INVITED COMMENTARY

INVITED COMMENTARY Chongchet [6] used a posterior approach, incising the ous, we do not hesitate to place some on the anterior sur- cartilage and scoring the antihelix area anteriorly, with face of the ear hidden under the antihelical fold, in order parallel incisions through the perichondrium and partially to avoid unnecessary undermining with its associated through the cartilage. complications. From the basic techniques described here, there are many modifications including definitive sutures for cre- ation of the antihelical fold, which in many cases results References in a sharp edge, irregular contours, or an unnatural look. 1. Ely ET (1881) An operation for prominence of the auricles. Arch In some cases of definitive sutures, dark suture material Otolaryngol 10:97 may be visible beneath the thin cover of the ear, or recur- 2. Becker OK (1949) Surgical correction of the abnormally protrud- rence may occur, due to suture failure. ing ear. Arch Otolaryngol 50:541±560 The ideal technique should not leave residual foreign 3. Converse JM (1955) A technique for surgical correction of lop ears. Plast Rconstr Surg 15:411±418 bodies in the ear, especially permanent sutures, have min- 4. MustardØ JC (1963) The correction of prominent ears by using imal incisions and have a dissection limited to the defect. simple mattress sutures. Br J Plast Surg 16:170±178 Surgery should precisely correct the cause of the deformi- 5. Stenström SJ (1963) A ªnaturalº technique for correction of con- ty and avoid sharp ridges on the antihelix or concha in or- genitally prominent ears. Plast Reconstr Surg 32:509±518 6. Chongchet V (1963) A method of antihelix reconstruction. Br J der to produce a natural result. Plast Surg 16:268±272 In the search for a method based on these concepts, a 7. Ju DMC, Li C, Crikelair GF (1963) The surgical correction of simple technique has evolved; this is easy to perform, it protruding ears. Plast Reconstr Surg 32:283±292 directly addresses the problem, and results in minimal 8. Gibson T, Davis WB (1958) The distortion of autogenous carti- lage grafts: its cause and prevention. Br J Plast Surg 10:257±274 scars and low morbidity. Since the scars are inconspicu- The authors' attempt to find a simpler method of correct- tilage correction! The 3 to 5 mm, skin ellipse described ap- ing prominent ears is laudable but to me the title of their pears to be at least 3.5 cm in length and the development paper is a misnomer as their procedure is far from mini- of 3 tunnels and the placing of 3 sutures which are to be mally invasive as well as suffering from several disadvan- tied only when the tension has been estimated, constitute tages, compared with the Chongchet operation. further invasion and complexity. As if this is not enough I have used Chongchet's procedure for more than 30 we are told more sutures can be placed through the fold years because it is both simple and reliable. Minor mod- laterally and medially but it is not clear to me how or when ifications, such as those I published in 1972 [1], can be this should be done. Further, they say that even more inci- introduced at the surgeon's discretion but the underlying sions may be needed to reduce the scapha and the ear lobe principle is scoring the anterior surface of the cartilage which could bring the total to 10 separate incisons com- under direct vision, access being gained via the excision pared to the 2 needed in the Chongchet operation. of a posterior skin ellipse. Finally it is a pity that after so much work we are un- In this new article it is stated that 3 separate incisions able to judge the results because of the poor quality of the are routinely used, 2 being on the anterior surface of the all-important post-operative photo (Fig. 2d) in which ear. These will of course leave more readily visible scars most of the ear on each side is covered by hair or deep than a posterior incision. Via one of the small anterior in- shadow. The operation is almost as intricate and poorly cisions blind scoring is undertaken which carries with it conceived as a recent article describing endoscopic cor- the disadvantages of possible irregularities and inadequate rection for prominent ears [3] where one is left wondering correction. If on the other hand one scores the anterior sur- if the authors have taken leave of their senses. face of the cartilage under direct vision, not only are these disadvantages eliminated but one can also score the carti- lage horizontally if need be as well as dividing the upper References and lower springs and modifying the tail of the antihelix. 1. Tolhurst DE (1972) The correction of prominent ears. Br J Plast If one scores well into the concha there is no need to ex- Surg 261-5 cise conchal cartilage as confirmed by Bozdogan ]2]. 2. Bozdogan MN (1997) Chongchet's otoplasty: not only a method The authors say that the work done on the anterior sur- of antihelix reconstruction. Eur J Plast Surg 20:231±235 3. Graham KE, Gault DT (1997) Endoscopic assisted otoplasty: a face of the cartilage ªwill have overcome the ear's tenden- preliminary report. Br J Plast Surg 50:47±57 cy to retropositionº yet they next embark on an excision of skin and the placing of deep retaining sutures to do pre- D.E. Tolhurst cisely what they say should have been achieved with car- 47 Aylesford Street, London SW1V 3RY, UK http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Plastic Surgery Springer Journals

INVITED COMMENTARY

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Publisher
Springer-Verlag
Copyright
Copyright © 1998 by Springer-Verlag Berlin Heidelberg
Subject
Medicine & Public Health; Plastic Surgery
ISSN
0930-343X
eISSN
1435-0130
D.O.I.
10.1007/s002380050085
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Abstract

Chongchet [6] used a posterior approach, incising the ous, we do not hesitate to place some on the anterior sur- cartilage and scoring the antihelix area anteriorly, with face of the ear hidden under the antihelical fold, in order parallel incisions through the perichondrium and partially to avoid unnecessary undermining with its associated through the cartilage. complications. From the basic techniques described here, there are many modifications including definitive sutures for cre- ation of the antihelical fold, which in many cases results References in a sharp edge, irregular contours, or an unnatural look. 1. Ely ET (1881) An operation for prominence of the auricles. Arch In some cases of definitive sutures, dark suture material Otolaryngol 10:97 may be visible beneath the thin cover of the ear, or recur- 2. Becker OK (1949) Surgical correction of the abnormally protrud- rence may occur, due to suture failure. ing ear. Arch Otolaryngol 50:541±560 The ideal technique should not leave residual foreign 3. Converse JM (1955) A technique for surgical correction of lop ears. Plast Rconstr Surg 15:411±418 bodies in the ear, especially permanent sutures, have min- 4. MustardØ JC (1963) The correction of prominent ears by using imal incisions and have a dissection limited to the defect. simple mattress sutures. Br J Plast Surg 16:170±178 Surgery should precisely correct the cause of the deformi- 5. Stenström SJ (1963) A ªnaturalº technique for correction of con- ty and avoid sharp ridges on the antihelix or concha in or- genitally prominent ears. Plast Reconstr Surg 32:509±518 6. Chongchet V (1963) A method of antihelix reconstruction. Br J der to produce a natural result. Plast Surg 16:268±272 In the search for a method based on these concepts, a 7. Ju DMC, Li C, Crikelair GF (1963) The surgical correction of simple technique has evolved; this is easy to perform, it protruding ears. Plast Reconstr Surg 32:283±292 directly addresses the problem, and results in minimal 8. Gibson T, Davis WB (1958) The distortion of autogenous carti- lage grafts: its cause and prevention. Br J Plast Surg 10:257±274 scars and low morbidity. Since the scars are inconspicu- The authors' attempt to find a simpler method of correct- tilage correction! The 3 to 5 mm, skin ellipse described ap- ing prominent ears is laudable but to me the title of their pears to be at least 3.5 cm in length and the development paper is a misnomer as their procedure is far from mini- of 3 tunnels and the placing of 3 sutures which are to be mally invasive as well as suffering from several disadvan- tied only when the tension has been estimated, constitute tages, compared with the Chongchet operation. further invasion and complexity. As if this is not enough I have used Chongchet's procedure for more than 30 we are told more sutures can be placed through the fold years because it is both simple and reliable. Minor mod- laterally and medially but it is not clear to me how or when ifications, such as those I published in 1972 [1], can be this should be done. Further, they say that even more inci- introduced at the surgeon's discretion but the underlying sions may be needed to reduce the scapha and the ear lobe principle is scoring the anterior surface of the cartilage which could bring the total to 10 separate incisons com- under direct vision, access being gained via the excision pared to the 2 needed in the Chongchet operation. of a posterior skin ellipse. Finally it is a pity that after so much work we are un- In this new article it is stated that 3 separate incisions able to judge the results because of the poor quality of the are routinely used, 2 being on the anterior surface of the all-important post-operative photo (Fig. 2d) in which ear. These will of course leave more readily visible scars most of the ear on each side is covered by hair or deep than a posterior incision. Via one of the small anterior in- shadow. The operation is almost as intricate and poorly cisions blind scoring is undertaken which carries with it conceived as a recent article describing endoscopic cor- the disadvantages of possible irregularities and inadequate rection for prominent ears [3] where one is left wondering correction. If on the other hand one scores the anterior sur- if the authors have taken leave of their senses. face of the cartilage under direct vision, not only are these disadvantages eliminated but one can also score the carti- lage horizontally if need be as well as dividing the upper References and lower springs and modifying the tail of the antihelix. 1. Tolhurst DE (1972) The correction of prominent ears. Br J Plast If one scores well into the concha there is no need to ex- Surg 261-5 cise conchal cartilage as confirmed by Bozdogan ]2]. 2. Bozdogan MN (1997) Chongchet's otoplasty: not only a method The authors say that the work done on the anterior sur- of antihelix reconstruction. Eur J Plast Surg 20:231±235 3. Graham KE, Gault DT (1997) Endoscopic assisted otoplasty: a face of the cartilage ªwill have overcome the ear's tenden- preliminary report. Br J Plast Surg 50:47±57 cy to retropositionº yet they next embark on an excision of skin and the placing of deep retaining sutures to do pre- D.E. Tolhurst cisely what they say should have been achieved with car- 47 Aylesford Street, London SW1V 3RY, UK

Journal

European Journal of Plastic SurgerySpringer Journals

Published: Jun 24, 1998

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