The complexity of the ear shape leads to a wide variety of potential developmental deformities. Even in normal appearing ears, it is rare that both ears are perfectly symmetric in shape. Once type of well known congenital ear deformity is that known as lidding. When it appears in newborns it usually represents when the continuation of the antihelical fold, the superior limb of the triangular fossa, fails to form. Without the support of this cartilaginous crus the upper ear develops varying degrees of folding over or lidding. These are major in presentation and the ear looks both misshapen and vertically short.
But a very minor form of lidding can also occur when there is extra tissue on the inferior end of the superior crus. The superior helical rim is a bit thicker and careful assessment will also show there is a minor loss of vertical ear height compared to the non-lidded side. This microform presentation of lidding can be viewed as a modest presentation along the broad spectrum of the congenital folded ear.
This minor form of helical lidding can be treated by direct excision of skin and cartilage. The helical rim is thicker because of the cartilage is slightly vertically longer. Skin removal alone is inadequate. This can be done under local anesthesia. The excisional area is closed with tiny dissolvable sutures. The scar line will heal invisibly due to the vascularity of the ear skin and its location on the bottom of the helical rim above the scapha.
Lidding correction can be done concurrently with any other type of aesthetic ear surgery from setback otoplasties to vertical ear reductions.
Dr. Barry Eppley