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Background: Otoplasty is a very common aesthetic ear surgery that has a long history of various techniques to lessen the appearance of the protruding ear. Regardless of the technique used the goal is to being the ear to a more pleasing position along the side of the head. What the position is has an ideal numerical value known as the auriculocephalic angle which is in the range of 25 to 35 degrees. But in surgery there is no angular measuring device that is precisely used to measure this angle as the ear is repositioned. It is more of a judgment as to the degree of change that looks good to the surgeon’s eye.

Besides asymmetry between the two sides the main risk in otoplasty surgery is over- vs undercorrection.While the auriculocephalic angle can be a measured guideline to determine the success of otoplasty surgery, ultimately it is the patient’s assessment of the result that matters most. As a result there are going to be some patients who feel their ears need to be moved back more than the surgeon’s intraoperative judgment and, hopefully far more rarely, the need to bring the ears back out a bit.

While the techniques have been well described for primary otoplasty, how to do do so in a secondary otoplasty for further ear setback is less well known.                    

Case Study: This female has a prior primary setback otoplasty using a combination of concha-mastoid and anti helical fold horizontal mattress sutures. Her result was a vast improvement in and measured assessment. While happy with the initial result she came back six months later and wondered if it was possible to set the ears back even closer to the side of head. (further reduction of the auriculocephalic angle) 

Under general anesthesia and through her existing well healed postauricular incisional scars, the folded ear cartilages were exposed, a conchal wedge was removed and additional concha-mastoid sutures placed. The key is doing is to ensure that the helical rim does not disappear behind the antihelical rim from the front view. Also the more the helical rim moves back it becomes necessary to also set the earlobe back which does not move with the superior cartilage work.

Her second otoplasty results were not as pronounced as the first one which could be expected. But in setting the ear back to the maximum it is important to not lose sight of the helical rim. When that occurs the change could easily be viewed as an overcorrection.  

Case Highlights:

1) A secondary otoplasty can be performed to further reduce the auriculocephalic angle.

2) To maximize the position of the ear as close to the side of the head as possible cartilage excision is needed from the concha and/or some reduction of the postauricular sulcus.

3) While the auriculocephalic angle can be reduced below the normal range it is important to prevent the helical rim from disappearing behind the anti helical fold. 

Dr. Barry Eppley

Indianapolis, Indiana

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