There are many surgical approaches for correction of the congenital lop-ear deformity. Many decades ago, surgeons used skin excision only with a great tension closure to reposition the ears. Studies showed that the cause of these deformities is the irregularities in cartilages. Therefore, modern otoplasty started to focus on the correction of the deformed cartilages.
One of the causes of this deformity is the absence of a well-formed antihelix rather than simply an excessive angle of the ear from the head. To correct this deformity the surgeon must create a new antihelix by making a curvilinear incision on the cartilage and fold it over and then secure it with permanent sutures.
Several other techniques are available which primarily use suturing to set cartilage position and contour. These approaches provided a more natural shape and minimized the unsightly ridges accompany­ing incisional and excisional methods.
Mustarde Technique
Mustarde technique is a multiple transcartilaginous permanent mattress suture to construct the antihelical fold. This method had the additional advantage of precisely setting the amount of antihelical folding by adjusting the tightness of the sutures.
Furnas Technique
Furnas technique uses sutures extending from the conchal bowl to the mastoid periosteum and from the scaphoid fossa to the temporalis fascia. Webster technique effectively combines newer and older techniques, using skin excision, resec­tion of excessive cartilage, and mattress sutures at the antihelical fold, to achieve natural contour and position.
Modern Approach
The great variety of techniques attests to the complexity of ear anatomy and the difficulty in achieving superior results with consistency. A modern approach to otoplasty is largely based upon the suture techniques developed by Mustarde and Furnas.
We have found that by using a graduated approach, first setting back the ear cartilage bowl and then contour­ing the antihelical fold as necessary, we are able to achieve the most natural-appearing result. This technique has the advantage of enabling precise positioning of the cartilage by progressively tightening the sutures until the desired contour is achieved.