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The Existence of a Natural Plica at the Anatomical Base of the Antihelix and its Surgical Importance to Address Protruding Ears: An Anatomicosurgical Study

  • Original Article
  • Face and Neck Surgery
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Abstract

Background

Protruding ears represent the main abnormality of the external ear, which has required numerous anatomic and surgical studies. Most studies give attention to the absence of the antihelix as the anatomic defect responsible for the clinical deformity of the lateral aspect of the ear that leads to its anteversion. The reason for this study is the controversial origin of the fold of the antihelix within the auricle framework, a field of interest for aesthetic otoplasty. The current study examined the medial surface of the cartilaginous ear frame from cadaver specimens with right morphology to investigate the starting point of the fold of the antihelix. This allowed for verification of a natural plica at the anatomic base of this antihelical fold, which to date has not had its topography described morphologically. It is acknowledged that relevant literature makes no reference to this innominate natural plica at the origin of the antihelix, whose anatomic and surgical importance is related in this report. This study aimed to show that the existence of a natural plica at the base of the antihelix in ear framing represents a landmark between normal and protruding ear morphology.

Methods

For 8 years, 118 ears were carefully investigated within rigid ethical principles based on a thorough review of the pertinent literature. The study investigated 16 selected cadaver specimens and 102 protruding ears dissected by the senior author including 49 bilateral cases (26 males and 23 females) and 4 unilateral cases (2 males and 2 females). Bifacial anthropometric measurements by calipers were used for documentation.

Results

A natural plica at the base of the antihelix was found in all cadaver ears selected with right morphology, whereas it was totally absent in every surgically treated protruding ear irrespective of color, gender, age, or ethnic origin. Ambilateral measures of the antihelix eminence certify the study object in normal specimens as well as its lack in abnormal ones.

Conclusion

Technical and topographic knowledge that a natural plica exists at the anatomic base of the antihelix is a valuable key point in recognizing the normal external ear. In addition, the making of a natural plica is the first and most effective factor in the reconstruction of the antihelical fold and its absolute absence results in the pathologic condition for protruding ears.

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Notes

  1. Fold (in Latin, “duplare”): what is turned back, folded; double, duplex..

  2. Plica (in Latin “plicatus”): what is fastened, plicated..

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Acknowledgements

The authors thank Prof. John C Mustardé (in memoriam); Prof. Maria G Ferraz, Department of Anatomy UFMS Campo Grande; Mr. Oldemir Felix, Institute of Legal Medicine Campo Grande, MS; and colleagues Drs. Eloy Pereira, Joaquim Vieira, Eduardo Hindo, Roberto Nachif, Juarez Avelar, Frederico Pohl, and especially Prof. Jorge Miguel Psillakis, for the revision of the manuscript and encouraging words. Special thanks go to Prof. Benedito Aparecido de Toledo, Head Professor of the Department of Anatomy at Rio de Janeiro School of Medicine, Gama Filho University, for his invaluable assistance.

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Authors and Affiliations

  1. Division of Plastic Surgery at Santa Casa General Hospital, Campo Grande, MS, Brazil

    Miguel Marques Oliveira & Gustavo Sousa Marques Oliveira

  2. Marques Interclínicas, Av Afonso Pena 3504, Suite 126, Campo Grande, MS, 79002-075, Brazil

    Miguel Marques Oliveira & Gustavo Sousa Marques Oliveira

  3. Campo Grande Clinic General Hospital, Campo Grande, MS, Brazil

    Daniel Sousa Marques Oliveira

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  1. Miguel Marques Oliveira
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  2. Daniel Sousa Marques Oliveira
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  3. Gustavo Sousa Marques Oliveira
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Correspondence to Miguel Marques Oliveira.

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The authors declare that they have no conflicts of interest to disclose.

Additional information

The study has been conducted in the Interclínicas-Interplástica Clinic, Campo Grande, MS, Brazil, since 2004.

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Oliveira, M.M., Oliveira, D.S.M. & Oliveira, G.S.M. The Existence of a Natural Plica at the Anatomical Base of the Antihelix and its Surgical Importance to Address Protruding Ears: An Anatomicosurgical Study. Aesth Plast Surg 41, 321–326 (2017). https://doi.org/10.1007/s00266-016-0750-6

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