Macrotia

Abstract: Reduction otoplasty is an uncommon procedure performed for macrotia and ear asymmetry. Techniques described in the literature for this procedure are few. The authors present their ear reduction approach that not only achieves the desired reduction effectively and accurately, but also addresses and creates the natural anatomic proportions of the ear, leaving a scar well hidden within the fold of the helix.

Abstract: Ear reduction has been performed occasionally for aesthetic considerations. This series is comprised of 8 patients representing 7 bilateral reductions and 1 unilateral reduction for a total of 15 ears. Historically, surgery for macrotia consisted of resections of full-thickness wedges from the periphery of the ear. The surgical defect was repaired by directly approximating the wound edges. Additional removal of triangular or crescent-shaped segments from adjacent sides of the wound prevented the cupping of the reconstructed ear. Secondary deformities were not uncommon consequences. The most distressing were cruciform scars that defaced the lateral surface of the ear. These were frequently exacerbated by the uneven coaptation of the underlying cartilages. The current technique places the incisions at strategic locations where the scars that form are less conspicuous. The initial steps are essentially identical with the lateral transhelical approach to otoplasty for protruding ears. In some patients, both procedures have been combined during the same operative session.

Abstract: Auricular surgery is a challenging subject in plastic surgery due to the complicated surface topography of the external ear. Although various techniques for ear reduction and helical rim reconstruction have been reported in the literature, an ideal method is yet to be defined. Double helical rim advancement flaps with scaphal resection presented in this report represent a practical technique for correcting macrotia and reconstructing helical rim defects. The amount of full-thickness resection at the helical rim is planned according to the desired reduction or extent of tumor. After helical excision, an incision that transects all the layers of the ear is carried out along the helical sulcus inferiorly and superiorly to yield two advancement flaps. Using scissors, a crescent from the scapha is excised through the full thickness of the ear. The flaps are approximated and sutured to the scapha by means of stitches that pass through skin and cartilage. The described technique has been performed successfully since 1998. It has been used for 12 cases of macrotia, 28 cases of tumor surgery, and 7 cases of ear reduction for asymmetric ears. No major complications have been encountered. Three cases are reported as examples of the procedure. Double helical rim advancement flaps with scaphal resection represent a versatile and safe technique that can be used for ear reduction, helical rim reconstruction, and correction for discrepancy in size of ears.