An alternative approach for correction of constricted ears of moderate severity  M.M. Al-Qattan  British Journal of Plastic Surgery  Volume 58, Issue 3, Pages 389-393 (April 2005) DOI: 10.1016/j.bjps.2004.10.002 Copyright © 2004 The British Association of Plastic Surgeons Terms and Conditions

Figure 1 (a) The moderately severe constricted ear deformity is characterised by lidding (with lidded cartilage) moderate reduction of the upper ear height (with reduced scapha, absent superior crus) and protrusion (with absent antihelix). The term ‘turn-over area’ is given to the posterior aspect of the skin of the upper ear at the beginning of the abnormal turn-over of the ear cartilage. (b) The first step of correction is the recreation of an antihelix with Mustardé sutures. This corrects the prominence. (c) The second step is correction of the upper ear deformity by excision of skin (at the turn-over area) and excision of lidded cartilage. Note that there is no attempt to recreate a new scapha by cartilage expansion. The ‘mastoid hitch’ represents the third step in which prolene sutures are sutured from the posterior aspect of the neohelix to the mastoid fascia which help to prevent recurrence of the cupping deformity. British Journal of Plastic Surgery 2005 58, 389-393DOI: (10.1016/j.bjps.2004.10.002) Copyright © 2004 The British Association of Plastic Surgeons Terms and Conditions

Figure 2 Demonstration of the three steps of correction. Step I (a, b, c): Mustardé sutures to recreate the antihelix and correct the prominence. Note that the elliptical skin excision in step I is vertically oriented and is located just below the turn-over area. Step II (d, e): correction of the upper ear deformity by transverse elliptical skin excision at the turn-over area and by excision of the edge of the lidded cartilage. Step III (f) is the mastoid hitch sutures between the posterior aspect of the neohelix and the mastoid fascia. British Journal of Plastic Surgery 2005 58, 389-393DOI: (10.1016/j.bjps.2004.10.002) Copyright © 2004 The British Association of Plastic Surgeons Terms and Conditions

Figure 3 Correction in a 12-year-old girl. (a) Pre-operative appearance. (b) Post-operative result at one year. Note the deficiency in the scapha and the absence of both the inferior crus and triangular fossa. British Journal of Plastic Surgery 2005 58, 389-393DOI: (10.1016/j.bjps.2004.10.002) Copyright © 2004 The British Association of Plastic Surgeons Terms and Conditions

Figure 4 Correction in a 6-year-old boy. (a) Pre-operative appearance. (b) Post-operative result at 6 months. Note the deficiency in both the scapha and triangular fossa. British Journal of Plastic Surgery 2005 58, 389-393DOI: (10.1016/j.bjps.2004.10.002) Copyright © 2004 The British Association of Plastic Surgeons Terms and Conditions