OTOPLASTY RECONSTRUCTIVE SURGERY AFTERCARE

otoplasty reconstructive surgery - diagnosis / preparation
Congenital abnormalities of the ear
Diagnosis of microtia is made by the obstetrician or pediatrician at the time of the child’s birth. The diagnosis of prominent or protruding ears, however, is somewhat more complex because the deformity is a matter of shape and proportion rather than the absence or major malformation of a body part. The head of a newborn infant is larger in proportion to its body than is the case in adults, and as a result, the shape of the ears may not concern the parents until the child is two or three years old.

Otoplasty to correct microtia is usually started when the child is at least five years old. The surgeon must remove a portion of rib cartilage in order to construct a framework for the missing ear, and children younger than five may not have enough cartilage. In addition, it is easier for the surgeon to use the child’s normal ear as a model for the size and shape of the reconstructed ear when the child is five or seven years old. Otoplasty for microtia is preceded by consultations between the surgeon and the child’s parents. Following the diagnosis, a comprehensive treatment plan is made that includes long-term psychosocial as well as surgical follow-up. The reconstruction of a missing ear must be done in several stages because the surgeon must allow for changes in the proportions of the child’s face and skull as he or she matures as well as attempt to make the new ear look as normal as possible.

As of 2003, there is some debate among plastic surgeons concerning the best age for performing a setback otoplasty. Many recommend the operation when the child is between five and seven years old. One reason is that the human ear has attained 85–90% of its adult size by this age, and therefore the surgeon can estimate the final size and shape of the ear with considerable accuracy. In addition, the cartilage in the ear is still relatively soft and easier for the surgeon to reshape. Another reason for performing an otoplasty in children in the early elementary school years is psychological; name-calling and teasing by peers can be emotionally destructive for children in this age bracket. On the other hand, some surgeons have reported performing setback otoplasties on children as young as nine months with no disturbances in the growth of the ear or recurrence of the problem.

Preparation for otoplasty in children should include an assessment of the child’s feelings about the procedure. Some surgeons consider opposition on the child’s part to be a contraindication for surgery, as well as unrealistic expectations on the part of the parents. In general, a positive attitude is associated with faster recovery and better overall results.

Preparation for otoplasty in adults includes a physical examination and standard blood tests. Patients are usually advised to discontinue taking aspirin and any other medications that thin the blood for two weeks prior to surgery. Plastic surgeons strongly urge adult patients to quit smoking before the surgery, because smoking delays and complicates the healing process. Adult patients are also asked to shower and shampoo their hair thoroughly on the morning of the procedure. Men should have a haircut or trim a day or two before surgery; women should braid or pin their hair close to the head.

Trauma
Avulsion injuries caused by bites, thermal or chemical burns resulting from industrial accidents, and other traumatic injuries of the auricle are diagnosed by emergency physicians.

Plastic surgery for traumatic injuries of the auricle is preceded by thorough cleansing of the wound and debridement of damaged tissue. It is important to treat ear injuries promptly because the ears are not well supplied with blood vessels. This characteristic makes it easier for infection to develop in parts of the auricle where the skin has been torn open or crushed. In some cases, plastic surgery is postponed for a few days and the patient is given oral penicillin to prevent infection.

Aftercare
After an otoplasty, the patient’s head is wrapped with a turban-type bandage that is worn for four or five days following surgery. The patient is instructed to wear a ski-type headband over the ears continuously for about a month after the turban is removed, and then at night for an additional two months. Warm compresses should be applied to the ears two or three times a day for two weeks after the turban is removed.

Patients should follow the surgeon’s instructions about washing their hair, and avoid holding hot-air blow dryers too close to the ear.

Patients should also avoid contact sports for at least three months after otoplasty. An anti-inflammatory medication (Kenalog) can be applied to the ear in the event of abnormal scar formation.

Risks
Some risks associated with otoplasties are common to all operations performed under general anesthesia. They include bleeding or infection of the incision; numbness or loss of feeling in the area around the incision; and a reaction to the anesthesia.

Specific risks associated with otoplasties include the following:
• Formation of abnormal scar tissue. This complication can usually be corrected later; plastic surgeons advise waiting at least six months for revision surgery.

• Hematoma, which is a collection of blood within a body organ or tissue caused by leakage from broken blood vessels. In the case of the ear, a hematoma can damage the results of plastic surgery because it creates tension and pressure that distort the final shape of the ear. Careful drying of the ear at the end of the procedure and application of a pressure bandage can reduce the risk of a hematoma. In the event that one develops, it is treated by reopening the incision and draining the collected blood.

• Distortion of the shape of the ear caused by overcorrection of deformed features.

• Reappearance of ear protrusion (in setback otoplasty). This complication is most likely to occur in the first six months after surgery.

Normal results
The normal result of an otoplasty is a reconstructed or reshaped ear that resembles a normal ear (or the patient’s other ear) more closely. In a setback otoplasty, the normal result is an ear that lies closer to the patient’s head without an overcorrected, pinned-back look.

Morbidity and mortality rates
The mortality rate in otoplasty is extremely low and is almost always associated with anesthesia reactions. The most common complication reported is asymmetrical ears (18.4%), followed by skin irritation (9.8%); increased sensitivity to cold (7.5%); soreness when the ear is touched (5.7%); abnormal shape to the ear (4.4%); loss of feeling in the ear (3.9%); bleeding (2.6%); and hematoma (0.4%).

Alternatives
Some ear deformities in children, including protruding ears and Stahl’s deformity, can be treated with ear molding in the early weeks of life, when the cartilage in the ear can be reshaped by the application of splints and Steri-Strips. One technique involves making a mold in the shape desired for the child’s ear from dental compound and attaching it to the ear with methylmethacrylate glue. The ear and the mold are held in place with surgical tape and covered with a tubular bandage or ear wrap for reinforcement. The mold and tape must be worn constantly for six weeks, with a change of dressing every two weeks. Ear molding is reported to be about 85% effective when it is started within six weeks after the baby’s birth. It costs less than surgery - about $600 - and is considerably less painful. The chief disadvantage of ear molding is its ineffectiveness in treating ear deformities characterized by the absence of skin and cartilage rather than distorted shape.

There are no effective alternatives to otoplasty in treating ear deformities or injuries in adults; however, some plastic surgeons use custom-made silicone molds to help maintain the position of the ears in adult patients for several weeks after surgery.