Abnormal folding of the ear is common. A Stahl’s bar or third crus is a frequent finding. In a small number of cases the upper pole of the ear flops over and here the term lop ear is used. In some ears, there is a kink of the ear (helical) rim or abnormal fusion of the ear (helical) rim to the antihelical fold. In some patients the whole ear appears collapsed vertically to give an ear of reduced height. A Stahl’s bar is easily and temporarily corrected by finger pressure but surgical correction can be difficult and this deformity is best corrected at birth with Ear Buddies™ splints.
If the golden period for splintage is missed, then a direct wedge excision of the Stahl’s bar [skin and cartilage] is the most reliable technique.
In a number of patients the ear helical rim is adequate but the scaphal hollow is folded backwards to rest on the conchal hollow. The height and shape of the ear can be improved by undoing the soft tissue tethering between the scaphal and conchal cartilages and splinting these structures apart with a cartilage graft from another part of the ear. Surgery can be avoided if the ear is splinted soon after birth with Ear Buddies™ splints.
Surgery for a lop ear can be avoided if the ear is splinted soon after birth with Ear Buddies™ splints. Moulding using Ear Buddies™ splints may improve a cup ear, but when the tissues are severely constricted, they must be surgically released.
In a cup ear the helical rim is constricted to give a prominent, cone-shaped ear. This is particularly difficult to correct. The constricted rim of a cup ear must be expanded in order to allow it to flatten. There are a number of techniques depending on the severity of the constriction. Sometimes, a formal ear reconstruction using a carved costal cartilage framework is advised.
To support a lop ear, sutures can be used to create a “U” shaped cartilage prop at the site of the missing upper antihelical fold, and the ear hitched to the mastoid fascia.
Sometimes only the lower two-thirds of an ear is visible and the groove above the ear seems lost. When the ear is gently pulled away from the side of the head, the upper pole cartilage becomes evident, having been hidden beneath scalp skin. The upper pole is excessively tethered and the lower pole is prominent. Moulding using Ear Buddies™ splints can correct cryptotia if started early enough. Surgical release is possible later in life.
If uncorrected by moulding using Ear Buddies™ splints at birth, a folded-over helical rim can be corrected by surgery later.
The rim can be notched or deformed by taping a baby’s ear without first fitting an Ear Buddies™ splint at birth. The rim of the ear can be augmented using a dermis graft.