Treatment as a newborn baby

About two thirds of prominent ears are evident are evident at birth. If there is an adequate amount of skin and cartilage, the prominence may potentially be correctable using a commercially available splint. The Ear Buddies™ splint can be ordered on-line. If worn soon after birth, correction can be achieved with only two weeks of splinting. If treatment is delayed the necessary duration of splinting increases. 

Correction as an older child or adult

Surgery should be delayed until a child is at least 5 years of age. The most common cause of excessive prominence is the absence of the anti helical fold of the ear causing the ear to protrude from the side of the head. The average prominence of an adult ear is about 19mm: about 5% of the population has an ear that is significantly more prominent. 

Surgery should not be offered to a child of more than 5 years of age unless she or he requests the procedure. Common triggers for this include persistent teasing, or a desire to wear hair up or shorter. Correction should produce an ear, which looks proportionate, and natural. The helical rim should still be visible on frontal view. Over-correction of the ear, bringing it too close to the side of the head, looks unnatural. 

Surgery

I perform the operation under general or local anaesthetic, as a day case procedure, lasting about 45 minutes per ear.

I use a “cartilage sparing” technique (rather than a cartilage scoring technique). The incision is made in the post-auricular sulcus (behind the ear). A thin ellipse of skin is excised and a flap of tissue is elevated off the back of the ear cartilage. One or two sutures may be needed to bring the conchal bowl closer to the side of the head. Multiple buried mattress sutures are used to deepen the anti-helical fold. The flap of fascia is then re-draped over the back of the ear (to reduce the potential for recurrence and to limit the prominence of the mattress sutures) before the skin is closed with absorbable sutures.

After care

Patients wake up with a heavily padded bandage around the ears, which is ideally kept in place for 1 week. I usually removed the bandage in clinic. I then recommend that patients use a soft-toweling headband when sleeping, for about 1 month. 

Return to sport and activity varies dependent upon the potential for trauma to the ear. Patients should not participate in a contact sport for at least 6 weeks after surgery. 

Risks 

There is a small risk bleeding and return to theatre on the first evening after surgery. There is a small risk of infection. There is a risk of asymmetry, over correction, infection, lumpy scarring, palpable sutures, and recurrence of the idiosyncrasy.