Simple Tips for Ear Lobule Reconstruction-“Lobuloplasty Revisited”

Abstract

Lobuloplasty is one of the most common procedures done in outpatient basis. It is performed by a wide spectrum of surgeons ranging from general surgeon to plastic surgeon. Inspite of the innumerous techniques used, the ultimate aim of the surgery is to obtain a soft supple lobule with a well-hidden cosmetic scar without the complication of recurrence. Single site local anaesthesia, scoring and undermining of the lobule flaps and the introduction of a small cartilage piece in recurrent cases can change the outcome of the patients result. This article explains how subtle changes are still possible in common procedures like lobuloplasty to change the outcome of the results.

Introduction

Ear lobule repair is one of the commonest procedures done by plastic surgeons. It is done for enlarged ear holes in the lobule. The cause is mainly attributed to use of heavy ear studs or rings that causes a downward dragging pole owing to gravity and eventually increases the dimension of the hole or even complete splitting which leads to unsightly appearance.

The procedure normally is done under local anesthesia where the local anesthetic agent is injected into the lobule by piercing the needle into the lobule in more than a single site to make it turgid and completely anesthetized. Then a 15 number surgical blade is used to excise the scar all around the previous hole following which the wound is sutured in the anterior and posterior aspect with 5-0 or 6-0 polypropylene or absorbable sutures as per the surgeon’s choice.

Modifications of lobuloplasty like Reiters and Alfords [1] technique of Parallel opposing flaps for partial cleft lobes, Tromovitch’s [2] zetaplasty for complete clefts and Fatah’s [3], Pardieu’s [4] and immediate repiercing [5, 6] techniques for cleft repair with preservation of hole have been described.

Inspite of the vast number of techniques, the ultimate goal of lobuloplasty is to achieve the highest level of cosmesis with least discomfort to the patient.

Procedure

Keeping in view the above complications, in this article we introduce 3 innovations to the procedure. To prevent multiple pricks in the lobule to achieve anesthesia, we recommend a single prick in the skin fold (Figs. 1a, 2a) that attaches the lobule to the face. At this site the nerve supplying the whole of the lobule can be anaesthetized instantly with a single prick avoiding multiple pricks and pain endured by the patient. Once the lobule is anaesthetized the turgidity of the lobule can be achieved by further injecting the anesthetic agent into the lobule around the previous hole area without any discomfort to the patient The ear lobule is supplied by anterior and posterior branches of greater auricular nerve which enter from the main trunk of greater auricular nerve through the skin fold which attaches the lobule to the side of the face and hence aiming at this crease can anesthetize the entire lobule in a single shot.

Fig. 1.

a Location of ear crease for injection site, b scoring of the scar ©, to form anterior (a) layer and posterior (b) layer, c horizontally placed conchal cartilage with convex surface anteriorly for recurrent enlarged ear holes in old patients, d posterolateral aspect of the auricle showing the cartilage harvest

Fig. 2.

a Injection site—single prick at ear crease, b scoring with undermining of scar tissue with NO 11 blade

In the vast number of patients who had undergone lobuloplasty using the traditional procedure, the sutured area still was observed to be depressed revealing the previous site of the enlarged hole. This is attributed to the scar tissue that resides in the neighboring area of the enlarged hole that was not completely excised during lobuloplasty. Taking this into account, we advocate an additional step of scoring each lobular segment into two layers after excising the scar tissue with a no 11 surgical blade (Figs. 1b, 2b), so as to incise the scar that adheres the anterior and posterior layers of the lobule. This is done even in a partial cleft without extending the incision across the skin bridge segment unlike the initial description of Apesos and Kane [7] of undermining. Then the layers are sutured separately anteriorly and posteriorly with 6-0 polypropylene sutures. This has practically eradicated the problem of depressed scar with a simple additional step.

In some patients with recurrent enlarged holes and in very old patients with shrivelled or split lobules, an additional cartilage piece is added horizontally in the inferior aspect of the previous hole as depicted in the figure (Fig. 1c). The convex surface of the cartilage (harvested from the auricle) (Fig. 1d) is placed anteriorly. This has been found to prevent the dragging pull over the scar in the future whenever the lady wears any ear stud and consequently preventing recurrence. This also enhances the aesthetic appearance of the lobule particularly in the old women.

Conclusion

The article highlights the use of a simple single prick technique of anesthetizing the entire lobule and also additionally highlights the importance of scoring the excised wound to decrease the complication of depressed scar postoperatively even in partial clefts thus improving the cosmetic appearance.

Compliance of Ethical Standards

Conflict of interest

Authors disclose that there is no conflict of interest.

Informed Consent

Informed written consent has been taken from the patients on which surgeries were performed as per the hospital protocol.