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Background: The ear has a complex shape due to its numerous cartilage convexities and concavities. Despite these topographic complexities the ear is best appreciated when it doesn’t stand out along the side of the head. (a normal auriculocephalic angle) But one other dimension, height, can also make the ear more noticeable than desired.

The typical height of the ear is stated to be in the low 60mm range, 63mms to be exact. The male ear is about 5% larger than a females which is also reflected in ear length. Generally an ear that has a height of 65mms or greater would be considered long and potentially unaesthetic.

Most male ears that I see for vertical ear reduction are usually north of 70mms. In these ears there is a large scapha furrow or helical fossa. This is the basis for the superior vertical ear reduction procedure by removal of part of the scapha fossa where permits the helical rim to be advanced downward, thus lowering the height of the ear.

But in patients with normal ear heights (65mms or less) the helical fossa is fairly narrow with little room for excision. This indicates that a different scapha cartilage approach is needed if the height of the ear is to be shortened.

Case Study: This male desired a smaller vertical ear height. By his own admission he needed just a little to bring down the upper helical curve a bit. He had a narrow helical fossa on both ears with an ear height of 65mms.

During his vertical ear reduction surgery an incision was initially made just inside the helical rim from the mid portion of the helix up to top off the scapha. A 5mm excision of skin and cartilage was down at the mid-helical rim level. The scapha cartilage was then incised all along its central length. The outer helical rim skin-cartilage flap was rotated downward and the cartilage edges overlapped rather than excised as in the traditional scapula reduction technique. This dropped the ear height down as the primary closure was done at the mid-helical horizontal scar line.

His immediate ear height changes was 5mms (65mms to 60mms) with a lower and rounder upper helical curve.

With a narrow or normal scapha furrow doing a cartilage and skin excision as in traditional vertical ear reduction may result in a cartilage or skin deficiency during closure. This will cause the helical rim to roll inward as it is advanced downward. It is better to not initially perform any excision, other than the needed mid-helical rim area, and only perform it during closure if needed.

The normal height ear can be vertically shortened a modest amount using a modified scaphal cartilage reduction technique with inferior helical rim advancement.

Case Highlights:

1) Vertical ear reduction is typically done in patients with large/long ears due to enlarged scapha and/or earlobe regions.

2) In the normal height ear vertical ear reduction can also be done but the scapha region has limited width to remove.

3) In the normal height ear it can be vertical shortened by a scapha cartilage split technique.

Dr. Barry Eppley

Indianapolis, Indiana

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