Background: The webbed neck is a well known congenital deformity that is associated with many different syndromes and conditions, most notably Turner’s syndrome. Its embryology is not precisely known although it is somewhat simplistically obvious looking at facial development and the migration of the ears upward from the neck at around 7 to 8 weeks in utero. The ears, mandible and neck are all interrelated at this point.
Because of the embryologic proximity it is common to see an elongated ear that sticks out, a short chin and/or submental fullness in many webbed neck patients. This may be most manifest in the Turner’s syndrome patient but there is evidence of it even in less affected mosaic-type patients. This triad of webbed neck deformities can all be treated during the webbed neck surgery although the intraoperative positioning must change to do so.
Case Study: This adult female (non-Turner’s) desired to have her neck webs reduced. At the same time she wanted her ears setback, which were long, but their increased length was not a concern to her. Lastly she had good chin projection but an obtuse cervicomental angle. (submental fullness)
Under general anesthesia and in the prone position a diamond pattern excision pattern was marked out with the direction of needed greatest web neck pull along its horizontal axis. The skin and very thick underlying fat tissue was excised down to the muscle fascia. Midline fascial plication was done with large permanent sutures.
The outer limbs of the diamond excision were brought into the midline and closed in multiple layers to further pull in neck webs. (diamond shape excision to vertical line closure)
From the same prone position the setback otoplasties were performed by.a small amount of postauricular skin excision and concha-mastoid sutures.
Finally in the prone position submental liposuction was performed with a small cannula.
Her early postop results showed a visible reduction in her neck webs. Measured evidence of the decrease in the neck width is seen in the lower hanging pendant from the neck chain. (now hangs 3 cmws lower) The ear position is also improved.
From the back view the neck webs showed similar improvement as well as that of the ear position.
The triad of webbed neck deformities involves the neck, ears and chin. It is almost as if they are being pulled toward that central neck point…or more accurately did not fully migrate into their most upward and inward positions. (particularly the neck and ears) Surgically pulling the neck inward and the ears back helps get them closer to their more ideal embryologic migration endpoint. There is always the question of whether or how much relapse will occur in webbed neck repairs, and there is almost always some, but once the patient gets to 4 to 6 weeks after the surgery the result stabilizes and then it is just a question of how the posterior neck scars do and will there will be any residual fullness that appears in the upper back below the incision line.
Key Points
1) Webbed neck patients often have a triad of deformities affecting the neck, ears and chin/neck which are embryologically connected.
2) During the webbed neck repair the setback otoplasty can be done from the same prone intraoperative position.
3) The chin deformity either requires an implant augmentation or submental liposuction or both.
Dr. Barry Eppley
World-Renowned Plastic Surgeon