The shape of the ear is incredibly complex and it is a miracle that the ear is properly formed as often as it does. But when it does not become adequately shaped there are many possibilities for its deformity. One such category of congenital ear deformity is that of the constricted ear. This is where the outer rim of the ear is smaller than it should be or tightened…much like that of a cinch around a waistband.
One form of a constricted ear deformity is that of the lop ear or lidding deformity. Like the well known lop eared rabbit, this is where the top half of the ear folds over onto itself. This is due to a deficiency of natural cartilage or normal cartilage stiffness in the upper third of the ear involving the scapha, superior crus and triangularis fossa. Without this support the superior helix folds over causing a marked decrease in vertical ear height as well.
While the lop ear can be easily folded back up into an upright position manually, it will not so easily stay that way for it lacks structural support to remain so. Thus simple cartilage suturing, like that in a setback otoplasty (ear pinning), will not usually work or will only have short term shape retention. Cartilage grafting is usually need to provide the support or ‘framework’ for ear shape retention.
The cartilage graft can be easily harvested from the tail end of the one of free floating ribs. (numbers 9 or 10) Only a 2 to 2.5 cm length of rib graft is needed that is carved to a curved shape with the perichondrium removed from the convex side. The rib graft is inserted behind the ear through a postauricular incision after a pocket has been made and the entire folded cartilage exposed. The ear is then folded back and the rib graft placed between the folded sides and sutured into place. This provides a stable construct for the ear to heal in its new shape.
The severe lop ear deformity is best reconstructed with a small rib graft. This ensures the ear will heal in an upright position without risk of a recurrent fold over due to inadequate cartilage support.
Dr. Barry Eppley
Indianapolis, Indiana