by Sammy Sinno, MD
My fondest memory during plastic surgery residency interviews was being handed a bar of soap with a plastic knife and told to carve an ear on the interview day. The level of appreciation I have for the complexity of the ear has grown tremendously since that day. Fortunately, we have an article in our literature to demystify some of the complexity.
Understanding the ear can be a challenge for residents. The complex external anatomy, multitude of deformities, and complexity of surgical treatments all contribute to haziness when trying to grasps this fundamental area of plastic surgery. The April 2012 article entitled “Ear Deformities, Otoplasty, and Ear Reconstruction” by Dr. Charles Thorne and Dr. Gordon Wilkes is a wonderful addition to our literature that simply and elegantly explains everything a resident needs to know about the ear. Importantly, this manuscript includes five key videos that beautifully demonstrate key techniques every resident should be familiar with.
The article begins with a discussion of otoplasty for prominent ears. The authors stress the importance of precise and meticulous preoperative analysis, which is arguably the most crucial portion of the operation. Dr. Thorne shares a wonderful video of his otoplasty technique that is clear and concise, with the text supplementing the salient points in the video. This section is completed by a discussion of perioperative management and complications, which are important considerations for young surgeons attempting this challenging operation.
Next, the authors review several ear deformities and key management features. Aside from the fact that these deformities are commonly tested on Inservice and board examinations, it is important for residents to understand these deviations from the normal auricular contour to obtain a comprehensive approach to otoplasty and ear reconstruction. Shell ear, macrotia, Stahl’s ear, constricted ear, cryptotia, and question mark ear are all reviewed.
After a brief discussion of nonoperative correction of ear deformities, the authors review total and subtotal ear reconstruction. Dr. Wilkes highlights this section with a video on carving of the ear framework, along with several illustrations of the Brent and Nagata techniques. Prior to scrubbing into my first ear reconstruction case, I remember reading this article the evening prior and feeling totally comfortable and prepared for the operative day ahead.
Reconstruction using Medpor framework and prosthetic reconstruction is discussed next. The last section is devoted to partial ear defect reconstruction by breaking the ear into thirds, which I have found personally very useful taking call in a major trauma hospital.
The only recommendation I would have for resident readers before delving deep into this article is to review the external anatomy of the ear. An excellent article on congenital auricular anomalies in Plastic and Reconstructive Surgery from 2005 reviews the topographic anatomy.
In summary, Drs. Thorne and Wilkes have contributed a masterpiece that will stand the test of time. This article is an absolute must for residents who wish to master their understanding of ear deformities, otoplasty and reconstruction. I encourage every resident to read this article and keep it close for clinical matters as well as Inservice and board review.
1. Thorne CH, Wilkes G. Ear deformities, otoplasty, and ear reconstruction. Plast Recon Surg. 2012. 129(4):701-716.
2. Porter CJ, Tan Swee. Congenital auricular anomalies: topographic anatomy, embryology, classification, and treatment strategies. Plast Recon Surg. 2005. 115(6):1701-1712.