Did you say reverse otoplasty? Yes, a case of reverse otoplasty is shown here as well as a brief discussion of how Dr. Hilinski can help lateralize an ear.
So what is reverse otoplasty and how does it differ from regular otoplasty? Well, it is – as the term sounds – just the reverse of what is done with ear pinning. So instead of bringing the ear closer to the side of the head, reverse otoplasty is accomplished by repositioning the ear so it sticks out farther.
Taking a close look at the adjacent photos for a visual guide, you can see how this patient’s right ear clearly looks abnormal. So what is the problem? The top half of his ear is congenitally poorly developed. Meaning, from birth his ear did not grow in the proper manner, which resulted in the cartilage remaining too close to the side of his head. In other words, the ear doesn’t stick out enough! If it did, the outline of his ear would not have the soft S-shaped contour outlined in green and shown here. Instead, the outline of his ear would be straighter and more vertically oriented.
Other instances where you will see this type of issue – where the ear is stuck too close to the side of the head – involve patients who had prior otoplasty surgery and the plastic surgeon overcorrected the ear. In these cases, the surgeon either took out too much cartilage in an effort to pin the ear and/or overly tightened the sutures in the process of setting the ear back. Regardless of the cause, the end result is the same as what you would see in this congenital case – an ear that appears tucked back too close to the head.
In both of these aforementioned situations, the goal is to lateralize the ear – or reposition it so that it actually sticks out further. That is precisely why Dr. Hilinski refers to this as ‘reverse’ otoplasty surgery. In cases where the patient had prior otoplasty, the term ‘reversal otoplasty’ has also commonly been used.
So how is this performed surgically? In most cases, the ear has to first be ‘released’ in some manner. Meaning, the ear has to be mobilized in order to allow proper movement to a new position. This is particularly important in cases where otoplasty, or ear pinning, was previously performed. That is because removal of cartilage, suture placement and scar tissue can all contribute to the ear being pulled in too tightly. Releasing all of these unwanted forces is a prerequisite to bringing the ear back out. In congenital cases, the cartilage still requires some degree of release. But, the amount and degree of surgical release is much less in comparison.
In most cases of reverse otoplasty, cartilage grafting is needed to support and keep the ear in the new location and position. Think of these cartilage grafts as being 2×4 pieces of wood used to cantilever something out to the side. This is visually demonstrated in the photo shown here where the yellow shaded areas represent the individual cartilage grafts used to splint the ear out to the side. In some cases a single, large graft can do the job. However, in most cases of reverse otoplasty, multiple grafts are needed to accomplish the goal of getting the ear to stay laterally (out to the side). In congenital reverse otoplasty, this cartilage can sometimes be harvested (taken) from an adjacent area of the ear for planned grafting. In the post otoplasty patient, the ear cartilage is usually no longer present. Therefore, cartilage is typically gotten from somewhere else, which includes the option of using tissue-banked sources.
Before and After Reverse Otoplasty
Sticking with our case example, here is a quick photo comparison of how an ear can be reshaped with reverse otoplasty technique. As you can readily note, the ear is no longer stuck against the side of the head. Now, it is more vertically oriented in terms of the outer border – and that is because a good portion of the cartilage and skin has been brought out laterally so you can now see it from the front view. In this instance, this was successfully accomplished by Dr. Hilinski using cartilage grafts taken from the same ear. In addition, the skin and soft tissue were moved around strategically in order to allow the ear to be pushed out to the side. The end result is an ear that now simply looks normal, which at the end of the day is always the goal!
Dr. John Hilinski has either authored or reviewed and approved this content.