Otoplasty: the case for skin incision by higher volume operators

Prominent ear correction in the paediatric population is a common and popular procedure, with demonstrable benefit in alleviating psychological distress. Posterior cartilage-sparing techniques for otoplasty have been shown to be consistently safer and better than cartilage-scoring alternatives, however excision of the posterior auricular skin during otoplasty, although a common first step, has not been shown to have any benefits over skin incision alone. In this study, we examined the association between skin excision and recurrence of ear prominence, by examining the collective surgical outcomes of five plastic surgeons, performing 118 otoplasties at the Royal Hospital for Sick Children Edinburgh, between January 2011 and December 2013. Recurrence of prominence at the first follow-up appointment (mean follow-up 3.4 months) was 10.2%. Surgeons with low case volumes had significantly higher recurrence rates than high volume operators. There was no statistically significant association between skin excision and recurrence of prominence. We still favour posterior, cartilage-sparing otoplasties, but based on our findings we do not advocate any skin excision at any stage of the procedure. Surgeons should not include paediatric otoplasty in their portfolio unless they are undertaking significant number of cases each year.