New modification in otoplasty: anterior approach.

After harvesting the conchal cartilage in a large series of secondary rhinoplasties using the anterior approach, there was a marked improvement in the shape of the auricle, with unnoticeable scarring hidden under the convolution of the antihelix. In this series of 250 cases, there were no hypertrophic scars or keloid formations. Based on these favorable results, a new modification of otoplasty was developed using only the anterior approach. Between 1992 and 2000, 108 otoplasties were performed on 55 patients to correct the prominent ear using only the anterior approach. All maneuvers used in modern otoplasty, such as conchal reduction, scaphal cartilage scoring and folding, placement of horizontal mattress buried sutures, conchal setback, and the positioning of the tail and upper pole, can be easily and effectively performed using only the anterior approach as described in this article. The use of an anterior approach does not disturb the neurovascular system of the ear because it is located on the ear's posterior side. Overall, patient and physician satisfaction has continued to be very high during the 8 years that this technique has been used. Some patients experienced a few minor complications, such as postoperative pain (16.3 percent), late suture reaction (1.8 percent), hidden helix (3.6 percent), and partial relapse (3.6 percent), that were easily corrected by the application of a Kaye-type buried suture and that were not directly related to the technique.