Otoplasty (Prominent ears)

Otoplasty

 Otoplasty (Prominent ears)

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Ear surgery, or Otoplasty, also known as pinnaplasty, is usually done to set prominent ears back closer to the head or to reduce the size of large ears.

For the most part, the operation is done on children between the ages of four and 14. Ears are almost fully grown by age four, and the earlier the surgery, the less teasing and ridicule the child will have to endure. Ear surgery on adults is also possible, and there are generally no additional risks associated with ear surgery on an older patient.

If you're considering ear surgery for yourself or your child, this information will give you a basic understanding of the procedure-when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your doctor if there is anything you don't understand about the procedure.

When ear surgery is performed by a qualified, experienced surgeon, complications are infrequent and usually minor. Nevertheless, as with any operation, there are risks associated with surgery and specific complications associated with this procedure.

A small percentage of patients may develop a blood clot on the ear. It may dissolve naturally or can be drawn out with a needle.

Occasionally, patients develop an infection in the cartilage, which can cause scar tissue to form. Such infections are usually treated with antibiotics; rarely, surgery may be required to drain the infected area

Pre-operatively

Your surgeon will discuss how to prepare for the operation. You will be asked about your, or your child's, medical history and have a full examination.

Before surgery you will talk to your surgeon about the operation and you will be asked to sign a consent form either for yourself or on behalf of your child. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

Your, or your child's, ears will be examined and their shape and size will be measured. A photograph will usually be taken before the operation so that the results of surgery can be compared with the original appearance.

Ears that appear to stick out or are overly large can be helped by ear surgery.
In the initial meeting, your surgeon will evaluate your child's condition, or yours if you are considering surgery for yourself, and recommend the most effective technique. He or she will also give you specific instructions on how to prepare for surgery.

If your child is young, your surgeon may recommend general anaesthesia, so the child will sleep through the operation. For older children or adults, the surgeon may prefer to use local anaesthesia, combined with a sedative, so you or your child will be awake but relaxed.

The operation

Ear surgery usually takes about two to three hours, although complicated procedures may take longer. The technique will depend on the problem.

With one of the more common techniques, the surgeon makes a small incision in the back of the ear to expose the ear cartilage. He or she will then sculpt the cartilage and bend it back toward the head. Non-removable stitches may be used to help maintain the new shape. Occasionally, the surgeon will remove a larger piece of cartilage to provide a more natural-looking fold when the surgery is complete.

An incision is made in the back of the ear so cartilage can be sculpted or folded. Stitches are used to close the incision and help maintain the new shape.

Another technique involves a similar incision in the back of the ear. Skin is removed and stitches are used to fold the cartilage back on itself to reshape the ear without removing cartilage.
 
In most cases, ear surgery will leave a faint scar in the back of the ear that will fade with time. Even when only one ear appears to protrude, surgery is usually performed on both ears for a better balance.

Finally, a bandage is wrapped around the head and over both ears. This is to protect the ears and keep them held in the new position while they heal.

Creating a fold in the cartilage makes the ear lie flatter against the head and appear more normal.

Post Operatively

Painkillers will be given to help with any discomfort as the anaesthetic wears off.
Most adults are able to go home on the same day a few hours after their operation. Children usually stay in hospital for a day or so.

If you have had a general anaesthetic, you will need to arrange for someone to drive you home and should try to organise for a friend or relative to stay with you for the first 24 hours.

Before going home, a nurse will give you some advice about how to care for the ears and make an appointment for any stitches and bandaging to be removed.

Adults and children are usually up and around within a few hours of surgery, although you may prefer to stay overnight in the hospital with a child until all the effects of general anesthesia wear off.

The patient's head will be wrapped in a bulky bandage immediately following surgery to promote the best molding and healing. The ears may throb or ache a little for a few days, but this can be relieved by medication.

Within a few days, the bulky bandages will be replaced by a lighter head dressing similar to a headband. Be sure to follow your surgeon's directions for wearing this dressing, especially at night.

Stitches are usually removed, or will dissolve, in about a week.

Any activity in which the ear might be bent should be avoided for a month or so. Most adults can go back to work about five days after surgery. Children can go back to school after seven days or so, if they're careful about playground activity. You may want to ask your child's teacher to keep an eye on the child for a few weeks.

Side effects & Risks

Anyone having a pinaplasty can also expect that:

•   the ears are likely to ache for the first few days after the procedure and will probably be tender for several weeks
•   the ears may feel a little numb after the operation but this usually settles within a few weeks
•   the procedure will leave a scar behind the ear that should fade over time
•   the dressing can chafe the ears and break the skin which can take a long time to heal

Complications are unexpected problems that can occur during or after the procedure. Most people are not affected. The main possible complications of any operation are bleeding during or soon after the procedure, infection and an unexpected reaction to the anaesthetic. It's also possible for a blood clot to develop in a vein in the legs (deep vein thrombosis or DVT).

Specific complications of a pinnaplasty are uncommon but can include:

•   an infection in the wound that may make the ear swollen and painful and cause the wound to weep - this is normally treated with antibiotics and regular dressing changes, but in rare cases further surgery may be needed to drain the infected area
•   a blood clot in the skin of the ear, which may dissolve naturally or may need to be drawn out with a needle
•   the development of unusually red or raised scars (called keloid scars), which some people have a genetic tendency to form
•   asymmetrical ear position - in a few cases further surgery may be necessary to readjust the ears
•   there is a risk that the correction of the prominent ear does not last permanently and the ear 'springs back' into its original position, but this is rare
• The chance of complications depends on the exact type of procedure that is being performed and other factors such as your general health. Your surgeon will be able to explain how the risks apply to you.