Eine einfache und physiologische Methode der Korrektur abstehender Ohren

Summary

In most protruding ears the antihelical fold is either poorly developed or completely missing. Many operative procedures therefore try to correct prominent ears by surgically creating a new antihelical fold.

Mustardé does it with 3–4 buried mattress sutures. Other authors try to fold the ear backwards by incising, abrading or removing a strip of cartilagefrom behind.

The new antihelix is usually secured with mattress sutures anchored to the cranium.

Stenström has demonstrated that it is easier and more physiological to break the spring of the ear cartilage alongthe front side of the proposed antihelical fold. Baruch, Kaye, Reichert and others have made use of this fundamental principle in different ways.

We developed a technique that allows correction of protruding ears with a minimum of surgical intervention and time, creating or increasing an antihelix by superficial scraping of the anterior perichondrium and cartilage.

Operative Technique (Figs. 1 to 8): Marking of the proposed antihelical fold and infiltration with local anaesthetic of anterior and posterior auricular skin along this line. The “tail” of the helical cartilage is then exposed and freed from its connective tissue attachments to the concha via a 1.5 cm skin incision at the posterior aspect of the lobule.

Tunnelling of anterior auricular skin along the marking through the retrolobular incision.

One leg of a sharp-toothed forceps or similar type of instrument is then introduced into this tunnel and the perichondrium and cartilage is scraped anteriorly along the new antihelix until the elastic spring is broken and the ear folds back into a more normal position.

In children (5–6 years of age) with thin and malleable ear cartilages this is all that is necessary.

In the majority of patients, however, it is better to secure the result with 3–4 buried chromic catgut or white silk sutures that are placed and reintroduced through their own stitch hole and tied within the depth of the concha anteriorly, n much the same way Kaye has proposed.

Sometimes an additional mattress suture is required to fix a protruding lobule to the mastoid process.

The retro-lobular incision may be closed by a pull-out 4-0 Nylon suture.

The ears are then covered with greased cotton wool and protected by a selfadhearing foam rubber dressing.

This operative technique has been applied to 30 patients (ages ranging from 5 to 28 years) with a total of 58 prominent ears over the past 1 1/2 years with pleasing results except for one (28a) suture fistula formation and one recurrence of a prominent lobule; both were easily corrected by one secondary mattress suture each.

The results were consistant and comparable to those achieved with other methods, yet with the following advantages.

• 1. Minimal surgical intervention on the growing ear cartilage with no exposure of cartilage; minimal bleeding or postop. discomfort and risk of infection.

• 2. Simple surgical technique with minimum of time consumption.

• 3. The missing or hypoplastic antihelix is created physiologically, delicately curved, neither as sharply edged as with cartilage excision nor as plump as sometimes with abrasion.

  The superior and inferior crura can be worked out individually.

• 4. The auriculo-cephalic sulcus is fully preserved, for no skin is excised. Scarring is minimal, as is the possibility of keloid formation.

• 5. The technique does not preclude any additional measures necessary in atypical ear deformities.

Zusammenfassung

Es wird über eine Methode der Korrektur abstehender Ohren berichtet. Ein minimaler chirurgischer Eingriff an der wachsenden Ohrmuschel mit kurzer Operationszeit erreicht auf physiologische Weise ein normal geformtes Ohr dadurch, daß die fehlende Anthelix durch subcutanes Knorpelritzen von vorne neu gebildet wird. Die neue Anthelixfalte wird in der Regel durch versenkte Matratzennähte gesichert.