Results of in-patient surgical management of auricular conchal esthetic defects

Abstract

We have analysed 127 congenital auricular conchal deformity cases treated at Lviv Municipal Cosmetology Hospital between 2016 and 2019, aiming to identify the spectrum and nature of postoperative complications, as well as the scope of surgical correction and preventive strategies. Age of patients varied between 7 and 54 years (mean- 25,7 ± 2,4 ), with almost 3 times more females than males, 93 versus 34. The patients primarily complained about unilateral or bilateral prominent ear deformities. Patients were assessed by A.T.Hruzdyeva score and metric characterization of the deformity. Enlarged height of cup with well-developed antihelix and its pedicle and scapho-conchal angle increased to 170 degrees was noted in 7 cases. Increased height of cup associated with poorly developed antihelix and its pedicle was noted in 69 cases. Unilateral prominent concha was noted in 12 cases. All patients were photographed preoperatively and 2-3 months and 1 years postoperatively. The following standard of photography was followed consistently: a) frontal view of head, scale 1:7, camera to patient distance 120 cm, b) posterior view of head, scale 1:7, camera to patient distance 120 cm, c) lateral close view of the ear concha, scale 1:2, camera to patient distance 40 cm. Both right and left ears were photographed. In 73 cases (57,5%), J. Mustarde otoplasty was performed with antihelix and its pedicles made more prominent by separate sutures without releasing the ear cartilage. In 38 cases, N. Bulstrode technique was utilized, with releasing the anti-helical cartilage on the other side. Out of 92 cases with tall cup, in 19 cases (14,9%) D. Furnas suture technique was utilized, in 18 cases (14,2%) tall cup was reduced according to E. Eitner technique, in 38 cases (29,9%), J. Davis lowering otoplasty was performed, and in 17 cases (13,4%) the tall cup was reduced from anterior access according to B. Bauer technique. Hemorrhage and hematoma formation were uncommon in the early postoperative period, with only 2 cases (1,6%) registered. In one case, superior auricular artery was the source of bleeding. In the other case, it was cutaneous vessels in the retroauricular access margin. Skin necrosis and pressure injuries were noted in 4 cases (3,2%), leading to superficial epidermolysis mostly along the anterior conchal surface, but occasionally affecting the posterior surface as well. In one case (0,8%) traces of the diamond green dye used intraoperatively were noticeable in soft tissues of the ear. In 1 adolescent patient, Dumbbell keloid was noted. In 8 cases, retroauricular fistulae from ligatures developed. In 14 cases, recurrence of prominent earcups was observed. Corrective surgery mostly implied the N. Bulstrode technique. Conclusions. 1. Surgical management of esthetic auricular conchal defects is a complex type of plastic and esthetic surgery and thus should be performed by specialized in-patient clinics. 2. Main early postoperative complications of otoplasty include bleeding and hematoma, skin necrosis and pressure lesions, visible contours and protrusion of sutures under thin covering tissues. 3. Key long-term complications of otoplasty include recurrence of prominent earcups and ligature fistulas, causes and mechanisms of which must be studied in-depth in terms of prevention and management.