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Wednesday, April 6, 2022

Ear Reconstruction in Children and Youths

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Best results happen very early in life

Congenital ear deformities occur in up to 20% of newborns. Studies have shown that the deformation should self-correct within one week, or it will need treatment. Other studies have shown that only 30% of infant ear deformities will self-correct. Most deformities can be corrected surgically later in life. However, if a child is evaluated within the first few weeks of life, the deformity frequently can be corrected non-surgically. Research has shown the best results are achieved if we apply ear molding before three weeks of life, but I have had success with application of ear molds at up to six weeks of life. If left uncorrected, ear protrusion and deformities can lead to teasing and long-term emotional consequences.

What is non-surgical ear molding? Right after birth, the newborn retains a high level of estrogen transferred from the mother’s body which is suggested to increase hyaluronic acid within the cartilage to prevent it from becoming firm. The ear cartilage can be molded into a new shape and secured for several weeks. Once the maternal estrogen is metabolized, the baby’s ear retains the new shape! I prefer a prefabricated ear mold system called “EarWells.” This is a silastic device with an adhesive backing. I typically shave a small amount of the baby’s hair to allow the adhesive to stick. I then clean the area and apply the sticky mold. There are smaller retractors within the system that enable me to reposition and reshape the ear. A small cap is then clipped on the front of the device to hold it in place. This will typically stick for about two weeks; at this point, I more than likely will reapply the device for another two weeks to allow full calcification to take place. At this point, “voilà!” – brand new ears!

This procedure allows for a completely pain-free and nearly risk-free way to reshape the baby’s ear. If this window of time within the few weeks of life is missed, I typically will wait until the child is at least over 5 years old to address the deformity surgery. At 5-7 years old, a child’s ears are very close to adult size; this allows me to have the greatest accuracy in surgical correction. Children tend to become self-conscious around 5 years of age and develop insecurities due to childhood bullying.

If you miss the two- to six-week window at the beginning of life, do not fret. Many ear deformities can still be corrected later on in life. Prominent ears can be corrected with a simple surgery known as “ear pinning,” a small incision behind the ear and three to four sutures taking the ear back. I always perform this surgery either under heavy sedation or general anesthesia in a child. An older teenager or adult can tolerate the procedure with lighter sedation. I leave the ears bandaged for several days and ask you to avoid vigorous activity or swimming for at least two to three weeks. “Prominent ear surgery” is the most common aesthetic procedure performed on adolescents and has been shown to have a very positive longterm psychosocial impact on the patient.

“Are ear deformities dangerous or indicate something is wrong with my baby?” A large baby inside a small mama can frequently result in the ears folding over or “getting squished.” In these cases, there are no other issues with the baby. Rarely, external ear deformities can be associated with another syndrome that can affect hearing and kidney formation. The most important thing is to confirm with your pediatrician that your baby passed the newborn hearing screen. If not, further workup with an ear, nose and throat doctor should be done first.

Paige Bundrick, MD, is the director of facial plastic and reconstructive surgery at LSUHSC Shreveport and will be joining the Shreveport Plastic Surgery Center this summer.

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