result left sideWhether the height or vertical length of the ear is too long is a personal judgment but there are normative numbers that can be used in this assessment. The upper limits of a normal ear length is around 65 to 70mms in adults. When an ear is too long the usual culprits of elongation are either the earlobe, the upper third of the ear or both. While a vertical earlobe reduction is easier and creates less scar, scapha reduction should be considered if that is a contributing source of the ear elongation.

Protruding ears that are also enlarged are an underrecognized type of otoplasty patient. An enlarged scapha makes it difficult to set the protruding ear back properly and runs the risk of it being either under or over corrected. Scapha reduction offers a direct approach to the enlarged ear in either the primary or secondary otoplasty patient.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Vertical Ear Reduction (Macrotia Surgery)

Tuesday, February 11th, 2014

 

Background: Otoplasty is a common aesthetic surgery for ear reshaping which very successfully corrects a protruding ear problem. From incisions behind the ear,  a cartilage fold is created by sutures that pulls the helical rim backward reducing its outer prominence and lessening the aurioculomastoid angle. While ears that stick out often look big, they usually only appear that way due to their protrusion.

While protruding ears are very common, a truly large ear or macrotia is very rare. Macrotia would be defined by an ear height that exceeds the normative height of which numerous studies show a mean height of around 60 to 63mms from the apex of the superior helix down to the inferior extension of the lobule. These same studies show that the lobule comprises under 2 cms or less than 1/3 of the total ear height. Morphometric measurements aside, there is also the patient’s perception of whether they think their ear is too long regardless of the actual measurement.

Macrotia reduction surgery is quite different than a traditional setback otoplasty. True vertical ear reduction requires a shortening or removal of skin and cartilage to create that effect. While there are many wedge resection techniques that will create substantial vertical reduction, which are borrowed from skin cancer resection and ear reconstruction technique, they result in a substantial risk of a prominent scar across the central aspect of the ear. While staggering the incisions across the concave and convex surfaces of the ear can help with the scarring substantially, it is still a high risk manuever in the aesthetic ear patient.

Case Study: This 25 year-old young male wanted to decrease the size of his ears. He felt they were too long and disproportionate to the rest of his face. The vertical length of his  ears were 71mms. Most of the excessive ear height was in the upper 1/3 of the ear with a large scaphal fossa.

Vertical Ear Reduction Technique (Scapha Reduction) Dr Barry Eppley IndianapolisUnder a field block of local anesthesia at the base of the ear and then directly into the ear, a  bidirectional reduction approach was done. A 5mm helical rim reduction was done on the lobule. Then a 7mm resection of skin and cartilage was done of the scapha fossa, placing the closure just inside the helical rim. To get the reduction, a transverse full thickness incision was needed across the helical rim so that the top of the ear would rotate downward. Dissolveable sutures were used throughout all incisions.

Vertical Ear Reduction Dr Barry Eppley IndianapolisThis superior and inferior vertical reduction reduced the ear height down to 60mms. (reduction of 11mms). The scarring was very minmal and the only long-tern concern with healing would be a potential small notch deformity at the helical rim. This could be created by a small scar revision if necessary.

Vertical ear reduction (macrotia reduction) can be successfully done with judicious excisional locations and meticulous surgical technique. Macrotia surgery can be done under local anesthesia with no real recovery other than some ear swelling and mild ear discomfort.

Case Highlights:

1) The large ear, known as macrotia, is most commonly one of increased vertical height.

2) In macrotia reduction surgery, the goal is to place scars at inconspicuous locations as possible. The central wedge reduction method usually results in prominent scarring.

3) Superior scaphal and inferior helical rim reductions can create up to a cm. of vertical height ear shortening with very acceptable scarring.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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