Phẫu Thuật Thẩm Mỹ Tạo Hình Tai Nâng Cao (Advanced Cosmetic Otoplasty)

577
59 Psychosocial, Behavioral, and Emotional Effects Following Otoplasty
Technical Results
The postoperative complications described for
this surgical intervention are pain, bruises, surgi-
cal wound infection, suture-related complications
such as extrusion of sutures or keloid formation,
cartilage irregularities, and recurrence of the
prominence. All of them are rare. Depending on
the authors, the suture extrusion rate is 10 %, and
the recurrence rate is between 5 and 10 % [ 1 ] .
The surgical treatment of suture extrusion
depends on the clinical course, but it is usually
solved by removing the suture, without a higher
rate of recurrence or need for redo-otoplasty.
Redo-otoplasty obtains successful results sim-
ilar to the initial procedure.
Psychosocial, Behavioral,
and Emotional Aspects
Social Cruelty
Pickhardt [ 9 ] de fi nes social cruelty as “aggres-
sively attacking another person with words or
actions directed to injure the victim’s well-
being, to damage his standing, or simply to
assert the aggressor’s dominance.” This occurs
in the middle school years, in children around
9–13 years old, because of the destabilizing and
challenging early adolescence period. Social
cruelty is exhibited by teasing, excluding, bul-
lying, rumoring, and ganging up. Aggressors
are protected by the desire of adolescents to
Fig. 59.1 Mustardé’s otoplasty

578
R.A. Cuesta and C.S. Beauregard
keep adults out, the “don’t-tell-on-peers” code
of secrecy and silence [ 9 ] . All of these forms of
social cruelty play on an adolescent’s deepest
fears (the physical aspect in the case of the
prominent ears).
Teasing is the act of making fun of a differ-
ence in others to criticize their traits, diminish
their social standing, and set them apart socially.
Humiliation is carried out with insults, making
the victim feel inferior.
Exclusion is the refusal to let someone associ-
ate with others or join a group, playing with the
fear of isolation.
Bullying is the act of verbally or physically
intimidating, injuring, coercing, or dominating
another person, acting thus in the fear of
weakness.
Rumoring is to use gossip to spread lies or
secrets about others that demean their social rep-
utation and play with the fear of defamation.
Ganging up is to join and act against others to
torment them, acting in fear of persecution.
Social cruelty produces anger, depression,
feeling demeaned, fear, humiliation, isolation,
hurt, and shame, and because it undermines the
victim’s social safety, it often reduces academic
focus and school performance. So, of course, it
can produce psychosocial and emotional prob-
lems in adult life. Social cruelty is also a symp-
tom of an underlying emotional discomfort that
largely originates in a common cause: the social
dislocation and developmental insecurity of early
adolescent change.
Early Adolescence
Early adolescence is a period of time that starts
around the age of 9 and ends at around 13 years
old. This is a very important period in which the
child becomes an adult and involves many
changes that makes the adolescent feels insecure.
The early adolescent needs to fi nd attachment
and acceptance in an independent and unstable
society of peers who are feeling insecure and vul-
nerable, too. It is this potent mix of insecurity,
vulnerability, and need for social belonging in a
more independent world of peers that is the cradle
for social cruelty [ 9 ] .
Social Cruelty and Prominent Ears
The most used form of social cruelty in the case
of children with prominent ears is to tease them
with insults and name calling. Its power arises
from the adolescents’ constant feelings of the
danger of being publicly exposed because of
some awkwardness or ineptitude. In fact, in this
period, they have an enormous appearance anxi-
ety, both boys and girls, because they are pain-
fully self-conscious and self-critical about their
physical appearance. They think that the others
will detect and judge their defects harshly and
turn against them. This makes them feel afraid
and insecure. In some cases of children with
prominent ears, we have also seen parents who
have psychosocial disturbances because of their
own experiences and come to consult us to pre-
vent their child from suffering the same fate.
Teasing in fl icts more damage when the victim
believes that the degrading is true and then feels
justly accused, so his or her self-esteem plummets.
A speci fi c characteristic of this form of social cru-
elty is that the motivation of the aggressor(s) can
sometimes be hard to determine, because the teas-
ers can say that they was just kidding, making the
victim feel doubly teased, not only for taking the
insult seriously, but also for overreacting and lack-
ing a suf fi cient sense of humor.
The surgical correction of prominent ears
should be carried out together with appropriate
coaching strategies about handling teasing, which
can reverse the victim’s psychosocial and emo-
tional disturbances. There are many strategies for
fi ghting against teasing, basically based on not
taking the teasing personally, for example, by
pretending to misunderstand it, ignoring it, laugh-
ing at it, or agreeing with it.
However, for most cases of children with pro-
truding ears, this is not enough, and they need
surgical correction.
Psychosocial Results Following
Otoplasty
There are many publications, papers, and studies of
the bene fi ts of otoplasty for prominent ears in terms
of psychosocial repercussions, cosmetics results,

579
59 Psychosocial, Behavioral, and Emotional Effects Following Otoplasty
and the degree of patient satisfaction . Most of them
are based in comparing health-related quality of
life scales before and after the surgical treatment,
which show an important improvement in the qual-
ity of life for most patients [ 10, 11 ] .
The authors published a “Satisfaction Survey
of the Evolution of 238 Otoplasties” carried out at
La Paz Hospital in Madrid in 2008 [ 1 ] . This study
was made by sending a satisfaction questionnaire
to 127 patients who underwent Mustardé’s oto-
plasty for prominent ears during the years 2003–
2006. The mean age was 8.15 ± 3.25 years (range,
1–15 years), with a follow-up period of
27.15 ± 13.62 months (range, 4–52 month). 38 %
of the patients were old enough to want the surgery
to correct a long-standing defect, having psycho-
social disturbances, and in 32 % of them, there
was also a reduction in school performance. All of
them recovered their self-esteem after the proce-
dure, even the patients who suffered total or partial
recurrence (6.29 % of cases).
In the article published by Gasques et al. [ 5 ]
on “Psychosocial Effects of Otoplasty in Children
with Prominent Ears,” it was noted that after sur-
gical correction, the patients feel less anxiety and
increased self-esteem, making important improve-
ments and learning achievements in in-group and
out-of-school activities.
Thus, the patients feel happier and report
increased social integration probably related to
the previously mentioned bene fi ts of improved
self-con fi dence, which makes them less vulnera-
ble to social cruelty.
In a few cases, surgical correction does not
have the bene fi ts expected. Cooper-Hobson and
Jaffe [ 10 ] reported in their study that this may be
because of extremely high expectations, even
with the best technical results. This can be
avoided simply by having a good, trusting physi-
cian-patient relationship, because this allows the
physician to understand the patient’s expectations
and to explain the results that can be achieved in
each particular case.
Conclusions
Prominent ears, although considered a minor
deformity causing no physiological problems,
can be an important source of psychosocial,
emotional, and behavioral problems. This sit-
uation is especially hurtful in the middle
school years because of the extreme feelings
of insecurity and vulnerability experienced in
the early adolescent period, which can be pro-
longed into adulthood.
Surgical correction of prominent ears is
an easy technique with a low risk of compli-
cations that has demonstrated improvement
in the psychosocial, behavioral, and emo-
tional problems related to these anomalies
(Figs. 59.2 and 59.3 ).
Fig. 59.2 ( a ) Preoperative. ( b ) Early postoperative results

580
R.A. Cuesta and C.S. Beauregard
References
1. Aguilar R, Soto C, Barrena S, Díaz M, López JC, Ros
Z, et al. Estudio de la evolución de 238 otoplastias
mediante encuesta de satisfacción. Cir Pediatr. 2008;
21(2):104–6.
2. Braun T, Hainzinger T, Stelter K, Krause E, Berghaus
A, Hempel JM. Health-related quality of life, patient
bene fi t and clinical outcome after otoplasty using
suture techniques in 62 children and adults. Plast
Reconstr Surg. 2010;126(6):2115–24.
3. Matsuo K, Hayashi R, Kiyono M, Hirose T, Netsu Y.
Nonsurgical correction of congenital auricular defor-
mities. Clin Plast Surg. 1990;17(2):383–95.
4. Sorribes MM, Tos M. Nonsurgical treatment of prom-
inent ears with the Auri method. Arch Otolaryngol
Head Neck Surg. 2002;128(12):1369–76.
5. Ely ET. An operation for prominence of the auricles.
Arch Otolaryngol. 1881;10:97.
6. Morestin H. De la reposition et du plissement cosmé-
tiques du pavillon de l’oreille. Rev Orthop. 1903;4:394.
7. Stenstrom SJ. A “natural” technique for correction of
congenitally prominent ears. Plast Reconstr Surg.
1969;42:189–201.
8. Pereira-Filho O, Eickhoff DR, Eickhoff DR, Bins-Ely J,
Bins-Ely J, Granemann AS, et al. Novel approach to closed
treatment of prominent ear without skin resection (endo-
plasty) of prominent ear without skin resection (endoto-
plasty). Plast Reconstr Surg. 2006;118(7 Suppl):55S.
9. Pickhardt C. Why good kids act cruel. The hidden
truth about the pre-teen years. Naperville: Sourcebooks
Inc; 2010.
10. Cooper-Hobson G, Jaffe WJ. The bene fi ts of otoplasty
for children: further evidence to satisfy the modern NHS.
J Plast Reconstr Aesthet Surg. 2009;62(2):109–14.
11. Gasques JA, de Pereira Godoy JM, Cruz EM.
Psychosocial effects of otoplasty in children with prom-
inent ears. Aesthetic Plast Surg. 2008;32(6):910–4.
a
b
Fig. 59.3 ( a ) Before surgical correction. ( b ) 7 postoperative day

Part VII
Miscellaneous

583
M.A. Shiffman (ed.), Advanced Cosmetic Otoplasty,
DOI 10.1007/978-3-642-35431-1_60, © Springer-Verlag Berlin Heidelberg 2013
60
Consent
Has my patient understood the procedure and
agreed to treatment? If yes is the answer, then
you have probably obtained legally valid consent
from your patient. However, it is good practice –
if not essential – to gain such consent in writing,
and this is stipulated in hospital guidelines and
protocols and sometimes the law. Consent forms
provide a useful starting point for obtaining con-
sent, but it plays mainly an evidentiary role and it
has signi fi cant limitations:
“I regard the consent form immediately before oper-
ation as pure window dressing….and designed to
avoid the suggestion that a patient has not been told.”
Lord Popwell in Taylor v Shropshire HA 1998
Historical Perspective and the
Importance of Consent
The fi rst legal case pertaining to consent was set-
tled way back in 1767 in the case of Slater v Baker
and Stapleton, where surgery had been performed
against the wishes of a patient, and has been
evolving as a concept ever since.
Consent is said to be necessary to uphold
patient autonomy as well as an ethical and pro-
fessional duty, but importantly it will lead to
improved clinical outcomes through better coop-
eration from patients. We should help patients to
make decisions through good explanations and
information resources.
Consenting patients in most hospitals revolves
around the consent form, which is fi lled in by the
surgeon outlining the relevant operation with
stated risks and bene fi ts. Patients express their
consent by signing this document. Written con-
sent is seen as the current gold standard, as other
forms of consent that may be explicit (verbal) or
implied are less robust and certainly unreliable if
challenged.
Some dif fi culties with our current method of
written consent include a “legalistic” approach,
the timing is often immediately before or close
to the operation, and the process tends to be neg-
ative by concentrating on risks and complica-
tions which can be signi fi cantly detrimental to
patients’ state of mind and anxiety in the run-up
to surgery. It has been shown that patients take in
very little of what they hear despite the best of
explanations in this scenario. Furthermore, the
consent form does not go very far in proving that
patients actually understand or that they have
capacity.
Many have attempted to improve consent
within this framework by enhancing consent
K. Shokrollahi , BSc, MBChB, MSc, LLM,
MRCS(Eng), FRCS(Plast) (*)
Mersey Regional Burns and Plastic Surgery Unit,
Ward 4d , Whiston Hospital ,
Warrington Rd , Liverpool L35 5DR , UK
e-mail: kshokrollahi@hotmail.com
A. Molajo , M.D., MRCS
Department of Plastic and Reconstructive Surgery ,
St Helens ad Knowsley NHS Trust, Whiston Hospital ,
Merseyside , UK
e-mail: adeyinka.molajo@gmail.com
Evolution of Consent
and Alternatives to Traditional
Consent Forms
Kayvan Shokrollahi and Adeyinka Molajo

584
K. Shokrollahi and A. Molajo
forms by making them procedure speci fi c,
providing improved patient information, and by
obtaining consent in a clinic or of fi ce setting
remote from the operating time. These may cer-
tainly improve aspects of the consent process,
but to make a real difference, an entirely new
and radical approach is required. Patients
request treatment instead of consenting to treat-
ment, and such a request-based method of con-
sent has recently been published [ 1, 2 ] . The
advantages are numerous and include a patient-
centric and constructive approach, superior doc-
umentation of consent which for the fi rst time
demonstrates both capacity and informed con-
sent in patients’ own handwriting and vocabu-
lary, speed (often completed prior to attendance
for surgery), and fl exibility (can be used
selectively).
Request for Treatment (RFT)
Request for treatment, otherwise called patient-
centered consent, is a type of written consent.
As with traditional consent, it relies on a form,
but this time it is a request form and it is com-
pleted by patients and fi nally signed by a sur-
geon accepting to undertake the procedure. It
can be used in isolation as the method of con-
sent or as dual consent (either permanently or as
a transitional step to request-only consent). The
forms used are very similar to traditional con-
sent forms, but instead of “I consent to” the
onus is “I request....” The name of the proce-
dure as well as risks and complications are all
written by patients in their own writing and
vocabulary.
The RFT process puts some advantageous
pressures on clinicians:
1. To provide excellent patient information
resources
2. To communicate well and explain suf fi ciently
such that patients are able to complete the
request forms
However, these pressures lead to practice
which is safe and patient-centric and leads to
truly informed consent – the documentation of
which should be beyond reproach.
A particular advantage to RFT is that it ensures
that patient expectations are aligned with surgeon
expectations. There is no doubt that the leading
cause of complaints and litigation is a mismatch
in this area. One learns a great deal at almost
every consent episode of RFT – what patients
expect to be the bene fi ts of their surgery, for
example, which is eye-opening at times. It is
therefore an excellent early-warning system for
unrealistic patients. If written consent is required
as evidence in court, the RFT document written
by the patient’s own hand stating various risks is
both a strong shield – in court – and indeed a psy-
chological barrier to litigation and complaints in
the fi rst place.
There are many aspects of the author’s prac-
tice for which RFT is routinely used, especially
cosmetic practice. Routine and minor procedures
will still bene fi t from its use, but surgeons will
tailor its use to those areas where they perceive it
to provide the greatest bene fi t. Example request
forms can be found at , and most
surgeons will tailor these forms for their own
requirements.
Consent for Otoplasty
The majority of patients undertaking otoplasty
are children, and therefore parents will be con-
senting on behalf of their children rather than
patients themselves. Prominent ears are viewed
in different social and cultural lights in different
ethnic and national groups, and this must be born
in mind. The vast majority of patients with
signi fi cant prominence are likely to experience
negative psychological effects by about the age
of six. I would recommend that the combination
of “sensible” parents and children whom are
either keen for surgery or indifferent about surgery

585
60 Evolution of Consent and Alternatives to Traditional Consent Forms
are good candidates for surgery. Obviously a pref-
erence for intervention from the child is desirable,
and surgery is scheduled for an appropriate time
when the child is able to contribute to decision-
making. A delay can also allow a less risky local
anesthetic procedure at an older age. It is impor-
tant to be cautious in children who demonstrate
reluctance to surgery, and careful consideration is
required before overriding the child’s wishes in
favor of parental wishes, although this is rare [ 3 ] .
References
1. Shokrollahi K. Request for treatment: the evolution of
consent. Review. Ann R Coll Surg Engl. 2010;92(2):
93–100.
2. Request for treatment: Patient centred consent www.
rft.org.uk . Accessed 5 Aug 2012
3. Shokrollahi K, Kaney S. Psychological considerations
in patient selection for pinnaplasty. J Plast Reconstr
Aesthet Surg. 2009;62(1):118.

587
M.A. Shiffman (ed.), Advanced Cosmetic Otoplasty,
DOI 10.1007/978-3-642-35431-1, © Springer-Verlag Berlin Heidelberg 2013
Index
A
Abnormal contour , 105
Abscess , 235, 419, 524, 544
Acne , 185
Adamson, P.A. , 106, 176, 479
Agarwal, A. , 30
Alexander, G. , 45
Algorithm , 59, 119
Allergy , 484, 487, 490
Anatomy of the prominent ear , 188, 218
Angulation , 273, 402, 523, 565
Anotia , 6, 7, 217
Antia, N.H. , 470
Antihelical fold , 9, 44, 67, 102, 112, 119, 127, 140, 143,
150, 163, 171, 184, 197, 214, 235, 245, 252, 267,
273, 280, 312, 323, 329, 338, 363, 371, 381, 384,
399, 415, 421, 426, 440, 453, 477, 513, 525, 528,
535, 546, 557
Antihelical hypoplasia , 76, 135, 150
Antihelical roll , 8, 144
Antitragal protrusion , 127, 252
Antitragohelicine fi ssure , 279–281, 283, 284
Antitragus-conchal junction , 529
Aplasia , 8, 9
Arnold’s nerve , 20, 66, 128, 272, 513, 557
Asymmetry , 70, 77, 99, 105, 107, 108, 111, 165, 181,
185, 188, 198, 228, 236, 282, 290, 346, 364, 368,
396, 469, 523, 527, 529, 533, 534, 572
Atresia , 8–10, 12
Auricular angle , 7, 9
Auricular cysts , 6
Auricular index of Topinard , 215
Auricular molding , 67, 221
Auricular pavilion , 112, 271–274, 438, 442
Auricular pits , 6
Auricular sinuses , 6, 7, 217
Auriculocephalic sulcus , 24, 25, 43, 140, 383, 482
Auriculomastoid sulcus , 121
Ayhan, M. , 251
Azad, S. , 401
B
Baker, D.C. , 188, 525
Ballenger, J.J. , 312
Balogh, B. , 37, 150, 536
Barbula hirci , 16
Barnes, W.E. , 59
Barsky, A.J. , 44
Basal cell carcinoma (BCC) , 407, 409, 410, 412,
539, 540
Bat ear , 98, 214, 217–219, 227, 230
Bauer, B.S. , 188, 359, 363, 369, 402, 479
Bauer otoplasty technique , 183–193
Baxter, H. , 44
BCC . See Basal cell carcinoma (BCC)
Becker, O.J. , 48, 52, 68, 143, 214, 358, 438
Becker’s technique , 50, 68
Beckwith-Wiedemann syndrome (BWS) , 6, 10, 12
Bleeding , 73, 105, 106, 146, 147, 177, 188, 224, 225,
283, 326, 330, 367, 373, 416, 418, 419, 428, 494,
511, 523, 525
Boo-Chai, K. , 485, 490
Borges, A.F. , 47, 48
Borge’s technique , 48
Bovill, E.S. , 77, 81, 514
Bradbury, E.T. , 38, 235, 269, 570
Branchial arches , 3–6, 9, 12, 127, 172
Branchial cleft , 3–5, 9
Branchial groove , 421
Branchio-oto-renal syndrome , 6
Brent, B. , 550
Bruising , 139, 146, 382
Buckled helix , 294
BWS . See Beckwith-Wiedemann syndrome (BWS)
C
Calci fi cation , 105, 311
Calder, J.C. , 106, 292, 327
Caouette-Laberge, L. , 106, 279–295, 438
Cartilage abrasion , 147, 214, 215, 231, 233
Cartilage bending , 253, 438
Cartilage breaking , 44, 45, 130, 132, 212
Cartilage cutting , 37, 65, 66, 68–70, 74, 76, 95,
101–103, 105, 106, 132, 143, 144, 147,
151, 214, 215, 228, 231, 253, 327,
357–359, 378, 416
Cartilage excision , 44, 46, 74, 112, 197, 224, 232, 235,
236, 334, 335, 357
Cartilage fl ap , 44, 401, 421
Cartilage folding , 337–360, 478

588
Index
Cartilage graft , 30, 293, 335, 401, 482–484, 486–491,
531–533, 548–552
Cartilage irregularities , 95, 101, 147, 228, 249, 275, 284,
289, 327, 358, 513, 523, 577
Cartilage loss , 105
Cartilage molding , 56
Cartilage prominence , 101, 421, 423, 577
Cartilage protrusion , 231, 425
Cartilage rasping , 143–147, 214, 443, 576
Cartilage scoring , 73, 75, 106, 119, 130, 132, 134,
136, 139, 143, 145, 151, 176, 214, 223, 230,
231, 236, 253, 267, 279, 288, 312–320, 358,
363, 368, 373, 378, 381, 399, 400, 421, 422,
443, 513, 514
Cartilage shaping , 95, 101–106, 108, 215, 358, 531
Cartilage sparing techniques , 65, 66, 70–74, 78, 132,
143, 205, 214, 215, 230, 231, 233, 249, 279, 327,
335, 358, 369, 371, 572
Castroviejo calipers , 454, 456
Cauda helicis fi xation , 453
Cauda helicis resection , 282
Cauli fl ower deformity , 134
Cellulitis , 188
Celsus, A.C. , 43
Cephaloauricular angle , 57, 76, 97, 171, 197, 273, 274,
337, 338
Cephaloconchal angle , 273
CHARGE syndrome , 10, 12
Chonchet anterior scoring technique , 273, 275
Chondritis , 78, 105, 115, 134, 143, 153, 165, 185, 188,
221, 327, 513, 523, 524
Chongchet technique , 56, 57, 358
Chongchet, V. , 56, 102, 106, 114, 123, 143, 145, 197,
214, 231, 267, 269, 324, 337, 358, 371, 438
Classi fi cation of auricular anomalies , 312
Classi fi cation of otoplasty techniques , 400
Cloutier, A.M. , 45, 46, 358
Cocheril, R. , 43
Colpaert, S.D. , 358
Conchal bowl
deep , 65, 67, 70, 72–75, 97, 101, 173, 174, 197, 252,
323, 338, 346, 421–423
hypertrophic , 235
Conchal displacement , 401, 424
Conchal graft , 482, 484, 488, 490, 491
Conchal hyperplasia , 69
Conchal hypertrophy , 124, 130, 132, 146, 158, 186,
218, 219, 231, 232, 329, 332, 335, 339,
355, 357, 365, 369, 399, 401, 404,
528–531, 557, 558
Conchal mastoid groove , 158
Conchal mastoid sutures , 69, 70, 75, 76, 124, 232, 240,
332, 334, 368, 545, 547
Conchal prominence , 232, 421, 427–429
Conchal protrusion , 250, 367, 427
Conchal reduction , 45, 75, 76, 123, 143, 174, 175, 182,
378, 402, 404
Conchal resection , 119, 187, 189, 368, 369, 403, 466,
525, 559
Conchal rotation , 156, 165, 252
Conchal setback , 74, 101–103, 174, 181, 232, 240,
329–335, 367, 369, 429, 479, 525, 545–552
Conchal strut , 547, 548
Concha valga , 183
Conchomastoid fi xation , 43, 421, 438
Conchomastoid setback , 72
Conchomastoid sutures , 130, 131, 133, 372, 421, 423,
494, 524–526
Conchoscaphal angle , 53, 127, 129, 338
Conchoscaphal sutures , 494
Condromuscular fl ap , 76
Congenital attached lobule , 175–176
Congenital ear deformities , 127, 217
Consent , 138, 221, 427, 467, 563, 566, 583–585
Constricted ear , 184, 218–220, 230, 233, 282, 289,
337, 399
Contracture , 177, 181, 549
Converse, J.M. , 52, 53, 68, 101, 114, 143, 188, 231, 337,
358, 415, 438, 525, 572
Converse technique , 147, 419, 444
Cooper-Hobson, G. , 570, 579
Cornetta, A.J. , 490
Costas, P.D. , 563
Crikelair, G.F. , 56, 58, 123, 438, 572
Crikelair technique , 58
Cryotherapy , 499, 500, 525
Cryptotia , 8, 312, 337
C-shaped helix , 289, 294–295
Cup ear deformity , 127, 219–220, 252, 282, 453,
455, 493
Cyanoacrylate glue , 77
Cyst , 6, 9, 247, 282, 290
D
Darwin’s tubercle , 7, 16, 187, 210, 215–217, 282, 493
Da Vinci, L. , 565
Davis, J. , 45, 49, 55, 56, 184, 358
Deformity , 5, 23, 37, 43, 66, 98, 111, 119, 127, 147,
149, 163, 171, 183, 197, 209, 242, 245,
250, 269, 272–273, 282, 297, 323, 329,
337, 363, 377, 381, 399, 415, 421, 425,
437, 453, 469, 477, 485–486, 493, 514,
523, 524, 527, 535, 539, 550, 557, 569,
570, 579
Dehiscence , 70, 73, 188, 225, 290, 342, 419, 446, 525,
526, 539
De la Fuente, A. , 76, 119
Dellon, A.L. , 558, 561
De Martino, G. , 43
Demel, R. , 45
Dermabrasion , 145, 147
DeSchweinitz, G.E. , 43
Diapasons , 558, 560
Diathermy , 149, 156, 158, 268, 269, 311–320, 513
Dibbell, D.G. , 490
Dieffenbach, J.F. , 43, 143, 171, 184, 197, 209, 323, 415,
421, 437, 529
Dislocation of helical cartilage , 292
Disruption , 68, 128, 184, 240, 517, 530, 532, 533

589
Index
Distortion , 43, 128, 155, 156, 185, 189, 205, 212, 220,
250, 327, 359, 371, 429, 430, 456, 489, 517,
529, 532
Dog ear , 438, 472, 473
Doppler ultrasound , 29
Dufourmental, C. , 47
Duplication of the auricle , 6
Dysaesthesia , 107
Dysmorphogenesis , 5–6
Dysphoria , 570
E
Ear lobe protrusion , 165, 218, 232–233, 338
Ear molding , 98
Ear protrusion , 99, 150, 158, 365, 415, 416, 543
Ear setback , 545
Ecchymosis , 275, 290, 344, 430
Edema , 225, 290, 465, 466, 517
Elastosis , 210, 214
Electrocautery , 73, 101, 102, 344, 358
Elf ears , 427, 429
Elliott, R.A. , 132, 184, 232, 359, 402
Elliott technique , 130, 400
Eltner, E. , 45
Ely, E.T. , 68, 95, 101, 130, 171, 184, 197, 209, 235, 323,
358, 425, 438, 576
Ely technique , 59
Endoscope , 101
Epidermolysis , 75, 76, 123, 441, 445
Erol, O.O. , 184, 279
Erythema , 517, 524
External postauricular fascia , 24, 28
Extrusion , 23, 29, 73, 75, 76, 78, 102, 103, 106–108,
115, 116, 143, 144, 146, 147, 165, 181, 188,
199, 228, 230–232, 249, 327, 346, 358, 359,
371, 373, 377, 378, 381, 382, 388, 435, 455,
467, 488, 525, 577
F
Falciform excision , 59
Farina, R. , 44
Farina’s technique , 44
Farkas, L.G. , 37, 150, 565, 566
Farrior, R.T. , 55, 68, 69, 74, 101, 102, 114, 523, 526
Farrior’s technique , 74
Fascial fl ap , 24, 33, 59, 73, 101, 103, 106, 139–141, 143,
228, 359, 371–378, 382–394, 400, 548
Fascial graft , 30, 551, 552
Fat graft , 122, 124
Fibrosis , 74, 76, 158, 214, 251, 257, 482, 485
Fishman, L.Z. , 47, 48
Fishman technique , 48
Fishtail design , 62
Fishtail excision , 59, 132, 259
Foreign body reaction , 270, 499
Frankfort line , 256, 373, 374, 565, 566
Fricke, J.C. , 539
Fritsch, M.H. , 73, 101, 103, 104, 198, 245
Frühwald, V. , 45
Fry, H.J. , 145
Furnas, D.W. , 59, 70, 101, 114, 143, 172, 184, 197, 232,
240, 259, 312, 324, 327, 358, 363, 402, 421, 572
Furnas sutures , 23, 24, 73, 132, 141, 232, 359, 389
Furnas technique , 130, 232, 369
G
Gasques, J.A. , 38, 579
Gault, D.T. , 184
Georgeu, G.A. , 84
Gersuny, R. , 44
Gibson’s phenomenon , 130
Gibson, T. , 56, 73, 123, 130, 132, 145, 184, 214, 231,
241, 267, 276, 359, 438
Gillies, H.D. , 184
Goals of otoplasty . See McDowell goals of otoplasty
Goldstein, M.A. , 44, 572
Gosain, A.K. , 37, 66, 150, 221, 479, 493
Goulian, D. , 478
Granuloma , 77, 78, 106–108, 132, 149, 165, 373, 377,
435, 488–490, 524
Grisel’s syndrome , 524
Guyuron, B. , 76, 400
H
Hatch, M.D. , 45, 103
Hatch suture , 292
Haug, R. , 43
Helical advancement fl ap , 470
Helical rim fl ap , 289, 382, 407, 472, 473
Helical tail fi xation , 479
Helical tail setback , 232–233
Helix-to-scalp distance , 97, 99
Hematoma , 70, 75, 77, 78, 103–106, 116, 132, 134,
143, 146, 147, 153, 160, 165, 181, 185, 188,
199, 225, 235, 242, 255, 275, 283, 290, 325,
327, 331, 346, 368, 377, 381, 414, 419, 429,
430, 445, 466, 484, 494, 509–511, 513, 514,
517, 523, 525, 535
Hemorrhage , 199, 269, 414
Hidden helix deformity , 430
Hillocks of His , 4–6, 10, 12
Holden, P.K. , 74
Holmes, E.M. , 45
Hooke’s law , 211
Horlock, N. , 59, 73, 101, 103, 106, 143, 228, 231, 359,
371, 377, 378, 382, 400
Horner, W. , 539
Hydrodissection , 283, 284, 438
Hyperesthesia , 562
Hyperpigmentation , 262
Hypersensitivity , 105, 188, 228, 445, 490, 524
Hypertension , 100, 225, 511, 523
Hypertensive crisis , 100
Hyperthyroidism , 100
Hypertrophic concha , 76, 120, 123, 235, 524
Hypertrophic lobule , 76, 119, 122

590
Index
Hypertrophic scapha , 76, 119, 121, 123
Hypoesthesia , 78, 199, 562
Hypoglycemia , 12
Hypopigmentation , 500
I
Incisionless otoplasty , 73–74, 101, 103, 235–248
Infection , 6, 73, 75, 77, 78, 104, 105, 107, 115, 134, 144,
146, 147, 154, 165, 182, 185, 188, 221, 222, 225,
228, 242, 269, 275, 282, 290, 327, 331, 346, 368,
373, 430, 445, 455, 490, 499, 513, 517, 518,
524–526, 544, 577
In fl ammation , 419, 517, 524
Intrinsic postauricular fascia (IPF) , 24, 25, 27–29,
31–34, 382
Intrinsic postauricular fascia fl ap , 27, 31
Irradiation , 251, 500, 503, 525
Irregularities , 65, 68, 70, 95, 97, 101, 108, 132, 147, 154,
181, 187, 228, 249, 275, 282, 284, 289, 294, 297,
299–308, 327, 335, 342, 358, 402, 443, 445, 451,
494, 513, 523, 530, 552, 577
Ischemia , 144, 160, 490, 539
Island technique , 69, 70, 76, 147, 163–169, 536
J
Jacobson’s nerve , 557
Janik, I. , 251
Janis, J.E. , 149
Jayes, P.H. , 52
Jayes types , 52
Jiamei, D. , 38
Johnson, P.E. , 324
Jones, N. , 33, 251
Joseph, J. , 43
K
Kamburoglu, H.O. , 38
Karacaoglan, N. , 329, 400, 402
Karagoz, H. , 478
Kaye, B.L. , 59, 184, 267, 324
Keen, W.W. , 43, 171, 197, 323
Kelley, P. , 281
Keloid , 73, 78, 101, 105, 107, 108, 140, 144, 146, 147,
181, 188, 198, 228–230, 290, 326, 346, 359, 368,
373, 402, 419, 435, 445, 490, 499–505, 523, 525,
572, 577
Keloid repair , 499–505
Klassen, A. , 570
Kolle, F.S. , 45, 47
Kolle’s technique , 47
Kristensen, H.K. , 52
Kristensen’s technique , 52
L
Laser , 73–75, 98, 102, 249–253, 255–260, 313, 317, 517
La Trenta, G.S. , 444, 447
Leclere, F.M. , 98, 198
Limandjaja, G.C. , 78, 188, 225, 228, 514
Lobule deformity , 199, 493, 494
Lobule hypertrophy , 76, 119, 122, 529
Lobule prominence , 155, 156, 187, 199, 477–479, 493
Lobule protrusion , 209, 233, 255
Lobule protrusion repair , 477–479
Lobule ptosis , 210
Lobule reduction , 104, 105, 119, 365, 463
Lobule setback , 455, 460, 477, 479, 494
Lop ear , 6, 8, 9, 43, 111, 140, 171–175, 183, 217,
245, 248, 312, 337, 427, 429, 453–455,
461, 463, 469
Lop ear reduction , 454, 455, 457–460
Lucerne technique , 111
Luckett, W.H. , 44, 68, 143, 146, 171, 197, 358, 415, 438
Luckett’s procedure . See Luckett’s technique
Luckett’s technique , 44, 45, 52, 400
M
MacColumm, D.W. , 45
Macrotia , 6, 43, 45, 127, 183, 184, 219, 252, 312, 337,
399, 469, 470
Mahler, D. , 267, 269
Mandibulofacial dysostosis , 6
Manushakian, H.S. , 83, 99
Maricevich, P. , 69, 147
Marx classi fi cation , 6
Masud, D. , 84
Matsuo, K. , 212, 217, 221, 400, 576
May fi eld head rest , 99
McDonagh, A.J. , 490
McDowell, A.J. , 45, 66, 129, 144, 149, 221, 253, 447,
529, 565–567
McDowell goals of otoplasty , 144, 149, 150, 221,
514, 567
McDowell’s technique , 46
McEvitt’s technique , 49
McEvitt types , 48, 49, 324
McEvitt, W.G. , 48, 49, 324
Meissner cells , 557
Melanoma , 411, 413
Merkel cells , 557
Messner, A.H. , 108, 327, 565, 566
Microtia , 6, 7, 10, 29, 38, 52, 171, 172, 197, 219, 323,
337, 550
Miller, C.C. , 44
Miller’s technique , 197
Mischkowski, R.A. , 491
Miyamoto, J. , 215
Monks, G.H. , 43
Mordon, S.R. , 74
Morestin, N.H. , 44, 184, 324, 358, 421, 438, 576
Morestin technique , 45
Murakami, W.T. , 145
Muscle fl ap , 59, 399–405
Mustarde, J.C. , 54, 103, 108, 130, 143, 172, 197, 267,
276, 298, 324, 327, 358, 425, 428
Mustarde’s approach , 143

591
Index
Mustarde’s otoplasty , 23
Mustarde’s sutures , 23, 24, 129, 130, 132, 134, 136,
139–141, 143–147, 184, 199, 203, 300, 327,
335, 401, 453, 455, 458, 460, 467, 543–548,
550, 552
Mustarde’s technique , 56, 132, 297–303, 306–308, 327,
331, 430, 514
N
Necrosis , 73, 75–78, 92, 104–106, 122–124, 134,
143, 144, 165, 188, 225, 241, 251, 290,
313, 327, 331, 346, 373, 378, 381, 419,
429, 430, 441, 509, 513, 517, 518, 523,
525, 526
Negrevergne otoplasty technique , 149–160
New, G.B. , 45, 48
Nicoletis, C. , 401, 403
Nordzell, B. , 184, 293, 358, 438
Nuara, M.J. , 232
O
Oculo-auricula-vertebral syndrome (Goldenhar’s
syndrome) , 9
O’Neill, J.K. , 86
Othematoma , 572
Otoabrader , 74, 132, 136, 201, 223, 231, 364, 365
Otobrasion , 200, 271, 273
Overcorrection , 23, 24, 105, 134, 139, 147, 155, 227,
290, 346, 381, 395, 396, 430, 438, 439, 454, 524,
526, 529–531, 534, 548–552
deformity , 228, 325, 532
Overresection , 367, 368, 529, 530, 551
Owens, N. , 59, 198, 232
Oyster splint , 499–505
P
Pacini cells , 557
Padovan, I. , 415
Pain , 74, 89, 99, 105, 116, 134, 154, 174, 177, 225, 254,
290, 327, 373, 429, 430, 466, 503, 517, 524, 525,
570, 572, 576, 577
Paletta, F.X. , 47
Paresthesia , 435
Patel, A.J. , 392
Payr, E. , 44
Perichondrial fl ap , 360, 401, 402
Perichondritis , 182, 199, 225, 235, 430, 491, 524
Pickhardt, C. , 577
Pierce, G.W. , 47, 184
Pilz, S. , 147, 566
Pitanguy, I. , 56, 69, 147, 163, 198, 358, 536
Pitanguy’s island technique , 69, 70, 198
Pitanguy’s technique , 535, 537
Pixie deformity , 172, 176
Posnick, J.C. , 562
Postauricular fascia , 24, 27, 28, 30, 59, 73, 228, 359,
371–378, 381–397
Postauricular sulcus , 45, 66, 71, 73, 76, 99, 101, 121, 128,
144, 150, 175–177, 180, 188, 209, 221, 222, 339,
355, 359, 384, 408, 410, 423, 428, 529, 533, 567
Posterior auricular fascial fl ap , 24, 25, 27–33, 59, 372,
373, 399–405
Potter, E.I. , 415
Powell, B.W. , 77, 511, 514
Preauricular cysts , 6
Preauricular pits , 6, 7
Preauricular sinuses , 6, 7, 282
Proportions of ear , 150, 216, 222, 281, 565, 567
Protruding helical root , 105
Protruding lobule , 150, 252, 255, 339, 453, 477–479
Protrusion helical margin , 173
Psychiatric therapy , 235
Psychological , 37, 38, 127, 135, 150, 183, 217, 220, 221,
235, 311, 425, 426, 435, 437, 569, 570, 575, 584
Psychosocial , 37–39, 66, 98, 108, 253, 311, 337, 377,
575–580
Q
Quality of life , 38, 183, 499, 569–572, 579
Qureshi, T.R. , 145, 313
R
Ragab, A. , 75, 102, 249
Ramkumar, S. , 77, 104, 512
Ramsay-Hunt area , 272, 273
Raveendran, S.S. , 490
Recurrence , 6, 23, 24, 39, 70, 73–78, 101, 106, 107,
115, 122–124, 134, 146, 147, 165, 169,
188, 214, 215, 227, 230, 267, 275, 276,
299, 302, 331, 346, 358–360, 368, 369,
371, 373, 374, 377, 378, 381, 382, 388,
401, 402, 430, 438, 440, 444, 446, 451,
479, 481, 489–491, 499, 502–505, 511,
512, 525, 535, 543–545, 577, 579
Reoperation , 69, 75, 77, 78, 122, 134, 327, 373, 445
Retroauricular fold , 416
Retroauricular skin fl ap , 408, 410, 411, 413
Reverse telephone ear , 228, 230, 477, 479, 493, 524, 526
Revision . See Reoperation
Rogers, B.O. , 43
Rubino, C. , 106, 271, 292
Ruttin, E. , 45
S
Salgarello, M. , 74, 106
Satiro’s ear , 219
Scaphal hypertrophy , 121, 123
Scaphal reduction , 76, 120, 121, 123
Scaphal resection , 119, 471, 472
Scapha scoring , 158, 365
Scaphocephalic angle , 446
Scaphoconchal angle , 52, 184, 198, 199, 204, 273, 297,
298, 323, 327, 528, 529, 557–559
Scaphoconchal sulcus , 559, 560

592
Index
Scar , 29, 104, 108, 124, 147, 177, 215, 229, 230, 240, 246,
250, 290, 335, 373, 395, 418, 435, 455, 467, 488,
490, 512, 517, 523, 525, 540, 550, 572
dystrophic , 228, 230
hypertrophic , 74, 75, 77, 78, 156, 181, 198, 275, 368,
369, 499, 525
Scharer, S.A. , 75
Schaverien, M.V. , 73, 106, 143, 375, 377, 378
Schlegel-Wagner, C. , 108, 281
Schwentner, I. , 570, 571
Scuderi, N. , 59, 76, 400, 401, 403
Seltzer, A.P. , 44
Semmes, J. , 557, 560, 561, 563
Semmes-Weinstein mono fi laments , 557, 561, 563
Sercer, A. , 52
Shokrollahi, K. , 77, 143, 392, 512
Siegert, R. , 479
Sinha, M. , 73, 106, 378
Skin fl ap , 407–414
Skin graft , 25, 293, 383, 407, 531, 549, 551
SMAS . See Super fi cial musculoaponeurotic
system (SMAS)
Smith, D.W. , 76, 400
Sobol, E. , 250
Songu, M. , 37–39, 571
Sorribes, M.M. , 576
Spira, M. , 59, 60, 132, 143, 280, 421, 479, 494
Spira posterior conchal fl ap , 402
Spira’s technique , 74
Split earlobe deformity classi fi cation , 485–488
Split earlobe repair , 481–491
Spock ears , 427, 429
Squamous cell carcinoma , 410, 413
Stahl’s ear deformities , 67, 68, 184, 217, 219, 230, 252,
282, 399
Stal, S. , 59, 421
Stark, R.B. , 54, 147
Stenströem, S.J. , 56, 73, 102, 114, 123, 130, 143, 145,
184, 214, 231, 240, 324, 358, 363, 368, 371, 400,
431, 511, 512, 572, 576
Stenströem’s otobrader , 74, 231
Stenströem technique , 56, 59, 130, 368, 401, 570, 576
Stenstrom technique . See Stenströem technique
Straith, R.E. , 52, 56, 358
Straith’s technique , 55
Super fi cial musculoaponeurotic system (SMAS) , 371, 372
Sushruta, P.S.S. , 43, 171, 184, 197, 323
Suture extrusion , 73, 75, 76, 103, 105, 143, 144, 147,
165, 188, 199, 228, 230–232, 249, 327, 346, 371,
378, 379, 381, 388, 435, 525, 577
Swelling , 105, 151, 225, 270, 374, 430, 482, 489, 525
Sylaidis, P. , 77, 105, 514
T
Tagliacozzi, G. , 43, 197, 323
Tamerin, J. , 55
Tang, C.J. , 77
Tan, K.H. , 106, 327
Tanzer, R.C. , 219, 324, 363, 369
Tanzer’s classi fi cation of constricted ear , 219, 220
Tardy, M.E. , 312
Tattoo , 86, 89, 91–92, 255, 256, 259, 283, 359, 364, 365,
438, 439, 481
Telephone ear , 100, 103, 105, 132, 135, 136, 155, 156,
189, 228–230, 252, 342, 359, 367, 368, 419, 430,
477, 479, 493, 524–526, 534, 550, 551
Thermal injury , 262
Thorne, C. , 479
Transposition fl ap , 176, 177, 180, 403, 531, 532, 549
Triangular eminence , 271
Tulle gras , 224, 269, 514
U
Ulceration , 269
Undercorrection , 70, 198, 227, 228, 275, 327, 529, 531,
533, 534, 546, 547
deformity , 147, 276, 358, 529, 531
Uneven setback , 134
V
Valente, A.S.C. , 75
Van Wijk, M.P. , 67
VAS . See Visual analog scale (VAS)
Vetter, M. , 77
Vidaurre, S. , 44
Visual analog scale (VAS) , 373, 374, 377
Von Frey, M. , 560
V-Y plasty , 158, 549, 551
V-Y setback , 453, 455
W
Weaver, D.F. , 48
Webster, G.V. , 59, 61, 130, 478
Webster’s technique , 61
Weerda, H. , 59, 172, 415, 416, 572
Weerda’s classi fi cation , 172
Wegener, H.E. , 59
Weinzweig, N. , 214, 253
Werdin, F. , 69
Wilcoxon signed-rank test , 559
Wong, M.C. , 77, 514
Wood-Smith, D. , 52, 59, 143, 158
Wood-Smith technique , 53, 62
Wright goals of otoplasty , 567
Y
Yazici, I. , 402–404
Ying, Z. , 29
Young, P.A , 543
Young’s technique , 47
Y-V setback , 493–496
Z
Z-plasty , 489, 539–541