Author Topic: NON-cosmetic otoplasty for congenital deformity causing erosion  (Read 5225 times)

Offline pctinker

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I am 70 and for the last two years a scab has been growing in my right ear just where the lower fork of the anti-helix terminates against the underside of the helix.  A year ago, a dermatologist prescribed flourouracil thinking it might be cancer, but, that made it worse.  A few months ago, relatives suggested it might be a fungus, and I tried tolnaftate, baking soda, bleach, and noxema.  It got worse but noxema gave some releif but NO CURE.

I just saw a 2nd dermatologist and he took a picture of the scab (with the help of he PA who held open the helix to reveal the scab area).  It was ghastly.  He immediately diagnosed it as erosion, caused by a congenital deformity aggravated by old age and my ineluctable practice of sleeping on that ear.   He explained that the anti-helix is supposed to like a round ridge that terminates into a smooth transition to the underside of the helix, and that there should be a millimeter or two distance between the terminal end of the anit-helix and the underside of the helix.  This is indeed the case with my left ear.  But, with my right ear, the ridge of the anti-helix has grown sharp over the years, like the edge of a chipped stone, and there is NO SPACE between the edge and the under side of the helix.  So, the anti-helix is RUBBING away the flesh of both the underside of the helix AND the terminal edge of the anti-helix, making it progressively worse.  He prescribed some medication to help it cure, but, he insisted that I force myself to avoid sleeping on that ear (even to the point of cutting a "ear hole" in the pillow so that the ear would not be pressed closed should I role over on my right side in my slumber).  He said that I could use cotten wedged between the two surfaces AFTER it heals up.  He told me not to touch that area or allow it to be agitated in any way, except to apply the medicines, until it heals.

I find his diagnosis very logical, and credible.  I was relieved, of course, to have cancer ruled out.  After I left, i began thinking about the problem, and, I am wondering if there might be a non-cosmetic otoplastic procedure that would excise a millimeter or two from the outer sharp ridge of the terminal end of the anti-helix, and shape it to be rounded both along the ridge and where it terminates so that the transition to the underside of the helix would not be a sharp crease, but a smooth round inner fold (as it is in a normal ear, such as my left ear).  This would in no way result in any outward cosmetic change to my ear (I DO NO seek any cosmetic changes), but would most likely involve very delicate and PRECISE mini-surgery and I suspect it would take a very experienced and talented EXPERT to correct this deformity so that I could once again sleep on my right side without developing more erosion.  I also worry about any likely scarring that might result and could even make the condition worse - that is why I would need a surgeon that truly knows how to minimize any post-otoplastic scarring.

Long post - sorry but this is a very nagging and even debilitating problem for me.  I will, of course, discuss this with my dermatologist next week but I thought someone on this forum might have thoughts.

Offline DrBermant

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Re: NON-cosmetic otoplasty for congenital deformity causing erosion
« Reply #1 on: July 28, 2012, 12:19:37 AM »
I am 70 and for the last two years a scab has been growing in my right ear just where the lower fork of the anti-helix terminates against the underside of the helix.  A year ago, a dermatologist prescribed flourouracil thinking it might be cancer, but, that made it worse.  A few months ago, relatives suggested it might be a fungus, and I tried tolnaftate, baking soda, bleach, and noxema.  It got worse but noxema gave some releif but NO CURE.

I just saw a 2nd dermatologist and he took a picture of the scab (with the help of he PA who held open the helix to reveal the scab area).  It was ghastly.  He immediately diagnosed it as erosion, caused by a congenital deformity aggravated by old age and my ineluctable practice of sleeping on that ear.   He explained that the anti-helix is supposed to like a round ridge that terminates into a smooth transition to the underside of the helix, and that there should be a millimeter or two distance between the terminal end of the anit-helix and the underside of the helix.  This is indeed the case with my left ear.  But, with my right ear, the ridge of the anti-helix has grown sharp over the years, like the edge of a chipped stone, and there is NO SPACE between the edge and the under side of the helix.  So, the anti-helix is RUBBING away the flesh of both the underside of the helix AND the terminal edge of the anti-helix, making it progressively worse.  He prescribed some medication to help it cure, but, he insisted that I force myself to avoid sleeping on that ear (even to the point of cutting a "ear hole" in the pillow so that the ear would not be pressed closed should I role over on my right side in my slumber).  He said that I could use cotten wedged between the two surfaces AFTER it heals up.  He told me not to touch that area or allow it to be agitated in any way, except to apply the medicines, until it heals.

I find his diagnosis very logical, and credible.  I was relieved, of course, to have cancer ruled out.  After I left, i began thinking about the problem, and, I am wondering if there might be a non-cosmetic otoplastic procedure that would excise a millimeter or two from the outer sharp ridge of the terminal end of the anti-helix, and shape it to be rounded both along the ridge and where it terminates so that the transition to the underside of the helix would not be a sharp crease, but a smooth round inner fold (as it is in a normal ear, such as my left ear).  This would in no way result in any outward cosmetic change to my ear (I DO NO seek any cosmetic changes), but would most likely involve very delicate and PRECISE mini-surgery and I suspect it would take a very experienced and talented EXPERT to correct this deformity so that I could once again sleep on my right side without developing more erosion.  I also worry about any likely scarring that might result and could even make the condition worse - that is why I would need a surgeon that truly knows how to minimize any post-otoplastic scarring.

Long post - sorry but this is a very nagging and even debilitating problem for me.  I will, of course, discuss this with my dermatologist next week but I thought someone on this forum might have thoughts.

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Welcome to our forum.

Right concept, wrong name. Ear Reconstruction and Plastic and Reconstructive Surgery of the Ear are better descriptions. Aged skin can be more delicate and fragile, the anatomy actually changes and the dermal supporting structures thin. I used to see such issues for burns, trauma, and cancer reconstruction of the ear quite frequently. Cancer treatments and bleaches can cause chemical burns of the skin and wounds. A sharp cartilage edge can increase pressure on the overlying thinned skin interfering with healing and reopening early healing tissues. Exposed cartilage can be a disaster, cartilage infections also will keep opening up. Getting into the hands of someone who can examine the problem, diagnose if there are infection or just wound healing issues, vs geometry of cartilage needing revision sounds like it an appropriate step. This is not typically a dermatologist, but someone who actively is managing Ear Reconstruction and understands the issues involved, typically a Plastic Surgeon or Facial Plastic Surgeon ENT. Check our resources about How to Pick Your Otoplasty Surgeon, but for the pictures look for ear reconstruction. Otoplasty is a subset of Ear Reconstruction. Determining if long exposed cartilage is infected can be quite difficult and failure to treat can lead to the wound opening yet again.

I have had to debride cartilage from parts of the ear from trauma, remove for cancer, and rarely infected cartilage. Sometime appearance has to be sacrificed depending on local resources, at other times, viable tissue moved to cover the problem area (flap with a blood supply). The next step I used to to have to decide what level of protection the healing structures needed. This can range from an open wound to a

Formal Ear Dressing to protect the ear initially from a patient lying against it. For some of my patients another stage was:


an ear protector, like wrestlers wear. I preferred to see and check the ear for fitting for my patients to make sure there was no pressure on healing structures. For those with fragile tissue, I also cautioned that care had to be taken to not injure other areas. Sometimes I added padding to change the protection pattern. Yes they look ridiculous, but try to keep an ear in a hole cut in a foam pillow?! OK for surgery with anesthesia to monitor, but not for a patient at home with or without partner.

Search on Amazon for Headgear and Ear Guards.



They come in so many different configurations, not all will work to protect the right part of an injured ear or donor sites that may also have been worked on during the surgery.

Sometimes it is an issue of making a splint to keep the helix off of the underlying tissues until they heal. And yet other times it is a matter of reshaping the ear such as in a Lop or Constricted Ear where the helix is folded over the ear sometimes hiding the antihelix to different degrees. Now we are back into the reconstructive otoplasty domain. Yes, an undiagnosed deformity like that can also be irritated and cause such a situation as you described. Posting my Standard Ear Pictures would be one way to document the problem and monitor the progress of healing for other to see and learn. However, elective surgery on potentially infected cartilage is something we tried to avoid.

But this get back to someone who has actually had to deal getting an injured ear to heal so that the right diagnosis and care plan designed and then even more importantly, monitored to see how it progresses. If there is a natural pressure of a Constricted Ear, then a head protector might not be the best first step.

Hope this helps,

Michael Bermant, MD
Learn More About Otoplasty Ear Surgery
Michael Bermant, MD
Retired Plastic Surgeon
Surgical Sculptor, Artist, Creative Thinker, Problem Solver
Plastic Surgery
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