Cartilage-Sparing Otoplasty: A Systematic Review

Objective: Cartilage-sparing techniques have continued to play a large role in modern otoplasty. Without invasion of the cartilage, the approach has been associated with less risk of skin necrosis, cartilage irregularities, hematoma, and infection. However, refinements are often needed to decrease the incidence of recurrence and suture extrusion. The objective of this systematic review is to assess the current evidence for cartilage-sparing otoplasty. Data Sources: PubMed and EMBASE databases. Study Selection: Search terms utilized were "cartilage" and "sparing" and "otoplasty." Exclusion criteria include book chapters, technical reviews, and non-English language articles. Data Extraction: On August 1, 2019, two independent authors performed a literature query with the aforementioned key words and databases. Data Synthesis: The initial search yielded 80 results, of which 20 final articles remained for final analysis. Sample sizes ranged from 17 to 565 patients, with 14 (70%) of the studies being case series with and without adjunctive techniques. Four (20%) studies compared outcomes between cartilage-invasive and cartilage-sparing techniques. Five (25%) studies were retrospective cohort studies and only one (5%) study was prospective in nature. However, according to the Oxford Centre for Evidence-Based Medicine scale, all of the studies were of low quality. Conclusions: Since the inception of cartilage-sparing otoplasty, various modifications of the approach have been described. Recent studies demonstrated superior outcomes compared with cartilage-invasive techniques; however, a personalized approach to each patient remains necessary and often may require a combination of both to achieve the most satisfying aesthetic result. Question: Is there a preferred method for otoplasty based on outcomes? Findings: Studies on otoplasty have low quality. Cartilage-sparing otoplasty outcomes seem to be superior to cartilage-scoring otoplasty. Meaning: Provide systematic review to surgeons who perform otoplasty with outcomes in order for a personalized approach to be implemented.