Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_813_Библиотеки_им_академика_М_И_Перельмана.pdf
368 Part VII&Facial Surgery
CERVICOMENTAL ANGLE
8. The angle between the chin and neck on sagittal view is ideally how large?
C. 105–120 degrees.
The cervicomental angle ideally should not be very obtuse or acute. Soft tissue techniques such as submental
lipectomy, platysmaplasty, anterior digastric resection, or submandibular gland resection can be used to
address aesthetic issues pertaining to the neck and submental region.
1,2,3
REFERENCES
1. Cohen SR. Genioplasty. In: Achauer BM, Eriksson E, Guyuron B, et al, eds. Plastic Surgery: Indications, Operations,
and Outcomes. Vol. 5. St Louis, Mosby–Year Book; 2000
2. Guyuron B, ed. Genioplasty. Boston: Little Brown; 1993
3. Yaremchuk MJ. Facialskeletal augmentation.In: Mathes SJ, Hentz VR, eds. Plastic Surgery: The Head and Neck. 2nd
ed. Philadelphia: Saunders Elsevier; 2006
WITCH'S-CHIN DEFORMITY
9. A witch's-chin deformity is best repaired via which surgical maneuvers?
D. Soft tissue correction.
Witch's-chin deformity is caused by ptosis of soft tissue caudal to the menton. As such, correction
involves soft-tissue techniques only, such as soft tissue or muscle resection (Table 49.1). In fact, augmentation may exaggerate the deformity.
Table 49.1 Classification System for Chin Deformity and Correction
Type Deformity Vector and Surgical Treatment
Class I Macrogenia Horizontal: Osteotomy with setback or osteotomy
Class II Microgenia Horizontal: Osteotomy with advancement, autogenous or alloplastic augmentation
Class III Combined Horizontal macrogenia with vertical microgenia: Osteotomy with lengthening and
Class IV Asymmetrical Short anterior lower face: Addition of wedge of bone to short side
Class V Witch's-chin Soft tissue correction
Class VI Pseudomacrogenia Soft tissue adjustment (not predictable)
Class VII Pseudomicrogenia Maxillary osteotomy
(Source: Reprinted with permission from Guyuron B, Michelow BJ, Willis L. Practical classification of chin deformities.
Aesthetic Plast Surg 19:257, 1995.)
1
Vertical: Osteotomy and resection
Both horizontal and vertical: Osteotomy, resection, and setback
Vertical: Osteotomy and lengthening, with or without graft
Both horizontal and vertical: Osteotomy, lengthening, and advancement, with or
without graft
setback
Horizontal microgenia with vertical macrogenia: Osteotomy with resection of horizontal segment and advancement
Normal lower facial height: Removal of wedge of bone from long side; add to short side
Long anterior facial height: Removal of wedge of bone based on long side
REFERENCE
1. Guyuron B, Michelow BJ, Willis L. Practical classification of chin deformities. Aesthetic Plast Surg 1995;19:257
POROUS POLYETHYLENE IMPLANT
10. Which of the following is an advantage of the porous polyethylene implant?
A. Lower infection rates than other implant types possibly due to increased vascular ingrowth.
The distinguishing characteristic of porous polyethylene implants is that they contain microscopic pores
that allow vascular ingrowth. The advantages conferred are a lower tendency to migrate and erode
underlying bone, and lower infection rates when compared with other types of implants, which are
incorporated into the tissue via encapsulation. However, there are disadvantages inherent to this
implant material and the resulting tissue architecture: placement is more difficult, requiring a larger
Chapter 49&Genioplasty 369
soft tissue pocket, and removal is likewise more difficult, as vascular ingrowth results in an implant
that is more tightly adherent to the surrounding tissues. Porous polyethylene implants can cause
prolonged edema/inflammatory reaction.
1,2
REFERENCES
1. Warren SM, Spector JA, Zide BM. Chin surgery VII: the textured secure implant—arecipeforsuccess.PlastReconstr
Surg 2007;120:1378
2. Guyuron B, Raszewski RL. A critical comparison of osteoplastic and alloplastic augmentation genioplasty.
Aesthetic Plast Surg 1990;14:199
SURGICAL TECHNIQUES: OSSEOUS GENIOPLASTY
11. A patient presents for correction of significant excess vertical chin height. Which of the following osseous
genioplasty techniques is most appropriate in this case?
A. Reduction genioplasty.
Osseous genioplasty can be categorized into three common types: reduction, sliding, and jumping
(Fig. 49.3). To correct increased vertical height or sagittal excess, reduction genioplasty (option A) is indicated. For this patient with excess vertical height, angling the osteotomy inferiorly will produce the desired
result of vertical reduction. Sliding genioplasty (option B) is the standard operation for horizontal (sagittal)
deficiency. Jumping genioplasty (option C) is indicated for correction of minor chin height excess. It is less
appropriate for the patient in question, whose chin height excess is more significant. Interpositonal bone
grafting is used for adding more vertical length which would be inappropriate for this patient. A centralizing genioplasty is best indicated to correct asymmetry using wedges of autologous bone graft.
1,2
ab
c
Fig. 49.3 Common types of osseous genioplasty. (a) Reduction genioplasty. (b) Sliding genioplasty. (c) Jumping
genioplasty.
et al, eds. Plastic Surgery: Indications, Operations, and Outcomes, vol 5. St Louis: Mosby-Elsevier, 2000.)
(Source: Reprinted with permission from Cohen SR. Genioplasty. In Achauer BH, Eriksson E, Guyuron B,
370 Part VII&Facial Surgery
REFERENCES
1. Zide BM, Warren SM, Spector JA. Chin surgery IV: the large chin—key parameters for successful chin reduction.
Plast Reconstr Surg 2007;120:530
2. Warren SM, Spector JA, Zide BM. Chin surgery V: treatment of the long, nonprojecting chin. Plast Reconstr Surg
2007;120:760
SURGICAL APPROACH: IMPLANT GENIOPLASTY
12. For implant genioplasty, which of the following is true regarding the extraoral approach when compared
with the intraoral approach?
B. More precise implant placement.
For implant genioplasty, there are two main surgical approaches: intraoral (where the incision is placed
in the anterior gingivobuccal sulcus) and extraoral (where the incision is placed on the submental skin).
The intraoral approach has the advantage of no visible scars while maintaining a similar infection rate
to the extraoral approach. However, the disadvantages of this approach include a higher risk of
improper implant position and higher chance of plate/screw extrusion. These are due to a lack of direct
visualization of the pocket when compared with the extraoral approach, and implants that are
improperly placed via the intraoral approach often are located superior to the proper position. The
extraoral approach allows more precise implant placement and possibly lower risk of malposition or
mental nerve injury. Closure of soft tissue and muscle during this approach should be strong in order to
prevent ptosis. The extraoral approach is relatively indicatedwhenundergoing concomitant procedures
that use the submental incision such as submental liposuction or platysma plication.
1,2,3
REFERENCES
1. Yaremchuk MJ. Facialskeletal augmentation.In: Mathes SJ, Hentz VR, eds. Plastic Surgery: The Head and Neck. 2nd
ed. Philadelphia: Saunders Elsevier; 2006
2. Terino EO. Alloplastic facial contouring by zonal principles of skeletal anatomy. Clin Plast Surg 1992;19:487
3. ZideBM, Warren SM, Spector JA. Chin surgery IV: the large chin key parameters for successful chin reduction. Plast
Reconstr Surg 2007;120:530
IMPLANT POSITION
13. Which of the following is accurate with regards to chin implant position?
C. The implant should be placed directly over the pogonion.
For augmentation genioplasty with implant, the proper position of the implant is subperiosteal, directly
over the pogonion. The pogonion is the most projecting portion of the mandible and defines chin excess
or deficiency in relation to the surrounding anatomy. Placing the implant directly over this point
achieves the aesthetic outcome by increasing chin projection to the desired amount. Placing the implant
superior to this position carries the risk of poor aesthetic outcome and damage to dentition, including
bone resorption, tooth erosion, and tooth asymmetry. This risk increases with the use of the intraoral
approach. Inferior misplacement over the menton, for example, does not sufficiently contribute to chin
projection and thus may not result in a good aesthetic outcome. It is likewise important to ensure that
implant position is sufficiently deep, with the target tissue pocket between the bone and the
periosteum. Placement superficial to this layer risksimplantpalpability and visibility.
1
REFERENCE
1. Yaremchuk MJ. Improving aesthetic outcomes after alloplastic chin augmentation. Plast Reconstr Surg
2003;112:1422
POSTOPERATIVE CARE
14. Which of the following should be considered for postoperative care after genioplasty?
B. Patients should be instructed to limit activity that increases heart rate for 5 to 7 days.
Postoperative care after genioplasty is essential to ensure patient safety and maximize aesthetic
outcome. Patients should wear an elastic chin support 24 hours a day for the first 5 to 7 days and then
at night for the next 1 to 2 weeks. They should also limit activity that increases heart rate for 5 to 7
Chapter 49&Genioplasty 371
days and sleep supine with the head of the bed elevated to 45 degrees for 3 to 5 days. Hard foods should
be avoided for 3 days after osseous genioplasty. Limiting salt intake and rinsing mouth after meals with
water and/or Peridex is also useful. Preoperatively, one dose of a first-generation cephalosporin such as
cefazolin is administered. This regimen is continued postoperatively for 3 to 5 days every 8 hours with
oral dosing. Glucocorticoids are also recommended—one intravenous dose should be given
perioperatively, and a steroid taper regimen is recommended postoperatively.
1,2
REFERENCES
1. Cohen SR. Genioplasty. In: Achauer BM, Eriksson E, Guyuron B, et al, eds. Plastic Surgery: Indications, Operations,
and Outcomes. Vol. 5. St Louis, Mosby–Year Book; 2000
2. Guyuron B, ed. Genioplasty. Boston: Little Brown; 1993
REOPERATION
15. For a patient who underwent implant genioplasty 1 day prior, which circumstance is an indication for surgi-
cal revision?
C. Significant paresthesias and/or neuropraxia.
Nerve symptoms such as motor or sensory deficit are not uncommon after genioplasty. Neurapraxia is
often a result of retraction injury due to stretching and pulling of tissues intraoperatively and on its
own does not necessitate immediate reoperation since spontaneous resolution often occurs within 2 to
6 weeks. Permanent nerve deficits are extremely rare. Certain implants may cause a significant
inflammatory response such as porous polyethylene which can cause edema for several weeks after
placement which then subsides. Causes include inadvertent nerve transect ion or avulsion during
surgery, or compression injury from an implant impinging on the nerve. For this reason, immediate
reoperation is indicated for any significant neurapraxia in which implant nerve compression is
suspected in order to prevent permanent deficits.
1,2,3
REFERENCES
1. Warren SM, Spector JA, Zide BM. Chin surgery VII: the textured secure implant—arecipeforsuccess.PlastReconstr
Surg 2007;120:1378
2. Guyuron B, Raszewski RL. A critical comparison of osteoplastic and alloplastic augmentation genioplasty.
Aesthetic Plast Surg 1990;14:199
3. Yaremchuk MJ. Improving aesthetic outcomes after alloplastic chin augmentation. Plast Reconstr Surg
2003;112:1422
50. Otoplasty
Stelios C. Wilson
See Essentials of Aesthetic Surger y, pp. 691–708
EAR ANATOMY AND DEVELOPMENT
1. The ear is 85% of its adult size by what age?
A. 1 year old.
B. 3 years old.
C. 6 years old.
D. 13 years old.
E. 18 years old.
EAR ANATOMY AND DEVELOPMENT
2. The vascular supply to the ear is mainly supplied by which t wo arteries?
A. Superficial temporal and posterior auricular arteries.
B. Superficial temporal and occipital arteries.
C. Facial and occipital arteries.
D. Transverse facial and posterior auricular arteries.
E. Descending facial artery and superficial temporal artery.
EAR ANATOMY AND DEVELOPMENT
3. The tragus is innervated by which of the following nerves?
A. Auriculotemporal nerve (CN V).
B. Great auricular nerve (C2–3).
C. Arnold's nerve (CN X).
D. Lesser occipital nerve (CN2–3).
E. Greater occipital nerve (CN2).
EAR ANATOMY AND DEVELOPMENT
4. The external acoustic meatus is innervated by which of the following nerves?
A. Auriculotemporal nerve (CN V).
B. Great auricular nerve (C2–3).
C. Arnold's nerve (CN X).
D. Lesser occipital nerve (CN2–3).
E. Greater occipital nerve (CN2).
EAR ANATOMY AND DEVELOPMENT
5. The great auricular nerve (C2–3) innervates which portion of the ear?
A. Tragus.
B. Helix.
C. Antihelix.
D. Scapha.
E. Lobule.
Chapter 50&Otoplasty 373
EAR ANATOMY AND DEVELOPMENT
6. In the ideal proportions of an adult ear, long axis of the ear inclines how many degrees from vertical?
A. 0 degrees.
B. 5–10 degrees.
C. 15–20 degrees.
D. 25–30 degrees.
E. >30 degrees.
EAR ANATOMY AND DEVELOPMENT
7. In the ideal proportions of an adult, the helix-to-mastoid distance in the upper third of the ear should be
which of the following?
A. 5–8 mm.
B. 10–12 mm.
C. 16–18 mm.
D. 20–22 mm.
E. 25–30 mm.
EPIDEMIOLOGY/PATHOLOGY
8. What is the incidence of abnormal ear morphology?
A. 1%.
B. 5%.
C. 10%.
D. 15%.
E. 25%.
EPIDEMIOLOGY/PATHOLOGY
9. Which of the follow is considered to be normal ear morphology?
A. A lobule that is parallel to the antihelical fold.
B. Obtuse conchomastoid angle.
C. The helix should project 2 to 5 mm more medially than the antihelix in frontal view.
D. Conchal wall depth of 1.8 cm.
E. Conchoscaphal angle <90 degrees.
INDICATIONS/CONTRAINDICATIONS
10. At what minimum age would surgical correction be advised?
A. 1–2 years of age.
B. 6–7 years of age.
C. 12–13 years of age.
D. 15 years of age.
E. 18 years of age.
SURGICAL TECHNIQUE
11. Mustardé technique refers to which of the following?
A. Mattress suturing to better define the antihelix.
B. Suture fixation of the conchal cartilage to the mastoid fascia.
C. Cartilage-breaking technique for severe prominent ear deformities.
D. Posterior lower 1/3 skin resection.
E. Technique for proper harvesting of auricular cartilage.
SURGICAL TECHNIQUE
12. The Furnas technique refers to which of the following?
A. Mattress suturing to better define the antihelix.
B. Suture fixation of the conchal cartilage to the mastoid fascia.
C. Cartilage-breaking technique for severe prominent ear deformities.
D. Posterior lower 1/3 skin resection.
E. Technique for proper harvesting of auricular cartilage.
374 Part VII&Facial Surgery
SURGICAL TECHNIQUE
13. The Converse-Wood-Smith technique refers to which of the following?
A. Mattress suturing to better define the antihelix.
B. Suture fixation of the conchal cartilage to the mastoid fascia.
C. Cartilage-breaking technique for severe prominent ear deformities.
D. Posterior lower 1/3 skin resection.
E. Technique for proper harvesting of auricular cartilage.
SURGICAL TECHNIQUE
14. The Modified fishtail excision refers to which of the following?
A. Mattress suturing to better define the antihelix.
B. Suture fixation of the conchal cartilage to the mastoid fascia.
C. Cartilage-breaking technique for severe prominent ear deformities.
D. Posterior lower 1/3 skin resection.
E. Technique for proper harvesting of auricular cartilage.
COMPLICATIONS
15. An 18-year-old male patient who had an otoplasty performed yesterday calls the office complaining of sud-
den onset of persistent, unilateral pain. What is the appropriate next step?
A. Reassure the patient that the pain will likely be worse on postoperative day 2 and then will start to get
better.
B. Have the patient apply ice to the area.
C. Add NSAIDs to the pain regimen.
D. Have the patient come to the ED or office to be evaluated.
E. Prescribe methylprednisolone to help with postoperative edema.
COMPLICATIONS
16. A 20-year-old female patient who had an otoplasty performed 4 days ago calls the office complaining of sud-
den onset of persistent, unilateral pain. What complication do you suspect based on timing?
A. Hematoma.
B. Infection.
C. Suture rupture.
D. Late deformity.
E. Nerve pain.
Chapter 50&Otoplasty 375
Answers
EAR ANATOMY AND DEVELOPMENT
1. The ear is 85% of its adult size by what age?
C. 6 years old.
The ear begins to protrude at 3 to 4 months of gestation and continues to grow during childhood.
Neonatal cartilage is malleable and soft and becomes stiffer and more brittle with age. By the age of 6,
the ear is 85% of its adult size. The average length of a 10-year-old male ear is 60 mm.
REFERENCES
1. Allison GR. Anatomy of the external ear. Clin Plast Surg 1978;5:419
2. Tan ST, Abramson DL, MacDonald DM, et al. Molding therapy for infants with deformational auricular anomalies.
Ann Plast Surg 1997;38:263
3. Tan ST, Shibu M, Gault DT. A splint for correction of congenital ear deformities. Br J Plast Surg 1994;47:575
4. Farkas LG, Posnick JC, Hreczko TM. Anthropometric growth study of the ear. Cleft Palate Craniofac J 1992;29:324
5. Adamson JE, Horton CE, Crawford HH. The growth pattern of the external ear. Plast Reconstr Surg 1965;36:466
EAR ANATOMY AND DEVELOPMENT
2. The vascular supply to the ear is mainly supplied by which t wo arteries?
A. Superficial temporal and posterior auricular arteries.
The vascular supply of the ear is predominantly from two branches of the external carotid system: the superficial temporal artery and the posterior auricular artery (Fig. 50.1).
1
1,2,3,4,5
Superficial
temporal
artery
Posterior
auricular
artery
Fig. 50.1 Vascularity of the external ear. (Source: Vascularity. In: Janis J, ed. Essentials of Aesthetic Surgery. 1st Edition.
New York: Thieme; 2018.)
REFERENCE
1. Allison GR. Anatomy of the external ear. Clin Plast Surg 1978;5:419
EAR ANATOMY AND DEVELOPMENT
3. The tragus is innervated by which of the following nerves?
A. Auriculotemporal nerve (CN V).
The t ragus and the crus helicis are innervated by the auriculotemporal nerve (CN V, V3 to be exact). The great
auricular nerve (C2– 3) divides into anterior and posterior branches and innervates the remaining scapha
and lobule. Arnold's nerve (CN X) innervates the external acoustic meatus and medial conchal bowl. The
lesser occipital nerve innervates the middle one-third helix and antihelix.
1
REFERENCE
1. Allison GR. Anatomy of the external ear. Clin Plast Surg 1978;5:419
376 Part VII&Facial Surgery
EAR ANATOMY AND DEVELOPMENT
4. The external acoustic meatus is innervated by which of the following nerves?
C. Arnold's nerve (CN X).
The tragus and the crus helicis are innervated by the auriculotemporal nerve (CN V, and specifically V3). The
great auricular nerve (C2–3) divides into anterior and posterior branches and innervates the remaining
scapha and lobule. Arnold's nerve (CN X) innervates the external acoustic meatus and medial conchal bowl.
The lesser occipital nerve innervates the middle one-third helix and antihelix.
1
REFERENCE
1. Allison GR. Anatomy of the external ear. Clin Plast Surg 1978;5:419
EAR ANATOMY AND DEVELOPMENT
5. The great auricular nerve (C2–3) innervates which portion of the ear?
E. Lobule.
The tragus and the crus helicis are innervated by the auriculotemporal nerve (CN V, specifically V3). The
great auricular nerve (C2–3) divides into anterior and posterior branches and innervates the remaining
scapha and lobule. Arnold's nerve (CN X) innervates the external acoustic meatus and medial conchal bowl.
The lesser occipital nerve innervates the middle one-third helix and antihelix.
1
REFERENCE
1. Allison GR. Anatomy of the external ear. Clin Plast Surg 1978;5:419
EAR ANATOMY AND DEVELOPMENT
6. In the ideal proportions of an adult ear, long axis of the ear inclines how many degrees from vertical?
C. 15–20 degrees.
In the ideal adult ear, the long axis of the ear inclines 15 to 20 degrees from vertical. Reference for ideal proportions of the ear is shown (Fig. 50.2).
Otobasion superioris
Fossa triangularis
Root of helix
Tragus
Intertragic notch
Otobasion inferioris
ab
Fig. 50.2 Proportions of the ear. (a) The normal ear and its parts. (b) The ear's critical proportions. (Source: Ear anat-
omy. In: Bentz M, Bauer B, Zuker R, ed. Principles & Practice of Pediatric Plastic Surgery. 2nd Edition. New York: Thieme;
2016.)
1,2
Helix
Superior (posterior) crus
Scapha
Inferior (anterior) crus
Cymbum conchae
Antihelix
Cavum conchae
Antitragus
Lobule
8°
15°-20°
37°
.10
.33
.5
.43
.5
.23
REFERENCES
1. Farkas LG, Posnick JC, Hreczko TM. Anthropometric growth study of the ear. Cleft Palate Craniofac J 1992;29:324
2. Macgregor FC. Ear deformities: social and psychological implications. Clin Plast Surg 1978;5:347
Chapter 50&Otoplasty 377
EAR ANATOMY AND DEVELOPMENT
7. In the ideal proportions of an adult, the helix-to-mastoid distance in the upper third of the ear should be
which of the following?
B. 10–12 mm.
In the ideal adult ear, the helix-to-mastoid distance should be in the range of 10 to 12 mm in the upper third,
16 to 18 mm in the middle third, and 20 to 22 mm in the lower third.
1
REFERENCE
1. McDowell AJ. Goals in otoplasty for protruding ears. Plast Reconstr Surg 1968;41:17
EPIDEMIOLOGY/PATHOLOGY
8. What is the incidence of abnormal ear morphology?
B. 5%.
The incidence of abnormal ear morphology in the Caucasian populations is approximately 5%. This tends to be an
autosomal dominant pattern of transmission in families. The three major contributing factors to the abnormal
ear morphology are underdeveloped antihelical fold, prominent concha, and protruding earlobe.
1,2,3,4
REFERENCES
1. Macgregor FC. Ear deformities: social and psychological implications. Clin Plast Surg 1978;5:347
2. Hao W, Chorney JM, Bezuhly M, et al. Analysis of health-related quality-of-life outcomes and their predictive
factors in pediatric patients who undergo otoplasty. Plast Reconstr Surg 2013;132:811e
3. Braun T, Hainzinger T, Stelter K, et al. Health-related quality of life, patient benefit, and clinical outcome after
otoplasty using suture techniques in 62 children and adults. Plast Reconstr Surg 2010;126:2115
4. McDowell AJ. Goals in otoplasty for protruding ears. Plast Reconstr Surg 1968;41:17
EPIDEMIOLOGY/PATHOLOGY
9. Which of the follow is considered to be normal ear morphology?
E. Conchoscaphal angle <90 degrees.
Absent tragus is not a major contributing factor to abnormal ear morphology. The three major
contributing factors to the abnormal ear morphology are underdeveloped antihelical fold, prominent
concha, and protruding earlobe. An underdeveloped antihelical fold generally has an an obtuse
conchoscaphal angle (>90 degrees) and the scapha and helical rim protrude causing a prominent upper
and middle third of the ear. The helix should project 2 to 5 mm more laterally, not medially than the
antihelix in the frontal view. A prominent concha can be either from excessively deep conchal wall (>1.5
cm) or obtuse conchamastoid angle causing a prominent middle third of the ear. Additionally, the lobule
and antihelical fold should lie in a parallel plane at an acute angle to the mastoid process. A protruding
earlobe causes prominent lower third of the ear.
1,2,3,4,5
REFERENCES
1. Macgregor FC. Ear deformities: social and psychological implications. Clin Plast Surg 1978;5:347
2. Hao W, Chorney JM, Bezuhly M, et al. Analysis of health-related quality-of-life outcomes and their predictive
factors in pediatric patients who undergo otoplasty. Plast Reconstr Surg 2013;132:811e
3. Braun T, Hainzinger T, Stelter K, et al. Health-related quality of life, patient benefit, and clinical outcome after
otoplasty using suture techniques in 62 children and adults. Plast Reconstr Surg 2010;126:2115
4. McDowell AJ. Goals in otoplasty for protruding ears. Plast Reconstr Surg 1968;41:17
5. Campobasso P, Belloli G. [Protruding ears: the indications for surgical treatment] Pediatr Med Chir 1993;15:151
INDICATIONS/CONTRAINDICATIONS
10. At what minimum age would surgical correction be advised?
B. 6–7 years of age.
In general, surgical intervention should not be performed before patients are 4 years of age. The ear is
nearly fully developed by 6 to 7 years of age, at which time surgery should be considered in appropriate
candidates. However, it is important to address timing on a patient-to-patient basis as some patients
may experience significant bullying at a young age and earlier intervention may be necessary.
1,2,3,4,5,6