Surgical Techniques in Otoplasty for Correction of the Prominent Ear: A Contemporary Review

Abstract

Prominent ear is the most frequent congenital deformity of the external ear, affecting approximately 5% to 10% of the population, and remains a recognised source of psychosocial distress in children and adults. More than a century of surgical innovation has produced an extensive armamentarium of corrective procedures, yet no single technique has proved universally superior. This review synthesizes contemporary evidence on otoplasty surgical technique. It examines the anatomical basis and normative measurements that govern operative planning, the timing of intervention, and the technical detail of the two dominant families of procedures: cartilage-sparing suture techniques, exemplified by the Mustardé conchoscaphal and Furnas conchomastoid sutures, and cartilage-modifying techniques based on anterior scoring, incision or excision. Adjunctive refinements are appraised, including postauricular fascial and dermofascial flaps designed to prevent suture extrusion and relapse, conchal reduction, lobule repositioning and reduction otoplasty for the coexisting macrotic ear. Minimally invasive alternatives, comprising incisionless suture otoplasty, laser-assisted cartilage reshaping, electromechanical reshaping and implantable clip systems, are discussed alongside neonatal auricular molding. Pooled contemporary data indicate a mean reduction of the mastoid-to-helical rim distance of approximately 12 mm, a cumulative complication rate close to 14%, a pooled recurrence rate of 2.8% and a revision rate of 2.1%, with suture extrusion the single most common adverse event. Cartilage-sparing approaches, particularly modified Mustardé–Furnas methods reinforced by a vascularized postauricular flap, currently offer the most favorable balance of durability and morbidity, whereas anterior scoring remains safe and reliable in high-volume units with disciplined case selection. Technique selection should be anatomically driven and individualized, dictated by the deformity and by cartilage pliability rather than by surgeon habit