Otoplasty

Ear Pinback

Otoplasty is a surgical procedure on the ear, typically for the individual with prominent or "big" ears.  Actually, saying these individuals have big ears is unfortunate, and completely incorrect. Their ears are not large. It is all an illusion, as the vertical and horizontal measurements of the prominent ear are usually normal. The deformity is that they protrude out from the side of the head or skull too far; and this is due to a loss of a critical fold in the ear cartilage.  The specific fold missing is the anti-helical fold.  This fold is what curls the ear back toward the side of the head.  Thus, any corrective surgery is designed to recreate that important fold.

Probably the most famous individual to ever be teased about this deformity is Dopey, "Oh Dopey. You have such funny ears."

Otoplasty
"Snow White & the Seven Dwarfs”, Disney, 1937. Said Snow White, "Oh Dopey. You have such funny ears."

Having prominent ear deformity can be emotionally devastating for the youngster, especially when they experience social shaming in elementary and secondary school.  The human ear will have achieved 80-90% of its mature development by 5 years of age.  Fortunately, most preschoolers are immune to peer ridicule.

Performing corrective ear surgery should best be delayed until the patient is at least age 5.  After then, they will begin to experience teasing from peers.  There is no maximum age to have this operation.

Dr. Baeke's experience has been that the shortcoming of the traditional Millard technique is the new 3-dimensional shape of the reconstructed ear will forever be dependant upon a few burried sutures.  If they ever break, "boing" the ear immediately returns to its prominent shape.  Have you ever accidentally struck the side of your ear and head against your automobile door window?

The Crikelair procedure, championed by Dr. Baeke, relies on no permeant buried sutures to maintain the results, rather by scoring, it relaxes the stiff ear cartilage to return to its natural shape.  In so doing, the ear should never be at risk of minor trauma ruining an otherwise beautiful result.

This is the only surgical technique employed by Dr. Baeke.  It works just as well on the young as old.  Insurance will often cover such a surgery.

The operation commonly takes about 1 hour per ear and is performed with the patient under a general anaesthesia.  It is performed as an outpatient.  Post op healing is rapid, and pain minimal.  Scarring is not visible, as the only scar is located on the back surface of the ear.

Complications are few, but would include discomfort, bruising, swelling, infection, asymmetry.

When I was a young plastic surgeon in training in San Francisco, the Crikelair otoplasty was the mainstay of that portion of my residency.  I imagined it would be just as widely taught in all other training programs.  How wrong I was.  To this day, I have not spoken with any of my plastic surgery or ENT colleagues who know anything about this technique.  I am pleased to offer it to those in need.  

If you wish to learn more, here is the obscure journal article published by Dr. Crikelair in 1964.

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