SUTURE OTOPLASTY BY DEGLOVING AND ANTERIOR CARTILAGENOUS SHAVING

ByKhalid A. Elmesallamy; Hesham A. Hegab; Akrum M. Elguindy*;

Kasem M. Kasem* ENT Department. Faculty of Medicine. Zagazig and Banha* Universities

ABSTRACT

Following the rule of natural tendency of a cartilage to curl against the weakened side, the present study present a procedure depends on degloving of the auricular cartilage, creation of an antihelical fold by horizontal mattress sutures, then careful excision of perichondrial cover followed by anterior cartilaginous weakening by shaving, then final refining of the degloved cartilaginous skeleton before redraping of the dissected skin over it. 35 ears of 20 patients were operated upon by the senior surgeon. Their ages ranged between 4 and 18 years (mean age 8.2 years). The esthetic results were excellent with hundred percent patient satisfaction rate. The postoperative complications either early or late were comparable to the results of many reported studies. The permanently corrected ears fulfilled the criteria for surgical success with high patient-parent-surgeon satisfaction rate.

INTRODUCTION

Otoplasty is an operation which is done to improve the appearance of the ears; it is most commonly done for protruding ears, often called “lop” ear or “cup” ear deformity. Protruding ears are frequent in white population with an overall incidence of 5% [1]. Affected children are often stigmatized by their peers and likely to ask for correction of this visible abnormal ear shape. For more than a century, many techniques for correction have been proposed; they can roughly be categorized as the cartilage incision techniques, versus the suture placement techniques. Both aim to correct the abnormal ear shape, namely the antihelical fold and concha protrusion [2]. After the early work of Gibson and Davis [3], Stenstrom studied the natural tendency of the cartilage to curl in a direction opposite to the side weakened [4]. More recent experimental work confirmed these findings [5]. It is certainly appealing to follow the normal tendency of the cartilage to curl and

create a predictable natural folding of an abnormally protruding ear. The aim of the present work was to evaluate the results of suture placement otoplasty by auricular degloving and anterior cartilaginous weakening by shaving.

MATERIAL AND METHODS

Thirty five ears of 20 patients with lop ear deformity constituted the material of the present work; all of them were having deep conchal bowls with different degrees of prominence. They were subjected to the following:

a) Preoperative evaluation: All ears were examined preoperatively and their many components were individually evaluated

1- The helical rim: Its irregularity and width, its folding (completely unfolded with increase helical diameter), prominence of Darwin’s tubercle, or increased folding with reduced helical diameters.

2- Concha: Examined for its prominence that cause marked elevation of the middle third of the auricle.

3- Shape and position of the lobule is assessed.

4- Anthelix for failure of development.

5- Lack of an acute angle at the root of the helix as it abuts the scalp.

6- Miscellaneous conditions including microtia, an ear truly large in all dimensions, incomplete development of helical eave, and a large scapha.

7- Discussion of all anomalies with parents and with adult patients.

8- b) Photographic documentation: Right and left lateral, frontal and posterior close up views.

c) Anesthesia: All operations in the present study were performed under general anesthesia because of the length of the procedure (2-3 hours) under the hands of the senior surgeon in bilateral cases, also because of the problematic patient compliance under local anesthesia specially those under 10 years.

d) Preoperative workup: The hair is shampooed the evening before surgery and adult female patients were asked not to wear cosmetics the day of surgery.

e) Operative procedure: With the patient under general anesthesia, full facial and adjacent hair preparation is carried out. Appropriate head drapes are stapled into place, and moist cotton pledgets are used to occlude the ear canals. The scapha is lightly folded onto the concha, and a row of ink

marks is made on the anterior ear skin that run from just lateral to the superior portion of the superior crus of the anthelix. Two marks are made on the skin within the fossa triangularis for placement of sutures, to reshape the superior crus of the anthelix.One percent Xylocaine with epinephrine 1:100,000 are lightly infiltrated subcutaneously with a 30-gauge needle, using approximately 1 cc on the anterior and posterior surfaces of the ear and in the postauricular sulcus and mastoid area. The opposite ear is marked in the same way. A 1.25-inch 25-gauge needle is lightly scraped on a scratch pad (the kind used to clean electrocautery tips) to remove its silicone coating. The first ear is then addressed after being reassessed for symmetry. The prepared (abraded) needle is passed through an ink mark from the anterior to the posterior surface of the ear. A cotton-tipped applicator dipped in methylene blue is used to wet the distal end of the needle and its shaft; the needle is then withdrawn, marking the posterior skin and underlying cartilage. The ear is maintained on a light stretch while this marking procedure is carried out, and all previously made ink marks are temporarily tattooed in this fashion. An incision is made in the posterior surface of the ear just lateral to the postauricular sulcus, extending from superiorly near the helical rim above down to the level of the ear lobe. No skin removal is attempted until the end of the procedure. The skin from the incision is dissected laterally to the helical rim with small, curved, blunt-tipped scissors, exposing the methylene blue dye marks in the cartilage. The dissection of the helical rim is then proceeds by using sharp-tipped scissors with the aid of either a Freer or a Cottle

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elevator while the skin is retracted and the lateral side of the ear is supported by the surgeon’s fingers. This step is the most difficult of the procedure as the skin is firmly adherent to the underlying subcutaneous tissue and perichondrium, also the cartilage is softer at the helical rim, so meticulous care must be taken while dissecting this area, also the helical rim must be freed completely before completing the degloving process. The skin over the lateral aspect of the ear is then dissected medially to fully expose the lateral aspect of the auricular cartilage using blunt-tipped scissors again. To complete the process, medial dissection from the postauricular incision is carried to the postauricular sulcus, and then to the mastoid periosteum; the posterior auricular muscle is moved a side with a blunt dissector. Now, the auricular cartilage with its perichondrium intact is completely freed of its skin cover and ready for the next step. Inspection of the auricular cartilage and identification of the dye marks then occur prior to creation of new anthelix and superior crus. Now we have two rows of marks, the first is just lateral to the concha (row 1), while the second is lateral to it and medial to the scapha and helical rim (row 2). The distance between them is slightly wider superiorly. A suitable 4/0 nonabsorbable suture with round, noncutting needle is used to create the antihelical fold and the superior crus (in the present series, the senior surgeon used 4/0 monofilament, nonabsorbable polypropylene with roundBodied half circle needle ).The needle is passed from the first upper mark of row (2) on the medial surface of the cartilage to the second upper mark of row (2) on the lateral surface, to the second upper mark of row (1) on the

medial surface and finally to the upper first mark of row (1) on the lateral surface (fig.1). The suture is left unknotted and long, and it is hold together with a short strip of sterile paper tape. Similar mattress sutures are placed between the scapha and lateral concha and tested but not tied. Three sutures for antihelical fold and one for superior crus are generally sufficient.

Fig. (1): Illustrates the dye marks and the mattress sutures in the degloved auricular cartilage.

After placement of all sutures, the concha-scapha sutures are then tied, with individual adjustment made in knot position to recontour the main body of the anthelix and the superior crus in a pleasing configuration. Some bowstringing of the sutures will result; the space created between concha and scapha will subsequently fill with fibrous tissue. The perichondrium over the newly created anthelix is dissected and excised, the cartilage is then weakened by shaving using a sharp knife (thicker cartilages of adults need more shaving, while in most children, gentle superficial shaving is satisfactory. Attention is then directed to the conchomastoid area. Two or three mattress sutures are placed between the concha and the mastoid area, beginning just medial to the concha-scapha sutures and extending through the mastoid periosteum. Tying of these sutures brings the concha closer to the mastoid

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area and reduces overall projection of the ear. In case where the concha is itself very large, and where placement of such a suture would rotate the posterior wall of the external meatus anteriorly and partially obliterate the meatus, a 1-cm-wide, laterally based flap of perichondrium and underlying cartilage is cut and sutured to the mastoid periosteum, to accomplish the same effect without compromising the external canal. The root of the helix is checked for outward angulation. If this is present and if the earlobe has not been set back, a postoperative “telephone ear” deformity may result. If the angle is too obtuse, a mattress suture is placed between the helical rim and the underlying temporalis fascia, when tied this should bring the helical rim into a more pleasing position closer to the ear. Attention is then paid to the margin of helical rim for irregularity or asymmetry or enlargement of Darwin’s tubercle. The excess cartilage is trimmed. The auricular skin is then redraped over the refined cartilage and the excessive skin created by medial displacement of the meatal surface of the auricle and the antihelical creation is then excised in a fusiform fascion. Attention now turns to the earlobe, which if protuberant, requires a single suture from the dermis of the lateral side of lobular skin to the most inferior portion of the concha. The postauricular skin incision is then closed with running horizontal mattress 4/0 plain catgut. The head drapes and cotton pledgets placed earlier are removed and dressing is applied: a moistened gauze with suitable length is applied to conform the scapha and fixed in place with 2-3 mattress

sutures passing from posterior to anterior surfaces over the gauze then to posterior surface again and knotted. Another moistened gauze to conform the concha and fossa triangularis is also applied, and one thin gauze covered with xeroform dressing in the posteroauricular sulcus. After treating the opposite ear surgically using the same procedure, several gauze fluffs are placed over both ears and a mastoid-type dressing is applied. Figures (2,3) illustrate the important steps of the operation.

f) Postoperative orders: All patients are placed on a 5-day regimen of antibiotics (usually cepalexin) 10 mg/kg per dose (250 mg/teaspoon or 50 mg/cc), administered every 6 hours. For pain, a 5-day supply of ibuprofen 20mg/kg/day in three divided doses to be taken every 8 hours as needed for pain. Patients discharged the day of surgery are seen in the office 24 or 48 hours later. At the first office visit (7 to 10 days postoperatively), the dressings are removed. The ears are cleansed with hydrogen peroxide, and the patient is placed in a hair/head band that lightly holds the ears in place. Such hair bands are particularly important during the hours of sleep. The band should be arranged to apply light, minimal pressure to the ears and to maintain them in proper position. It is advisable to have younger children wear a stockinet cap at night for 2 to 3 weeks after dressing removal to avoid accidental bending of the ears during sleep. The sutures dissolve spontaneously and any crusting over the skin closures is treated with daily cleansings with peroxide-soaked cotton swabs. Hair may be shampooed after the dressing is removed.

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Table (1) : Patient’s data SerialNo.

Sex Age (years)

Affected ear Other abnormalities

1 male 6 Bilateral symmetrical Bilateral preauricular sinus2 male 6 Bilateral symmetrical Bilateral preauricular sinus3 male 7 Bilateral symmetrical4 male 6 Bilateral symmetrical5 female 4 Bilateral symmetrical6 male 6 Right ear7 male 10 Bilateral symmetrical8 male 12 Bilateral asymmetrical Left preauricular sinus9 female 12 Bilateral symmetrical10 male 8 Bilateral symmetrical11 female 6 Bilateral asymmetrical12 female 11 Right ear13 male 6 Left ear14 female 7 Bilateral symmetrical15 male 5 Bilateral asymmetrical Bilateral preauricular sinus16 female 5 Bilateral symmetrical17 male 6 Bilateral symmetrical18 female 18 Left ear19 female 11 Left ear20 male 12 Bilateral symmetrical

Table (2) : Goals of otoplasty Goals of Otoplasty According to McDowell [6] and Wright [9]. 1 : Correction of protrusion in upper one third of the ear2: The helix of both ears should be seen beyond the antihelix in the frontal view3: The helix should have a smooth and regular line throughout 4: The postauricular sulcus should not be markedly decreased or distorted5: Protrusion should measure between 15 and 20 mm.6: Position of ears should match closely (within 3 mm difference at any given point).

Table (3) : Answer to Questionnaire and Patient SatisfactionQuestion Yes (%) No (%) Total

Pain when the ear is touchedLoss of sensation on the earOccasional skin irritation (wound)Ears symmetricalNormal ear shape

1 (5)2 (10)1 (5)

19 (95)19 (95)

19 (95)18 (90)19 (95)1 (5)1 (5)

2020202020

Satisfaction TotalVery satisfied Satisfied Dissatisfied Very dissatisfied 15 (75%) 5 (25%) 0 (0%) 0 (0%) 20 (100%)

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Fig. (2): (A) (B) (C)

Anterior surface of the degloved left auricular cartilage with dye marks seen (A), posterior surface showing mattress suture (B), and the created antihelical fold (C).

Fig. (3): (A) (B) (C) Anterior cartilage weakened by shaving (A), left ear skin redraped over refined cartilage (B), and dressing sutured in place to conform the scapha and the triangular fossa (C).

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Fig. (4): (A) (B) (C)Preoperative frontal view (A), posterior view ( B), and right lateral view (C) of a 4 years old girl

Fig. (5): (A) (B) (C)Same patient and (views), 6 months postoperatively

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Fig. (6): (A) (B)Preoperative, frontal view (A), and posterior view (B), of a 6 years old child

Fig. (7): (A) (B)Same patient and (views), 6 months after surgery

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Fig. (8): (A) (B)Preoperative frontal view (A), and posterior view (B) of 12 years old boy.

Fig. (9): (A) (B)Same patient, and (views), 6 months postoperatively

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RESULTS

Of the twenty operated upon patients, 12 were males (60%), while 8 were females (40%). Their ages at the time of operation ranged between 4 and 18 years with an average of (8.2 years). Bilateral symmetrical lop ear deformities were found in 12 patients (60%), bilateral asymmetrical deformities in 3 patients (15%) and unilateral lop ear deformity in 5 patients (25%). Of the unilateral cases, 3 were females (60%) while 2 were males (40%). The right ear was the site of the disease in 2 cases (40%) while the left ear was the site in 3 cases (60%). Abnormalities other than lop ear deformity and related deep conchal bowl were detected in 4 cases (20%), in the form of: Bilateral preauricular sinus, 3 patients (15%), and left preauricular sinus, one patient (5%), (Table1). After fully understanding the goals of otoplasty operation (Table 2), the postoperative results were as follows:No early postoperative complications were detected. Among the late complications, no objective complications were detected in the postoperative follow up period (6-12 months) regarding the shape, position and symmetry of repaired ears.After answering the questionnaire by older patients and parents of younger patients (Table 3), pain when the ear is touched was reported by one patient (5%), loss of sensation of the ear by two patients (10%), and occasional skin irritation by one patient (5%). One more patient (5%) reported some degree of asymmetry and another one (5%) reported an abnormal ear shape; he thought that his right ear became closer

to the head. As regards postoperative patient satisfaction, 15 patients (75%) were very satisfied by the results of operation, 5 patients (25%) were satisfied, and in spite of some patients notice regarding the ear shape and asymmetry, none of them was dissatisfied or very dissatisfied by the result of the operation. Figures (4-9) show the photographic pre and post operative changes for some cases.

DISCUSSION

The goals of otoplasty and shortcoming of different surgical techniques have been well documented by McDowell [6] and others [7,8,9]. In recent years, more attention has been focused on “Suture techniques” to correct the abnormal cartilage shape, often in combination with cartilage weakening procedures on the posterior surface of the cartilage [10,11] or 0n its anterior surface [7,8,9] but generally without widly exposing the anterior surface of the auricular cartilage [2]. Although the cartilage cutting techniques are often regarded as one group of operations, there are actually many different techniques that use a transcartilagenous incision. Luckett [12] introduced an incision in the auricular cartilage at the location of the proposed antihelical fold, this cartilage incision is made to create the antihelical fold sharply; therefore, the fold created is not natural. Cartilage incision between the helix and the antihelix to gain access to the anterior surface of the auricular cartilage has been proposed. Stenstrom and Heftner [13] published a technique in which the anterior surface of the ear is

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widely exposed for direct scoring and weakening to create a natural antihelical fold but without cartilage incision. Some authors combine the technique of permanent sutures for the antihelical fold with cartilage incision and resection in the concha without cartilage scoring [7]. The technique used in the present series was based on the idea of normal tendency of the cartilage to curl in a direction opposite to the side weakened. It has the advantage of preserving the cartilage, excision of the perichondrial cover of the created antihelical fold to prevent the regrowth of weakened anterior cartilage, weakening of the anterior cartilage by shaving under direct vision, and meticulous refining of the auricular cartilaginous skeleton before redraping of the dissected skin over it with a net result of predictable, natural and smooth folding. But it also has the disadvantage of difficult dissection of the skin with possible danger of compromising its blood supply although not seen in our series; also increase length of the procedure is one of its disadvantages. By discussing the results of the present study; the age at surgery varied from 4 to 18 years, (mean age 8.2 years). Table (1) showed that 50 percent of the patients were operated upon before or at the age of 6 that coincides with many other authors [2,7,12] who found no reason to postpone the surgery to after school entry age. 60 percent of our cases were males while only 40 percent were females, that explain the need for surgery by males than females because of their shorter hair style that makes protruded ears more noticeable. The incidence of early postoperative complications were very low reaching to zero in this study, may be due to relatively low number of operated upon

patients compared to many published survey studies. Bleeding was reported by many investigators in a ratio ranged between 0.8 to 33 percent [2,10,11,14,15,16]. The incidence of infection ranged between zero percent [2,17] and 5.2 percent [10,11,15,18], in our series, a broad spectrum antibiotic is routinely prescribed for 5 days although others reported no statistical difference without antibiotic prescription [2]. Adamson et al [19] are strong advocates of prophylactic antibiotics (systemic and wound irrigation) and attribute their low infection rate (0 of 62 cases) to their use. Hematomas have a low incidence in all reported series as in ours. Some authors have cautioned against the use of a closed dressing for the first postoperative week, and have suggested changing the dressing after 24 hours [19,20] to detect any early complications. In the first 5 cases of our series, we followed their regimen for fear of skin necrosis due to aggressive skin dissection, but afterwards with gaining more experience with the procedure, we preferred to leave the dressing intact for one week unless there is severe pain. We strongly agreed Elliott [21] who rightfully stressed that pain is perhaps the most significant symptom of a complication in the early postoperative period. After instructing the patients and their parents about the importance of long term regular 6 month follow up; we faced a great difficulty in following our patients. Only 8 came for follow up after 6 months and one year, while the remaining 12 answered the questionnaireby telephone. Pain when the ear is touched was reported by the first operated on patient (5%), the pain was present in the last visit one year after the operation , it was due to sharp knot felt

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under the posterior skin surface, the patient refused revision operation to borrow the knot and preferred to be familiar with the condition. Pain when the ear is touched is still a problem in suture placement otoplasty, and was reported by many authors [14,19,21]. Louise et al [2] reported pain for more than 2 years after surgery in 22 of their series (5.7%), and found another 29 patients (7.5%) hypersensitive to cold or touch. Hypoesthesia was complained of by 2 patients (10%) of the present series but improved 3-4 months after surgery, our ratio was higher than that reported by Louise et al (3.9%) may be due to relatively longer postauricular incision used in the procedure. Occasional skin irritation of the posterior surface of the ear was reported by one patient (5%) and improved by steroid cream application for several days. 95 percent of our patients found their repaired ears symmetrically accepted, only one patient (5%) reported asymmetry of ears. This patient was having unilateral lop eared deformity and the other ear was slightly deformed by reduced helical rim and prominent Darwin’s tubercle, the operation was done only for the lop eared according to the patient’s desire. Postoperative asymmetric ears were reported in the literature with a rate ranged between 5.6 up to 33 percent [2,22,23]. Abnormal ear shape was another complication reported by one patient of the present series (5%) in spite of his satisfaction by the result of surgery. The same complication was reported by others [22,23,24]. Unsatisfactory cosmetic results were found in 13.3% of the cartilage cutting techniques as compared with 6.4% of suture techniques [24]. In the present study (95%) of the patients were very satisfied by the results of surgery, while

(5%) were satisfied. This patient satisfaction rate of 100% is comparable to that reported by others [2,22,23,24,25], the best of them reached to 94% and was reported by Louise et al [2].

CONCLUSIONS

Suture otoplasty by degloving and anterior cartilaginous weakening by shaving permanently changes the shape of the ear without cartilage incision or cutting, does not rely on skin excision. The procedure depends on the natural spontaneous curling of the cartilage in the opposite direction of weakened surface. The cosmetic results are excellent and the postoperative complications are less than reported by others.

REFERENCES

1- Adamson, P. A., and Strecker, H.D. (1995): Otoplasty techniques. Facial Plast. Surg. 11: 284.

2- Louise Caouette, Nicolas G., Patricia B. and C. Belleville. Feb. (2000): Anterior scoring techniques and results in 500 cases. Plast. Reconstr. Surg. 105:2: 504.

3- Gibson, T., and Davis, W. B. (1958): The distortion of autogenous cartilage graft: Its cause and prevention. Br. J. Plast. Surg. 10: 257. Quoted from Louise Caouette, Nicolas G., Patricia B. and C. Belleville. Feb. (2000): Anterior scoring techniques and results in 500 cases. Plast. Reconstr. Surg. 105:2: 504.

4- Stenstrom, S. J. (1963): A “natural” technique for correction of congenitally prominent ears. Plast. Reconstr. Surg. 32: 509.

5- Hagerty, T. A., Barone, E. J., and Cohen, I. K. (1998): Endoscopic

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otoplasty in rabbit model: Effect of mechanical abrasion on ear cartilage deformation. Plast. Reconstr. Surg. 101:487.

6- McDowell, A. J. (1968): Goals in otoplasty for protruding ears. Plast. Reconstr. Surg. 41: 17.

7- Elliott, R. A., Jr. (1990): Otoplasty: A combined approach. Clin. Plast. Surg. 17: 373.

8- Bruck, H. G. (1973): Correction of prominent ears. Arch. Otolaryngol. 98: 10.

9- Wright, W. K. (1970): Otoplasty goals and principles. Arch. Otolaryngol. 92:568.

10- Backer, D. C. , and Converse, J. M.(1979): Correction of protruding ears: A 20-year retrospective. Aesthetic Plast. Surg. 3: 29.

11- Maniglia, A. J., Maniglia, J. J., and Witten, B. R. (1977): Otoplasty: An electic technique. Laryngoscope 87: 1359.

12- Luckett, W. H. (1910): A new operation for prominent ears based on the anatomy of the deformity. Surg. Gynecol. Obestet. 10: 635. Quoted from Adamson, P. A., and Strecker, H.D. (1995): Otoplasty techniques. Facial Plast. Surg. 11: 284.

13- Stenstrom, S. J., and Heftner, J. (1978): The Stenstrom otoplasty. Clin. Plast. Surg. 5: 465.

14- Adamson, P. A. (1985): Complications of otoplasty. Ear Nose Throat J. 64:568.

15- Goode, R. L., Proffitt, S. D., and Rafaty, F. M. (1970): Complications of otoplasty. Arch. Otolaryngol. 91: 352.

16- Tan, K. H. (1986): Long-term survey of prominent ear surgery: A comparison of two methods. Br. J. Plast. Surg. 39: 270.

17- Furnas, D. W. (1990): Complications of surgery of the external ear. Clin.Plast. Surg. 17: 305.

18- Calder, J. C., and Naasan, A. (1994): Morbidity of otoplasty: A review of 562 consecutive cases. Br. J. Plast. Surg. 47: 170.

19- Adamson, P. A., McGraw, B. L., and Tropper, G. J. (1991): Critical review of clinical results. Laryngoscope 101: 883.

20- Feuerstein, S. S. (1974): Revision techniques in otoplasty: Evaluation and management. Otolaryngol. Clin. North Am. 7: 133.

21- Elliott, R. A., Jr. (1978): Complications in the treatment of prominent ears. Clin. Plast. Surg. 5: 479.

22- Messner, A. H., Crysdale, W. S. (1996): Otoplasty clinical protocol and long-term results. Arch. Otolaryngol. Head Neck Surg. 122: 773.

23- Vuyk, H. D. (1977): Cartilage-sparing otoplasty: A review with long-term results. J. Laryngol Olol. 111: 424.

24- Dennis Lee, Charles D. Bluestone. June (2000): The Becker technique for otoplasty: Modified and revisited with long-term outcomes. Laryngoscope 110: 949.

25- Melvin Spira. Sept.(1999): Otoplasty: What I do now-A 30-year prespective. Plast. Reconstr. Surg. 104: 3: 834.

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الملخصالعربى -------------

الجلد سلخ بعد الخيوط وضع بواسطة األذن تجميل عمليةالغضروفاألمامى وكشط القفاز خلع علىطريقة

اتجاه فى الذاتى األلتواء خاصية األذن لغضروف أن والتجارب األبحاث أثبتتالخاصيه هذه من اإلستفادة تم وقد إضعافه يتم الذى السطح ألتجاه معاكسالمترهله األذن فى الخارجى األذن لبرواز المقابل المفقود البروز إنشاء فى

وثالثين خمسة على األذن تجميل عملية البحث هذا فى اجريت حيث البارزه أوعنها يتسبب والتى المترّهله األذن مشكلة من يعانون مريضا لعشرين أذنا

. تراوحت وقد هذا المرضى هؤالء لدى السيىء النفسى المردود من المزيد) الذكور نسبة وازدادت سنة عشرة وثمانى سنوات اربعة بين %)60أعمارهم

اإلناث ( مما%) 40عن الذكور شعر قصر مع وضوحا أكثر األذن بروز يكون حيث . هذه وفى اإلناث من أكثر الجراحة هذه مثل إلجراء حاجتهم ازدياد يفسر

ثم القفاز خلع طريقة على الجلد بسلخ األذن غضروف تعرية يتم العمليهالخيوط باستخدام وذلك األذن إلطار مقابل بروز بإنشاء الغضروف تعديل

يتم السابقه لحالته الغضروف ارتداد عدم ولضمان السطح الجراحيه إضعافغضروفى الحول الغشاء ازالة بعد وذلك الكشط بواسطة البارز االمامى

االخيره اللمسات وضع وبعد الخارجى األذن إلطار المقابل للبروز المغلف " لسابق " المسلوخ الجلد إرجاع يتم األذن غضروف وهو األساسى الهيكل على

الجلد من الزائد الجزء من التخلص بعد الخارجى الجرح اقفال ثم ومن وضعهالجلد تثبيت ثم األذن لبرواز المقابل البروز تخليق عمليه عن والناتج

فى المتبع كذلك الرأس وبرباط الطبى الشاش من بقطع المعدل بالغضروفتسجل . فلم للغايه مشجعة العمليه نتائج جاءت وقد هذا الحلمى النتوء عمليات

فقد الجرح التئام بعد ما مضاعفات أما الجراحيه للعمليه أوليه مضاعفات أيهمصاحب الم المرضىمن أحد اشتكى حيث األخرى باألبحاث قياسا كانتضئيلةتحسنت وقد باألذن األحساس فقد او ضعف من عانا قد واثنان األذن للمس

الكريمات باستخدام زالت األذن بجلد حكة من عانى وواحدا تباعا حالتهما . عدم المرضى أحد الحظ فقد لألذن التجميليه النتائج بخصوص أما الموضعية

من أكثر رأسه من اقتربت قد أذنه أن آخر ورأى الشكل فى األذنين تطابقالنسبه جاءت وقد الجراحه نتائج عن عام بشكل رضاهم من الرغم على الالزم

حاله تسجل لم حيث ممتازه العمليه بنجاح ذويهم وكذا المرضى لقناعه العامهواحده . قناعة عدم

فائقة تجميلية نجاح بنسبة تتميز العملية هذه أن الى البحث نتائج خلصت وقدمن جزء استئصال أو قطع يتم لم حيث المنشوده النجاح مقومات مع تطابقت

الخلفى السطح شد على األذن شكل تغيير يعتمد لم وكذلك األذن غضروفالطبيعى البروز من األذن لبرواز المقابل البروز اقترب وايضا األذن لجلد

خاصية على إعتمادا الدوران وانسيابيه الملمس نعومة حيث من العاديه لألذنإضعافه تم الذى معاكسللسطح اتجاه الغضروففى .التواء

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