Otoplasty / Pin Back of Prominent Ears and Conchal Reduction
The 3 principal causes of prominent ears are failure of scaphal folding, conchal hypertrophy and earlobe protrusion. Enlarged earlobe, wide scapha, prominence of Darwin’s tubercle may add to the deformity. Although the deformity seems minor, but it is frequently the subject of peer teasing and ridicule. Otoplasty generally refers to a surgical procedure to pin-back prominent ears. The most common method used is the anterior scoring technique together with conchal reduction when necessary.
The procedure involves making a cut behind the ear and lifting the skin off to expose the front surface of the ear cartilage. The front surface of the ear cartilage is scored (or partially cut) to make it curve backwards to create the antehelical folds. When there is concha prominence, a conchal reduction is performed by removing excess cartilage. A few internal stitches may be applied to hold the shape of the ear cartilage. The skin envelope is redraped to cover the cartilage. A tie-over dressing is applied to help mould the skin flap back onto the cartilage. For adult patients, the procedure can be done under local anaesthesia and sedation. General anesthesia is more suitable for children. The possible complications (<5%) include bleeding, hematoma, infection, skin blisters and loss of skin flap and cartilage.
The procedure takes about 2-3 hours. Post-operatively a head-bandage is applied to keep the dressings in place. The head bandage is removed on the next day after wound inspection if there is no evidence of haematoma. The stitches and tie-over dressings are removed after 1 week. For children, this procedure is usually done under general anaesthesia as day surgery or hospitalization for 1 day.
In our experience, the anterior scoring method in combination with conchal reduction when necessary creates the most natural folding and contour of the ear by shaping the cartilage. The result is long lasting with minimal risk of recurrence.
Earlobe Keloid Treatment
Earlobe keloid is one of the most common complication following ear piercing. The keloid usually develops after an episode of wound or skin infection. The keloid tends to grow in size and becomes hard. Sometimes they may symptomatic with itchness and tenderness on palpation. The approach to management of earlobe keloid is usually a combination of surgery and scar treatment thereafter to prevent recurrence.
A surgical excision is recommended as a first step to remove the hard nodular keloid scar. The surgery can be done under local anaesthesia. As much of the keloid scar is removed as possible and the wound closed primarily without much distortion to the earlobe. A clean surgical excision without any bleeding will ensure optimal healing condition for the wound and minimize the risk of recurrence. The union of the wound is achieved after 1 week when the stitches are removed.
One month after the excision when the wound is fully healed and stable, we begin the second step of the scar management with intralesional injection using triamcinolone. We advise gentle massage of the scar with silicone gel at home in between injections. A serial triamcinolone injection is done every 4-6 weekly until the scar remains soft and pliable. Usually most of them can be controlled after 3-5 treatments. There is a 10-20% risk of recurrence of the earlobe keloid.
Repair of Torn Earlobe
The most common cause of torn earlobe is accidental tearing while wearing ear-rings or prolonged use of heavy ear-rings. They result in an enlarged or open earlobe hole, which cannot hold or fit the ear-rings. The defect may be repaired under local anaesthesia by refreshing the edges of the hole and suturing them together. Meticulous surgical technique, good haemostasis and surgical repair are essential to achieve primary healing and retaining the shape of the earlobe. In most cases, the earholes are fully closed and a new earhole is created at a new location next to the repair after 3 months. Sometime the ear hole may be preserved using a flap rotation technique.
The procedure takes about 1 hour under local anaesthesia. The recovery time is about 1 week.