Otoplasty.

Abstract:  When multiple techniques are described to address a single condition, it is axiomatic that no single technique is ideal. Using mattress sutures to create an antihelical fold when one is absent provides benefits that outweigh the risks of this technique. It is a technique that can be learned quickly and mastered with experience. Goode's successful revision otoplasties with mattress sutures suggest that excessively springy ears are not the reason for failure. His results suggest that technical errors may be responsible for the lack of success at the initial procedure. No technique is without complications or limitations, and this technique is no exception. Conservative resection of the concha just medial to the lateral edge with reapproximation to the cauda helicis offers a quick, reliable approach to prominent conchal bowls. Prominence of the lobule was not described in detail. The lobule should, of course, be corrected if it contributes to the ear deformity. Chosen operative techniques should be adaptable to various deformities, and it is preferable, therefore, that the surgeon is comfortable with multiple techniques. The first step in this level of comfort is to acquire a detailed knowledge of ear anatomy. Only by having a firm grasp of the normal can the abnormal be understood precisely. Although a sound technical platform is required to achieve superior results, excellence is achieved only by a thorough, detailed preoperative analysis. A combination of mattress sutures to address the antihelix and lateral resection of the conchal bowl produces excellent results in most cases. Applying a rote technique to all deformities, however, is ineffective and will compromise results. Superior outcomes can be attained only with command of a combination of acute diagnostic skills, knowledge of various surgical techniques, and the ability to execute those techniques.