Otoplasty Health Article

Definition

Otoplasty refers to a group of plastic surgery procedures done to correct deformities of or disfiguring injuries to the external ear. It is the only type of plastic surgery that is performed more often in children than adults.

Purpose

Otoplastic surgery may done for the following reasons:

• To reconstruct an external ear in children who are born with a partially or completely missing auricle (the visible part of the external ear). This type of birth defect is called microtia; it occurs in such disorders as hemifacial microsomia and Treacher Collins syndrome. Most cases of microtia, however, involve only one ear.
• To correct the appearance of protruding or prominent ears. This procedure is also known as setback otoplasty or pinback otoplasty.
• To correct major disparities in the size or shape of a patient's ears.
• To reshape deformed ears. One congenital type of deformity is known as Stahl's ear, which is characterized by a pointed upper edge produced by the flattening of the ear rim and folding of the cartilage. Stahl's deformity is also known as Vulcan ear or Spock ear because it resembles the ears of the well-known Star Trek character.
• To repair or reconstruct the auricle after traumatic injuries or cancer surgery.

Otoplasty is considered reconstructive rather than cosmetic surgery. Consequently, it is often covered by health insurance. People who are considering otoplasty for themselves or their children should check with their insurance carrier about coverage. The average surgeon's fee for an otoplasty in the United States in 2001 was $2,168.

Otoplasty is not done to correct hearing difficulties related to the structures of the middle and inner ear. Hearing problems are treated surgically by otolaryngologists (physicians who specialize in ear, nose, and throat procedures).

Demographics

Statistics for congenital deformities of the external ear are difficult to obtain because the causes are so diverse. Such genetic disorders as Treacher Collins syndrome and hemifacial microsomia affect between one in 3,500 and one in 10,000 children. In addition, microtia has been associated with certain medications taken during pregnancy—particularly anticonvulsants, which are drugs given to treat epilepsy, and isotretinoin, a drug prescribed for severe acne.

Stahl's deformity is found more often among Asian Americans than among Caucasian or African Americans. As of 2003, it is thought to be a hereditary disorder.

Setback or pinback otoplasty is the most frequently performed procedure for reconstruction of prominent or protruding ears. According to the American Society of Plastic Surgeons, 33,107 setback otoplasties were performed in the United States in 2001. This figure represents about 2% of all plastic surgical procedures. There are no exact statistics on the incidence of protruding ears in the general population, although about 8% of patients treated for this deformity have a family history of it. Large or protruding ears appear to be equally common in males and females; however, it is easier for girls and women to avoid social discomfort by styling their hair to cover their ears. This factor may explain why a slight majority (53%) of setback otoplasties is done on boys. Although most setback otoplasties are performed in children between the ages of four and 14, the second largest group of patients in this category is women in their 20s and 30s.

The most common cause of trauma requiring otoplasty is human and animal bites. Although exact figures are not known because many bite cases are not reported, a large percentage of dog and human bites cause wounds on the head and neck. With regard to human bites, the single most common injury requiring medical treatment is auricular avulsion, or tearing of the external ear. In the United States, 93% of patients treated for ear injuries caused by human bites are males between the ages of 15 and 25. Most cases of auricular avulsion in children, however, are caused by dog bites, which are likely to cause crushing as well as tearing of the tissues. Although statistics cover bites on all parts of the body, it is still noteworthy that plastic surgeons in the United States performed 43,687 operations to repair injuries caused by animal bites in 2001.

Description

Otoplasty in children is performed under general anesthesia; in adults, it may be done under either general anesthesia or local anesthesia with sedation. Most otoplasties take about two or three hours to complete. Many plastic surgeons prefer to use absorbable sutures when performing an otoplasty in order to minimize the risk of disturbing the shape of the ear by removing stitches later.