Otoplasty in Children

Otoplasty is most commonly performed in young people, often children. In the very young, it is usually the parents who first notice the prominence of the ears. Mother and father are concerned with their child being exposed to peer ridicule, especially in preparation of the child entering school. When in the teen years, it is commonly the youth who are asking to “pin back the ears”. By that time, most young patients have adjusted to the protruding auricles by covering the ears with their hair. Girls do not wear their hair short or in a pony tail and boys prefer rather long hair.

How Early In The Child’s Development Can Otoplasty Be Performed?

Although performing plastic ear surgery for prominent auricles in children as young as 2 or 3 years of age have been reported, we prefer to wait until age 4 or 5. At this time, the ears have almost reached they full size and set back procedure can safely performed without undue interference with the normal growth pattern. When kids enter school, their appreciation for body characteristics and variation increases and they develop astute observation abilities. Mockery at such an early age can be emotionally traumatic interfering with the development of a healthy self esteem. Although these considerations may play a role for the parents, it is important to understand that from a physical standpoint, the otoplasty procedure can be performed at any point in the child’s life. Therefore, one should certainly not rush the child into a surgical procedure performed for appearance reasons. Dr. Fechner recommends that the parents discuss the planned procedure with the child beforehand in order to decrease threats of surprise and the unknown.

Consultation For Pediatric Otoplasty

The consultation for ear surgery routinely involves the child and the parent(s). Dr. Fechner examines the child in a thorough but playful manner, often with the kid sitting on mom’s or dad’s lap. The facial structures in general and the ears in particular are observed. The specific ear prominence is measured and possible asymmetries are noted. The discussion always involves specific questions about anesthesia, the procedure and techniques in particular, aftercare and anticipated results. The goals and possible limitations of the procedure are discussed in detail. Therefore, this otoplasty consultation is extremely important in identifying the specific issues of the child’s condition and to demystify cosmetic ear surgery.

Anesthesia Choice For Ear Surgery In Children

Although in the teenager or adult Dr. Fechner performs otoplasty routinely using local anesthesia with a pre-operative sedative, secondary to lack of compliance, this is not possible for the young child. In children younger than 10 years of age, otoplasty is performed under general anesthesia in an outpatient setting. Commonly, a parent is allowed to be with the child until he/she is asleep. The procedure takes about 1 hour 45 minutes, a time that may feel like days to the parents. The parent is usually led to the bedside of the child upon its awakening which adds to the overall comfort of the process. In general, our impression is that to overall otoplasty procedure is much more stressful for the parents than the child.

Recovery After Ear Set-Back Surgery In Children

The recovery is usually relatively straightforward. The child will be tired for the remainder of the procedure day which makes tolerance for the head dressing easier. This dressing will be removed on the following day in Dr. Fechner’s office. The ears are inspected for appropriate healing progress and an early “preview” of the decreased prominence can be observed. A lighter dressing will be applied. Pain is mild to moderate and most children do well on Tylenol (although a stronger pain suspension will be prescribed along with prophylactic antibiotics). In preparation of the procedure, the parents will have purchased a sports sweat band for the child which will be applied starting on the second day. Suture removal is not necessary as Dr. Fechner uses self-absorbing stitches. Further follow up will be on day 7 and after 6 weeks.

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