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Question 6#

The following is true about otoplasty:

a. Glue can be used effectively instead of head bandages
b. Conchal reduction should be undertaken using an anterior approach in most cases
c. Closed techniques of cartilage scoring have high recurrence rates
d. Splinting of the ear after birth to correct prominent ears is an old wives’ tale and simply does not work
e. Suture techniques have lower complication rates than cartilage scoring techniques

Correct Answer is A

Comment:

Glue can be used effectively instead of head bandages. Glue for postoperative splinting in the context of suture techniques of prominent ear correction was first described in 2008 and can be used instead of head bandages. This removes the need for an office appointment for removal of head bandages, patients can shower after the first postoperative day, and girls in particular can wear their hair long hiding any stigmata of surgery immediately postoperatively. A finer subcuticular skin closure can also be used, and bandages falling off are no longer an issue. An ‘internal corset’ using an anteriorly-based fascial flap can provide further support to the ear in this context 1, 2. Conchal reduction is best undertaken from a posterior approach to hide the scar, although anterior approaches have been described for this purpose and also for harvest of cartilage grafts without undue cosmetic morbidity. Closed scoring techniques such as popularised by Stenstrom are not particularly associated with any increased risk of complications. Many consider suture techniques to have lower complication rates than cartilage scoring techniques in otoplasty. There is no incontrovertible evidence for this and a number of groups have published excellent results with low complications 3. When severe complications occur, they anecdotally seem to be more prevalent in open cartilage scoring techniques, although this is a controversial and unproven statement. Splinting of the ear within weeks of birth can be effective for correction of prominent ears due to some residual plasticity of the ear cartilage. Skin glue can also be used for this task 4 as well as a number of proprietary or custom-made appliances. 

References:

  1. Shokrollahi K, Cooper MA, Hiew LY. A new strategy for otoplasty. J Plast Reconstr Surg 2009; 62: 774-81. 
  2. Shokrollahi K, Tanner B. ‘Glue ear’: beginning of the end for head bandages after prominent ear correction? J Plast Reconstr Aesthet Surg 2008; 61(9): 1077.
  3. Caouette-Laberge L, Guay N, Bortoluzzi P, Belleville CB. Otoplasty: anterior scoring technique and results in 500 cases. Plast Reconstr Surg 2000; 105(2): 504-15.
  4. Scrimshaw G. The 30-second otoplasty. Ann Plast Surg 1983; 10(1): 86-7.