Otoplasty, from Ancient Greek οὖς (oûs), meaning "ear", and πλαστός (plastós), meaning "moulded", is a procedure for correcting the deformities and defects of the auricle (external ear), whether these defects are congenital conditions (e.g. microtia, anotia, etc.) or caused by trauma. Otoplastic surgeons may reshape, move, or augment the cartilaginous support framework of the auricle to correct these defects. Congenital ear deformities occasionally overlap with other medical conditions (e.g. Treacher Collins syndrome and hemifacial microsomia).
History
Antiquity Otoplasty (surgery of the ear) was developed in ancient India and is described in the medical compendium, the Sushruta Samhita (Sushruta's Compendium, c. 500 AD). The book discussed otoplastic and other plastic surgery techniques and procedures for correcting, repairing and reconstructing ears, noses, lips, and genitalia that were amputated as criminal, religious, and military punishments. The ancient Indian medical knowledge and plastic surgery techniques of the Sushruta Samhita were practiced throughout Asia until the late 18th century; the October 1794 issue of the contemporary British Gentleman's Magazine reported the practice of rhinoplasty, as described in the Sushruta Samhita. Moreover, two centuries later, contemporary practices of otoplastic praxis were derived from the techniques and procedures developed and established in antiquity by Sushruta.
19th century In Die operative Chirurgie (Operational Surgery, 1845), Johann Friedrich Dieffenbach (1794–1847) reported the first surgical approach for the correction of prominent ears — a combination otoplasty procedure that featured the simple excision (cutting) of the problematic excess cartilage from the posterior sulcus (back groove) of the ear, and the subsequent affixing, with sutures, of the corrected auricle to the mastoid periosteum, the membrane covering the mastoid process at the underside of the mastoid portion of the temporal bone, at the back of the head.
20th and 21st centuries In 1920, Harold D. Gillies (1882–1960) first reproduced the auricle by burying an external-ear support framework, made of autologous rib cartilage, under the skin of the mastoid region of the head, which reconstructed the auricle; he then separated this from the skin of the mastoid area by means of a cervical flap. In 1937, Dr. Gillies also attempted a similar pediatric ear reconstruction with an auricle support framework fabricated from maternal cartilage. This otoplasty correction technique proved inadequate, due to the problems inherent to the biochemical breakdown and elimination (resorption) of the cartilage tissue by the patient's body. In 1964, Radford C. Tanzer (1921–2004) re-emphasized the use of autologous cartilage as the most advantageously reliable organic material for resolving microtia (abnormally small ears), because of its great histologic viability, resistance to shrinkage, and resistance to softening, and lower incidence of resorption. The development of plastic surgery procedures, such as the refinement of J.F. Dieffenbach's ear surgery techniques, has established more than 170 otoplasty procedures for correcting prominent ears, and for correcting defects and deformities of the auricle; as such, otoplasty corrections are in three surgical-technique groups:
Group I - Techniques that leave intact the cartilage support-framework of the ear, and reconfigure the distance and the angle of projection of the auricle from the head, solely by means of sutures, as in the permanent suture-insertion of the Mustardé technique the Merck stitch method and the incisionless Fritsch otoplasty for creating an anti helical fold: Mustardé technique: An open invasive method, whereby the retroauricular cartilage is extensively exposed, a part of the skin is excised, and mattress sutures are inserted. Merck stitch method: a minimally invasive method, by which the ear is no longer cut open and the cartilage is left completely intact. The mattress sutures are inserted in the ear through 2 to 3 small stab incisions on the back of the ear. Incisionless Fritsch otoplasty: It is a combination of the minimally invasive technique and the Stenström technique, whereby the cartilage on the front of the ear is scored with superficial incisions. Group II — Techniques that resect (cut and remove) the pertinent excess cartilage from the support-framework of the auricle, which then render it pliable to being re-molded, reconfigured, and affixed to the head at the projection distance-and-angle characteristic of a normal ear; the relevant procedures are the cartilage-incision Converse technique and the Chongchet–Stenström technique for the anterior-correction of prominent ears. Group III — Techniques that combine the excision of cartilage portions from the support framework of the auricle, in order to reduce the degree of projection and the distance of the external ear from the head.
Surgical anatomy of the external ear
The auricle The external ear (auricle) is a surgically challenging area in terms of anatomy, composed of a delicate and complex framework of shaped cartilage that is covered, on its visible surface, with thin, tightly adherent, hairless skin. Although of small area, the surface anatomy of the external ear is complex, consisting of the auricle and the external auditory meatus (auditory canal). The outer framework of the auricle is composed of the rim of the helix, which arises from the front and from below (anteriorly and inferiorly), from a crus (shank) that extends horizontally above the auditory canal. The helix merges downwards (inferiorly) into the cauda helices (tail of the helix), and connects to the lobule (earlobe). The region located between the crura (shanks) of the antihelix is the triangular fossa (depression), while the scapha (elongated depression) lies between the helix and antihelix. The antihelix borders in the middle (medially) to the rim of the concha (shell) and the concha proper, which is composed of the conchal cymba above (superiorly) and the conchal cavum below (inferiorly), which are separated by the helical crus, and meet the antihelix at the antihelical rim. The tragus (auditory canal lobule) and the antitragus (counterpart lobule) are separated by the intertragal notch; the auditory canal lobule does not contain cartilage, and displays varied morphologic shapes and attachments to the adjacent cheek and scalp.
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