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What is ear surgery?
Plastic surgery of the ear is commonly performed to
correct the position of the ears that protrude
significantly from the sides of the head. Such
protrusion makes the ears appear larger than normal.
Overly large ears are a rare condition called MACROTIA.
Protruding ears may occur on one or both sides in
varying degrees and are not associated with hearing
loss. Even adult dissatisfaction with previous ear
surgery is a basis for plastic surgery of the ear.
There are other less common ear deformities that can
affect one ear or both, and may or may not affect
hearing ability. The restricted ear also called a “lop
or cup ear’, has varying degrees of protrusion, reduced
ear circumference, folding or flattening of the upper
helical rim, and lowered ear position. The Stahl’s ear
is distorted in shape due to an abnormal position of the
superior crus to the antihelix. In cryptotia, or (hidden
ear) the upper rim of the ear is buried beneath a fold
of scalp secondary to abnormal folding of the upper ear
cartilage toward the head. The folding is the reverse of
that commonly seen in the protruding ear.
MICROTIA is the most complex congenital ear deformity.
The outer ear appears as either a sausage shaped
structure resembling little more than the earlobe, or it
may have more recognizable parts of the concha and
tragus or other normal ear features. It may or may not
be missing the external auditory or hearing canal.
Hearing is impaired to varying degrees. Reconstruction
of microtia requires staged surgical procedures (usually
3) to create a normal external ear. These surgeries may
be followed by surgery to improve hearing as well.
Treatment of protruding or disfigured ears is possible
as early as age 5, when a child’s ear cartilage is
stable enough for correction. Children who are good
candidates for ear surgery are:
• Healthy, without a life-threatening illness or
untreated chronic ear infections
• Co-operative and follow instructions well
• Able to communicate their feelings and do not voice
objection when surgery is discussed
Teenagers and adults defined as good candidates for ear
surgery are:
• A healthy individual, who does not have a
life-threatening illness or medical conditions that can
impair healing
• Non-smokers
• Individuals with a positive outlook, who has realistic
goals for improvement in mind
What makes my
surgery unique?
Each case of ear surgery is highly individual, as the
delicate and highly individual anatomy of the ear.
Through analysis of ear axis and positioning on the
head, ear size and angle of protrusion, Dr. Lovric will
tailor a technique to precisely correct the exact
features that are disproportionate or deformed.
Repositioning protruding ears is the most common form of
ear surgery performed. It is widely performed with a
good record of safety and fulfilling patient goals. Even
when only one ear appears to protrude, ear surgery may
be performed on both ears to achieve a more balanced
result. Just as all of our faces are asymmetric to some
degree, results of ear surgery may not be completely
symmetric, although the goal is to create an ear as
normal in structure and balanced in proportion to other
facial features as possible.
Surgery for constricted ear and other deformities may
use similar techniques as correction for protruding
ears, in addition to other methods. These more complex
techniques often utilize conchal cartilage that would
otherwise be discarded, as a graft to support and shape
the restructured ear. A secondary procedure to obtain an
optimal result may be necessary. An individualized plan
is always required to define goals and achieved desired
results.
Treatment of microtia involves an individualized
surgical plan that may require multiple procedures to
achieve desired results. While the goal is to create a
normal appearing external ear, ear reconstruction may be
combined with other surgery to improve hearing. Where
cartilage, the flexible, bone-like structure that forms
the outer ear, is badly misshapen or too little exists
to create a more normal ear, reconstruction may require
cartilage grafts. These are typically taken from the
existing ear structure or the patients ribs.
Ear surgery revision is sometimes requested by adults
who are dissatisfied with prior surgery. This may
include an unnatural appearance, over-correction where
ears appear to be sharply pinned back and irregularities
of the ear folds. Concern with residual earlobe
prominence is also common.
Even slight variations in normal ear anatomy can
significantly affect appearance. The most common
structures involved in protruding or deformed ears
include three formations of cartilage:
• The helical lobular complex (curve of the outer rim to
ear lobe)
• The anti-helical fold (curve just inside the helical
rim)
• The conchal complex or inner shell.
Correction of protruding ears uses surgical techniques
to create or increase the antihelical fold and to reduce
enlarged conchal cartilage. Internal, non-removable
sutures are used to create and secure the newly shaped
cartilage in place. External incisions close the
incision. Techniques are individualized, taking care not
to distort other structures and to avoid an unnatural
‘pinned back’ appearance.
Ear surgery offers near immediate results in cases of
protruding ears, visible once the dressings that support
the new shape of the ear during the initial phases of
healing are removed. With the ear permanently positioned
closer to the head. Surgical scars are either hidden
behind the ear or well-hidden in the natural creases of
the ear. With improved proportion and balance of facial
features, the newly formed ears will most likely be
framing a confident smile.
Following the surgery?
Bandages or dressings will be applied to keep the
surgical site clean, protect it from trauma and to
support the new position of the ear during initial
healing. Before released after surgery, you will be
given specific instructions that may include:
• How to care for the surgical site
• Keeping bandages or dressings intact
• Medications to aid healing and reduce the potential
for infection
• Specific concerns to look for at the surgical site or
in overall health
• When to follow up with Dr Lovric
Progress and healing?
Discomfort immediately following ear surgery is normal
and can be controlled with pain medication. There may be
an itchy feeling under the bandages. It is essential
that bandages remain intact and are not removed for any
reason. Failure to do so may result in loss of some of
the correction and may require a secondary surgery. A
return to light normal activity is possible as soon as
the day following surgery, as long as the ears are
protected. Children should refrain from rough or
aggressive play until healing is complete.
Dr Lovric will remove the dressing 5-7 days following
ear surgery. The surgical wound will be cleansed and any
external stitches will be removed. You will be
instructed on how to care for incision sites.
Healing will continue for several weeks and incision
lines will slowly refine and fade. Continue to follow Dr
Lovric’s instructions and attend follow up visits as
scheduled.
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