The bandages remain on for 7-10 days. It is very important that the bandages are left undisturbed during this time. At 7-10 days, you will be asked to bring your child to an outpatient clinic where the bandages will be removed by the nursing staff. The nursing staff will thoroughly check the wound site and remove any stitches. It is normal for the ears to be bruised and swollen at this stage.
Frequently Asked Questions
Following surgery, the ears may bleed a little. You should return to the hospital if there are any signs of significant bleeding. Occasionally, the wound may become infected. This may present as pain, swelling and discharge from the area. If this occurs, you should return to the hospital. Children with an infection may feel generally unwell without any specific signs. In the majority of cases, antibiotics will result in resolution of the problem. Scarring may develop over the weeks following surgery. In the majority of cases, the scar is well healed and almost invisible. However, approximately 1-2% of patients will develop a hypertrophic scar that is raised and obvious. It is almost impossible to predict who will develop this scar. They may be difficult to treat and require further surgery and or treatment. Finally, some patients are disappointed after surgery feeling that the ears have been over corrected or under corrected. In addition, some people may feel that there is ongoing asymmetry where one side is slightly different to the other. Reoperation for these problems is best deferred for at least 12-18 months to allow the scars to mature and for the final appearance to become obvious.
In the vast majority of cases, this operation is performed as a day case. Most people can go home after surgery. We recommend that patients sleep well propped up in bed with 3-4 pillows, and that they avoid coughing, stooping or bending in the days following surgery. These actions can increase the venous pressure in the head and neck area and contribute to bleeding from the wound edges.
Long acting local anaesthetic is infiltrated into the skin around the wound. This will render the ears almost entirely numb for 12-24 hours. We recommend analgesics such as Calpol for children and Solpadol for adults. It is best to take analgesic medications regularly for the first few days. We also recommend that non-steroidal anti-inflammatory medications be avoided in the days following surgery as they may contribute to bleeding from the area.
An incision is made in the skin behind the ear. The cartilage of the ear will be reshaped by making a series of small incisions on the posterior aspect. Sometimes it is necessary to split the cartilage and to fold the ear back on itself. A number of permanent sutures are used to hold the cartilage in the correct position. Over time, it is possible that these sutures may become palpable beneath the skin on the posterior aspect of the ear. Recent modifications have helped to minimise this problem. Bandages are applied for a number of reasons – they absorb any blood in the area and help to keep the ear in the correct position. The skin is closed with soluble sutures that do not need to be removed.
In children, the operation is performed under general anaesthetic. The anaesthetist will ask questions about your child’s health. There are some anaesthetic risks, but there are not usually significant in a healthy child. In adults, an otoplasty may be performed under local anaesthetic. It often requires the patient to sit still for 45 minutes to 60 minutes.
Professor Kelly insists that all patients referred for an otoplasty are sent by a GP or other medical consultant. You will be seen by Professor Kelly before surgery. It is important that you provide a full, detailed history including all allergies and previous operations. During the examination, a number of preoperative photographs will be taken and stored in your file. You will be given an information leaflet that explains the operation and its complications.
Surgery is usually only performed on children aged 7 years and older. It is rarely performed on children younger than 7 years, because they have a higher risk of complications and cannot fully understand why they are having surgery. In addition, the ear cartilage in very young children is often difficult to mould because it is soft and sutures may sometimes pull through the tissues.
Apart from the condition, cryptotia, there is no medical necessity to undergo surgery. It is believed that an otoplasty is essentially a cosmetic procedure. However, a lot of surgeons also believe that the operation can improve self-esteem especially in patients who have undergone bullying in the past.
Otoplasty attempts to set the ears back in a position that is closer to the head. It is important that co-operation from the patient is forthcoming and that the patient wants to have the procedure (even children). The operation will lead to a permanent change in appearance and because a child’s face is changing over time, it is well suited to young children (7 years and above). Adult faces are relatively stable and any significant change in appearance is often noticed by others.