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Original Investigation |

Correcting the Lobule in Otoplasty Using The Fillet Technique

Haneen Sadick, MD1; Verena M. Artinger, MD2; Frank Haubner, MD2; Holger G. Gassner, MD2
[+] Author Affiliations
1Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, University Hospital Mannheim, Mannheim, Germany
2Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, University of Regensburg, Regensburg, Germany
JAMA Facial Plast Surg. 2014;16(1):49-54. doi:10.1001/jamafacial.2013.2146.
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Importance  Correction of the protruded lobule in otoplasty continues to represent an important challenge. The lack of skeletal elements within the lobule makes a controlled lobule repositioning less predictable.

Objective  To present a new surgical technique for lobule correction in otoplasty.

Design, Setting, and Participants  Human cadaver studies were performed for detailed anatomical analysis of lobule deformities. In addition, we evaluated a novel algorithmic approach to correction of the lobule in 12 consecutive patients.

Interventions/Exposures  Otoplasty with surgical correction of lobule using the fillet technique.

Main Outcomes and Measures  The surgical outcome in the 12 most recent consecutive patients with at least 3 months of follow-up was assessed retrospectively. The postsurgical results were independently reviewed by a panel of noninvolved experts.

Results  The 3 major anatomic components of lobular deformities are the axial angular protrusion, the coronal angular protrusion, and the inherent shape. The fillet technique described in the present report addressed all 3 aspects in an effective way. Clinical data analysis revealed no immediate or long-term complications associated with this new surgical method. The patients’ subjective rating and the panel’s objective rating revealed “good” to “very good” postoperative results.

Conclusions and Relevance  This newly described fillet technique represents a safe and efficient method to correct protruded ear lobules in otoplasty. It allows precise and predictable positioning of the lobule with an excellent safety profile.

Level of Evidence  4.

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Figure 5.
Graphic Comparisons of Operative Results

A, Visual analog scores (VAS) for preoperative and postoperative evaluations of study participants. B, Mean preoperative and 3-month postoperative VAS scores. In the VAS scale, 1 indicates very good; 2, good; 3, satisfactory; 4, unsatisfactory; 5, poor; and 6, very poor.

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Figure 4.
Postoperative Coronal Views after Lobule Correction Via the Fillet Technique

A, Illustration; B, photograph.

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Figure 3.
Intraoperative Otoplasty Images of the Fillet Technique

Left panels are illustrations; middle panels, cadaver dissections; right panels, intraoperative clinical images. A, Suture dissection and transection of the lobular soft-tissue insertions via the fillet technique; the extent of this dissection may be modified intraoperatively as dictated by the deformity. B, After dissection, the anterior and posterior surfaces of the lobule may move and advance freely in relation to each other. C, Advancement of the posterior flap allows for correction of angular protrusion in both the axial and the coronal plane by anterior to posterior and superior to inferior advancement, respectively. Inferior to superior advancement also allows for effective correction of lobular concavity.

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Figure 2.
Dissection Along the Inferior Conchal Bowl up to the Antitragus and Release of Soft-Tissue Attachments

Dissection allows for better control of the axial angular protrusion of the lobule by advancement of the posterior flap superiorly. A, Illustration; B, anatomic cadaver dissection; C, clinical intraoperative image.

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Figure 1.
Lobule With Predominant Protrusion

A, Protrusion evident in the coronal plane. B, Predominant protrusion in the axial plane. C, Protrusion of the remaining auricle, with inherent shape causing a concavity.

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