Most children have prominent ears. During development, their ears appear subtly larger in comparison to their head size. This is normal and improves with age. But a small percentage of children have a more exaggerated appearance. Their ears are cupped, prominently protrude from the head and lack normal definition. Severe cases do present real concerns: specifically involving the early school years (kindergarten through second grade) and a child’s interaction with his or her peers. Before that milestone age, children are rarely subjected to peer interaction for an extended period of time. Once in the early school years, psychoscocial development can be severely affected by prolonged negative peer interaction. The negative affects of teasing, taunting and social isolation is well supported in medical literature. Therefore, an evaluation of a child with a notable prominence of their ears is highly recommended before the age of 5. If the parents are considering corrective surgery, this should be completed around the time that primary school begins.
Parents are often surprised at how much the appearance of the ears can be improved with a simple operation. Utilizing a few technical maneuvers, the prominence is removed without drastically changing the natural shape of the ear. The scars are well hidden and the recovery is very short. Ultimately, the facial proportions are improved in a subtle and desirable manor. For children and adults alike, it is a great way to restore the natural balance to their face.
Two common findings on physical exam are synonymous with prominent ears:
The area commonly referred to as the anti-helix, consist of cartilage filled ridges located in the middle part of the ear, above the ear canal. In individuals with prominent ears, these ridges are blunted or are non-existent. During an otoplasty, it is these ridges that are reconstructed using permanent sutures and surgical techniques. This maneuver flattens out the top of the ears, removing the cupped appearance. Equally as important is the angle by which the ear protrudes from the head (cephaloauricular angle). On average, this angle is less than30 degrees when measured to the skin behind the ear. For individuals with prominent ears, this angle is often increased secondary to the prominence of the concha, which is the cartilage that surrounds the ear canal. During otoplasty, the angle and the prominence of the concha is addressed. This may require decreasing the angle of the ear with permanent sutures. In more severe cases, a portion of the concha is removed.
To actually examine the scar, the ear has to be manipulated by bending it forward. Immediately after surgery, the scar may be slightly red but this resolves within 6 months in almost all cases. In our office, we use multiple treatment modalities post-operatively to avoid a noticeable scar formation.
This surgery is very well tolerated, especially in children, but it is not pain free. There is often a mild to moderate amount discomfort, usually limited to the first week after surgery. For young patients, the pain is well controlled with Tylenol with codeine (Tylenol #3). For adult patients, a stronger oral pain medication is prescribed. Swelling can persist for up to 2 weeks. A compression dressing is often worn for the first week and antibiotics are required for a short period after surgery.
In children, rarely do I combine an Otoplasty with other surgeries. Clearly, for patients less than 5 years old, the surgery time should be limited. On the contrary, Otoplasty is almost always combined with other procedures in adults at my Denver area clinics. This includes, facelifts, rhinoplasties, chin implants and eye rejuvenation procedures. Adding on an Otoplasty to these cases does not increase the recovery time and has the benefit of enhancing the results.
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