Otoplasty

Otoplasty (Greek οὖς, oûs, 'ear' + πλάσσειν plássein, 'to shape') denotes the surgical and non-surgical procedures for correcting the deformities and defects of the pinna (external ear), and for reconstructing a defective, or deformed, or absent external ear, consequent to congenital conditions (e.g. microtia, anotia, etc.) and trauma (blunt, penetrating, or blast). The otoplastic surgeon corrects the defect or deformity by creating an external ear that is of natural proportions, contour, and appearance, usually achieved by the reshaping, the moving, and the augmenting of the cartilaginous support framework of the pinna. Moreover, the occurrence of congenital ear deformities occasionally overlaps with other medical conditions (e.g. Treacher Collins syndrome and hemifacial microsomia). Otoplasty (Greek οὖς, oûs, 'ear' + πλάσσειν plássein, 'to shape') denotes the surgical and non-surgical procedures for correcting the deformities and defects of the pinna (external ear), and for reconstructing a defective, or deformed, or absent external ear, consequent to congenital conditions (e.g. microtia, anotia, etc.) and trauma (blunt, penetrating, or blast). The otoplastic surgeon corrects the defect or deformity by creating an external ear that is of natural proportions, contour, and appearance, usually achieved by the reshaping, the moving, and the augmenting of the cartilaginous support framework of the pinna. Moreover, the occurrence of congenital ear deformities occasionally overlaps with other medical conditions (e.g. Treacher Collins syndrome and hemifacial microsomia). Otoplasty (surgery of the ear) was developed in ancient India, in the 5th century BC, by the ayurvedic physician Sushruta (ca. 800 BC), which he described in the medical compendium, the Sushruta samhita (Sushruta's Compendium, ca. AD 500). In his time, the physician Sushruta and his medical students developed otoplastic and other plastic surgical 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 5th-century medical book, the Sushruta samhita. Moreover, two centuries later, contemporary otoplastic praxis, slightly modified, derives from the techniques and procedures developed and established in antiquity, by the Indian ayurvedic physician Sushruta. 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 pinna 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. In 1920, Harold D. Gillies (1882–1960) first reproduced the pinna by burying an external-ear support framework, made of autologous rib cartilage, under the skin of the mastoid region of the head, which reconstructed pinna he then separated from the skin of the mastoid area by means of a cervical flap. In 1937, Dr. Gillies also attempted a like pediatric ear reconstruction with a pinna support framework fabricated with maternal cartilage. That otoplasty correction technique proved inadequate, because of 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 the defects and deformities of the pinna; 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 pinna 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: a) 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. b) 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.