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Aesthetic Otoplasty
Thomas Procedures in Facial Plastic Surgery
Peter A. Adamson MD, FRCSC, FACS
Professor and Head
Division of Facial Plastic and Reconstructive Surgery
Department of Otolaryngology - Head and Neck Surgery
University of Toronto
Toronto, Ontario, Canada
Facial Plastic Surgeon
Profi les Beverly Hills
Los Angeles, California, USA
2011
PEOPLE’S MEDICAL PUBLISHING HOUSE—USA
SHELTON, CONNECTICUT
People’s Medical Publishing House-USA
2 Enterprise Drive, Suite 509 Shelton, CT 06484 Tel: 203-402-0646 Fax: 203-402-0854 E-mail: info@pmph-usa.com
© 2011 PMPH-USA, Ltd.
All rights reserved. Without limiting the rights under copyright reserved above, no part of this publication may be repro­duced, stored in or introduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechani­cal, photocopying, recording, or otherwise), without the prior written permission of the publisher.
11 12 13 14/PMPH/9 8 7 6 5 4 3 2 1
ISBN-13: 978-1-60795-129-2 ISBN-10: 1-60795-129-0
Printed in China by People’s Medical Publishing House Copyeditor/Typesetter: Spearhead Global, Inc. Cover designer: Mary McKeon
LibraryofCongressCataloging‐in‐PublicationData
Adamson, Peter, 1946­Aesthetic otoplasty : Thomas procedures in facial plastic surgery / Peter A. Adamson, Jason A. Litner.
p. ; cm. — (Thomas procedures in facial plastic surgery)
Includes bibliographical references and index. ISBN-13: 978-1-60795-129-2 ISBN-10: 1-60795-129-0
1. Otoplasty. 2. Surgery, Plastic. I. Litner, Jason A. II. Title. III. Series: Thomas procedures in facial plastic surgery. [DNLM: 1. Ear, External—surgery. 2. Reconstructive Surgical Procedures—methods. 3. Surgery, Plastic— methods. WV 220] RF127.A33 2011
617.9'5—dc23 2011013729
Notice: The authors and publisher have made every effort to ensure that the patient care recommended herein, includ­ing choice of drugs and drug dosages, is in accord with the accepted standard and practice at the time of publication. However, since research and regulation constantly change clinical standards, the reader is urged to check the product information sheet included in the package of each drug, which includes recommended doses, warnings, and contra­indications. This is particularly important with new or infrequently used drugs. Any treatment regimen, particularly one involving medication, involves inherent risk that must be weighed on a case-by-case basis against the benefi ts anticipated. The reader is cautioned that the purpose of this book is to inform and enlighten; the information con­tained herein is not intended as, and should not be employed as, a substitute for individual diagnosis and treatment.
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Preface
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Otoplasty is often casually approached as a quick and relatively painless procedure, but the surgeon who is most knowledgeable understands the com­plexity of this ‘simple’ operation. Overcoming the intrinsic cartilaginous spring of the native auricle to reproduce a naturally symmetrical and stable contour, remains a very challenging proposition. Every good operation begins with a meticulous assessment and assiduous operative planning. Assurance of a satisfactory otoplasty result rests also on fastidious execution of that plan with a view to­wards reinforcing the stability of the cartilaginous auricular framework. Our graduated technique, starting with conservative postauricular skin exci­sion and conchal setback, and followed by anti­helical shaping via precise suture placement, has yielded exceedingly reproducible outcomes and a high degree of patient satifaction in our hands. Sup­plementary adjustments can then be individualized based on the persistent deformity noted. We reserve cartilage-cutting techniques for the rare instance of a densely thickened or infl exible cartilage that is re­fractory to cartilage-sparing manipulations.
A formula for enduring success with this fascinating aesthetic procedure combines an ap­preciation for anatomic nuance with painstak­ing attention to detail and untiring intraoperative reevaluation. The vast number of known otoplasty methods is a tribute to the level of diffi culty in­volved in this procedure. The objective of this vol­ume is to provide a critical and comprehensive review of the state-of-the-art of our specialty as it relates to cosmetic auricular surgery. It is our hope that this information has been distilled to the ex­tent that surgeons of every experience level may fi nd some surgical pearls within these pages that are of some use to their current and future practice of otoplasty. Whatever the preferred maneuvers, adherence to the goals and principles outlined in this volume will help to circumvent the manifold pitfalls associated with this challenging but reward­ing operation.
Peter A. Adamson, MD, FRCSC, FACS
Jason A. Litner, MD, FRCSC
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Table of Contents
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Chapter 1 History and Philosophy .....................................................................1
Introduction ..................................................................................................................................................1
References ......................................................................................................................................................4
Chapter 2 Anatomy and Embryology................................................................. 7
Introduction ..................................................................................................................................................7
Auricular Histology .......................................................................................................................................7
Auricular Embryology ...................................................................................................................................8
Auricular Anatomy ........................................................................................................................................9
References ....................................................................................................................................................13
Chapter 3 Aesthetic Parameters and Specifi c Deformities ........................ 15
Introduction ................................................................................................................................................15
Auricular Deformities ..................................................................................................................................16
Specifi c Auricular Syndromes......................................................................................................................17
References ....................................................................................................................................................19
Chapter 4 Clinical Evaluation, Surgical Goals and
Psychological Implications ................................................................................ 21
Introduction ................................................................................................................................................21
Physical Examination ..................................................................................................................................21
Photographic Assessment ............................................................................................................................22
Surgical Goals ..............................................................................................................................................22
Psychological Implications and Timing of Surgery ....................................................................................25
References ....................................................................................................................................................27
Chapter 5 Marking, Infi ltration, and Soft Tissue Management .............. 29
Introduction ................................................................................................................................................29
Surgical Technique .......................................................................................................................................30
References ....................................................................................................................................................34
viii / Table of Contents
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Chapter 6 Cartilage Management ................................................................... 35
Introduction ................................................................................................................................................35
Surgical Technique .......................................................................................................................................36
References ....................................................................................................................................................43
Chapter 7 Adjunctive Procedures: Management of the Helix,
Scapha, and Lobule ................................................................................................45
Introduction ................................................................................................................................................45
Surgical Technique .......................................................................................................................................45
References ....................................................................................................................................................53
Chapter 8 Closure, Dressings, and Postoperative Care ..............................55
Introduction ................................................................................................................................................55
Surgical Technique .......................................................................................................................................55
References ....................................................................................................................................................62
Chapter 9 Selected Cartilage-Cutting Otoplasty Techniques ................63
Peter A. Adamson and Jason A. Litner
Introduction ................................................................................................................................................63
Surgical Technique .......................................................................................................................................63
References ....................................................................................................................................................71
Chapter 10 Selected Cartilage-Scoring Otoplasty Techniques ...............73
Introdution ..................................................................................................................................................73
Surgical Technique .......................................................................................................................................74
References ....................................................................................................................................................85
Chapter 11 Selected Small Incision and Incisionless
Otoplasty Techniques ..........................................................................................87
Introduction ................................................................................................................................................87
Surgical Technique .......................................................................................................................................87
References ....................................................................................................................................................94
Chapter 12 Selected Cartilage-Suturing Otoplasty Techniques .............95
Introduction ................................................................................................................................................95
Surgical Technique .......................................................................................................................................95
References ..................................................................................................................................................100
Chapter 13 Selected Combination Otoplasty Techniques ......................... 101
Introduction ..............................................................................................................................................101
Surgical Technique .....................................................................................................................................101
References ..................................................................................................................................................114
Chapter 14 Comparison of Otoplasty Techniques .......................................117
Introduction ..............................................................................................................................................117
Surgical Technique .....................................................................................................................................117
References ..................................................................................................................................................121
Table of Contents / ix
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Chapter 15 Complications of Otoplasty ....................................................... 123
Introduction ..............................................................................................................................................123
Early Complications ..................................................................................................................................124
Late Complications ....................................................................................................................................129
References ..................................................................................................................................................132
Chapter 16 Aesthetic Pitfalls in Otoplasty .................................................135
Introduction ..............................................................................................................................................135
General Aesthetic Pitfalls ...........................................................................................................................135
Specifi c Technical Aesthetic Pitfalls ...........................................................................................................141
Reverse Telephone Ear Deformity .............................................................................................................141
References ..................................................................................................................................................144
Index ...................................................................................................................... 147