SETBACK OTOPLASTY

Setback otoplasty is designed to reduce the prominence of ears. Children are commonly teased about prominent ears and the surgery is usually performed in the early school years (about age six). Prior to this the child has no particular awareness of the prominence of their ears and no particular desire to have them setback. They are also less prone to cooperate with the bandage regime required after surgery when younger than six.

Thereafter surgery can be performed at any age. Not uncommonly adults seek this surgery as they wish to wear their hair up, or in the case of men, have their hair cut short.

The risks of surgery
All surgery has risks and bleeding and infection are common to almost all operations. If bleeding occurs a blood clot may form beneath the skin of the ear resulting in loss of a small area of skin overlying that blood clot and a subsequent scar. Prior to surgery you should avoid things that are inclined to make you bleed such as aspirin, vitamin E, arthritis pills, red wine and smoking.

Infection in the ear is rare and you will be given intravenous antibiotics at the time of your surgery to reduce this risk further. This is because infection in the cartilage of the ear can be quite nasty, with a protracted course of discharge and distortion and scarring to the ear. Fortunately this is quite rare.

The ear will feel numb after the operation and strange to touch for quite some months. This will not affect your hearing except while you are wearing the bandage. Most people have a difference in their ear size and shape prior to surgery and this tends to persist after surgery. However, once the ears are set back the differences are much less apparent and tend to be of no consequence.

Again rarely an ear can spring back out after a setback otoplasty. This is more common in the adult where the cartilage is stiffer and not as easy to fold as in the child. If this occurs then surgery can be repeated [after a few months have passed], with resolution of the problem.

Planning Surgery
As mentioned above it is best to wait until the child shows an interest in his ears being setback. A young, uncooperative child may interfere with the bandage after surgery and even disrupt the wound. Once they have been teased once or twice about their ears they are much more interested in having the problem fixed and more likely to cooperate.

In the adult one simply needs to plan a week where one can wear a head-bandage without being conspicuous. Thereafter return to work is usually possible as soon as the bandage is removed.

Where will the surgery be performed?
Setback otoplasty is performed usually as an outpatient procedure in a hospital or day procedure centre.

Anaesthesia
For the child a general anaesthetic will be required. An adult may find sedation and local anaesthesia a very comfortable way to undergo the surgery with a more rapid recovery, but general anaesthesia is available if preferred.

Surgery
Setback otoplasty takes approximately one hour. An incision is made on the back of the ear and through this incision the cartilage is exposed and either part of it excised or simply reshaped to allow it to fold back towards the head. These changes are then secured with long-lasting sutures and the wound closed with absorbable sutures. Thus usually only a scar on the back of the ear is present and this is well-hidden by the ear itself.

Recovery
You will leave the operating theatre with a bandage on the ears somewhat similar to a turban. It is important that the bandage stay intact for one week after surgery. It helps to shape and protect the ear. This is why the cooperation of the child is essential at this stage.

Thereafter it is recommended that you wear a headband at night for four weeks after surgery so that the ear is not pulled forward while you are asleep.

Local anaesthetic injections are used to make the ears numb for 12 hours after surgery. Thereafter there is some discomfort but usually simple Panadol or Panadeine is sufficient. The ears will be sore if knocked and the patient is usually more comfortable sleeping somewhat upright to reduce the swelling to the ears.

A week after surgery the bandage is removed and a headband applied at night for four weeks. Doctor Scamp uses absorbable sutures, which do not usually require to be removed.

It is not recommended that you indulge in contact sport for four weeks after surgery.