Author Topic: Post Surgery Worries  (Read 6770 times)

Offline MorningSun

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Post Surgery Worries
« on: August 22, 2012, 06:06:46 PM »
Hello, I had otoplasty (conchal setback with cartilage removal and antiheical fold creation in both ears) a couple of days ago. Since the operation I am noticing a pulling sensation behind the ears. When I attempt to rotate my head to either side I feel the pulling sensation with discomfort, so I can only rotate about 45 degrees. I get the same feeling when really raising my eyebrows and fully smiling. Is this just due to the sutures and the incision healing or should I be worried?  There is no bleeding, or excess swelling, and neither ear feels worse than the other.  Thanks.

Offline DrBermant

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Re: Post Surgery Worries
« Reply #1 on: August 22, 2012, 08:16:31 PM »
Hello, I had otoplasty (conchal setback with cartilage removal and antiheical fold creation in both ears) a couple of days ago. Since the operation I am noticing a pulling sensation behind the ears. When I attempt to rotate my head to either side I feel the pulling sensation with discomfort, so I can only rotate about 45 degrees. I get the same feeling when really raising my eyebrows and fully smiling. Is this just due to the sutures and the incision healing or should I be worried?  There is no bleeding, or excess swelling, and neither ear feels worse than the other.  Thanks.

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

I preferred Suture Conchal Bowl Setback over excision. I did not like a step off in front of the ear that some contour anatomy forced.

Nerves surround the ear and injury to the nerves is one of many possible Otoplasty Complications. Nerves can be hypersensitive for many possible reasons. Just the process of numbing up the ear is one of temporarily "poisoning" the nerve to block transmission of pain can sensitize nerves. The process of putting in the needle for the Plastic Surgery Anesthesia local anesthetics is also an art form.The passage of the needle itself can injure the nerves. Too much medication, certain ones are stronger, also can hurt the nerve to different degrees. Cutting, dissection, suturing all can injure nerves. As a nerve recovers regaining sensation it typically becomes hypersensitive. Traction on tissues puts tension on irritated nerves. Some degree of nerve injury occurs with any surgery. The question becomes one of degree of injury and is there still an insulting factor like a nerve caught in a suture.

Nerves can also be irritated by lack of protection which is why I used a Formal Ear Dressing. Yet, a poorly placed dressing also can cause damage, which is why I made my patients let me change the dressing myself if it became dislodged.

It was rare for my ear patients to complain of discomfort, but there are different operations, different techniques, and different surgeon's skills. Such discussions should be part of the consultation of risks, benefits and alternate methods of care. I asked my patients to call me immediately if they had any problems or concerns different than what we discussed before surgery. Problems were rare in my practice, but I would rather see the patient, check the ear, and change the dressing just to make sure everything was alright.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
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Offline MorningSun

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Re: Post Surgery Worries
« Reply #2 on: August 25, 2012, 06:49:52 AM »
Thanks for the reply Dr Bermant, it was very insightful.

 My surgeon in NY used surgical glue to stick the ears back after surgery as she prefers this to using a head bandage after the 1st day.  The glue remains until 7 days post-op.  I get the feeling the glue is contributing to the tight 'pulling' feeling when I move my head.  Is it also possible that the sutures in the incisions could cause a feeling of tightness and  pulling when moving my head?  My real worry is that it is something to do with the internal sutures.  Is it possible for the internal sutures for the conchal setback or antihelical fold to cause any sort of restricted movement?

Thanks again
David

Offline DrBermant

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Re: Post Surgery Worries
« Reply #3 on: August 25, 2012, 07:15:17 AM »
Thanks for the reply Dr Bermant, it was very insightful.

 My surgeon in NY used surgical glue to stick the ears back after surgery as she prefers this to using a head bandage after the 1st day.  The glue remains until 7 days post-op.  I get the feeling the glue is contributing to the tight 'pulling' feeling when I move my head.  Is it also possible that the sutures in the incisions could cause a feeling of tightness and  pulling when moving my head?  My real worry is that it is something to do with the internal sutures.  Is it possible for the internal sutures for the conchal setback or antihelical fold to cause any sort of restricted movement?

Thanks again
David

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

You are welcome.

Part of the design of any surgery should be swelling, discomfort, bruising, and patient education. I chose to document the path in between the before and after results with pictures, detailed examination, and surgical notes.  This way I could evaluate what was happening, and evolve my methods if I saw something I liked or did not. Putting that path typical for my patients helped with their education as to expectations what they should experience after surgery. It also helped with early intervention as they were asked to call me immediately if their own experiences were not of my typical patients' recovery.

I never used the glue in that fashion. The dressings are expensive vs the glue. But I do not like such tethering healing structures if they swell or have problems. I also like the micro atmosphere of the dressing against the healing wounds until the tissues are ready for the outer world and topical wound care. Compare what you have written to my patients' typical Otoplasty Experiences. In particular read about their comfort after surgery. It was on my list of questions to ask each patient to see & document how they were doing.

Although I have not evaluated the path in between by seeing pictures (many surgeons choose not to take them or show them), based on your descriptions, the glue would not have been something I would have tried. In my opinion, if a path is better, then show it with accurate documentation so others can decide what to use or choose.

Why not consider posting Standard Otoplasty Pictures to show how the ears are currently for others to better understand. However, ear problems come in different degrees so showing the before images would aid understanding the original problem.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
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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