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Prominent Ear Correction



Summary
Anaesthesia required. Local anaesthetic in majority of cases (occasionally general
anaesthetic eg the very young child)
Type of procedures offered. Earfold® Conventional surgery
Duration of surgery. 30 minutes.
Place of procedure. Outpatient department for Earfold®
(or operating theatre for conventional surgery)
Head bandaging required? None after Earfold® procedure. After conventional surgery
head bandaging required for 5-7 days.
Recovery period. Earfold®: return to work the next day (or later that day).
Simple painkillers for 3/5 days. Return to near full activities
within 1 week. No contact sports for 6 weeks

Open surgery: possible off school/work for 1 week with head
bandage. Return to full activities short of contact sports or significant
exertion at 1 week post op.



Q. Is prominent ear surgery correction successful?
Prominent ear surgery correction is extremely successful with a vast majority of patients being very happy with the results. Mr Fogarty has substantial experience in prominent ear correction surgery having a commitment to the Royal Belfast Hospital for Sick Children where the majority of his paediatric interest is in such conditions.

Q. How is prominent ear surgery carried out?
Anaesthesia. Usually only local anaesthesia is required The younger patient (i.e. the early primary school years) may prefer to have general anaesthesia. In later primary school years the procedure can be carried out under local anaesthesia.

Who carries out the surgery?
Mr Fogarty.

What techniques are used?
Mr Fogarty prefers the use of that Earfold® technique.
The benefits of this include;
- patient sees the likely result before the surgery takes place ie in the clinic at consultation.
- patient decides how they want their ears to look preoperatively.
- ‘walk in, walk out’ local anaesthetic procedure
- no head bandage required
- minor tenderness/no pain
- rapid recovery
- no time off work/school


How long does the surgery take?
The Earfold® surgery would take no longer than 30 minutes. Conventional surgical correction (where necessary) usually takes 60minutes.

Where is the surgery carried out?
The surgery may be carried out as an outpatient in the outpatient department using a preformed metal clip known as an Earfold®. With the Earfold® procedure one can have the procedure carried out in approximately 20-30 minutes in an outpatient setting and thus does not require any general anaesthesia and nor does it require a head bandage after the treatment. One is thus able to return to work/school even on the same day, as there is no requirement for head bandaging and no recovery required from a general anaesthetic.


What are the risks of surgery?


Recurrence (< 5%).
The risk of recurrence is extremely small and this is related to the elasticity of the underlying cartilage. In prominent ears the cartilage is manipulated/moulded but the inherent elasticity means that one can get a recurrence of the prominence. In the unlikely event of this occurring then further surgery may be required to push the ears further back.

Asymmetries
All patients have asymmetric ears including the normal population and thus a slight degree of asymmetry is inevitable and indeed normal. In normal daily life only one ear is usually viewed at a time unless one is facing an individual head on. If any symmetry were outside of the bounds of normality this would be likely due to recurrence of any prominence and if this were significant then further surgery would be required to correct any recurrent prominence of the ears.

Bleeding (less than 1%)
The risk of bleeding is extremely small and can occur as the anaesthetic solutions wear off and increased blood supply returns to the ear. In the unlikely event of any bleeding occurring then a return to the operating theatre would be required to staunch any bleeding or a head dressing may be required for pressure purposes. Usually the cosmetic outcome is not adversely affected by such bleeding and having Mr Fogarty on hand to address any bleeding issues mitigates any potential problems due to any delay in addressing bleeding issues.

Infection (less than 1%)
With any surgical procedure there is a risk of infection. While complete measures are taken to minimise the risk of infection unfortunately the risk of infection is not zero. In the unlikely event of infection occurring early review with Mr Fogarty will again mitigate any significant complications that could occur as a result of infection. Temporary removal of the Earfold® implant may be required in the unlikely event of deep infection

Pain
Usually the procedure itself is carried out under local anaesthesia and this is painless. Once the local anaesthesia wears off after a number of hours very mild discomfort may be discerned but this is readily treatable with simple painkillers such as Paracetamol or ibuprofen. If the ears are tender in the first week then this may give rise to some discomfort when sleeping and thus a head bandage can be used in this situation. It is extremely rare that anybody would ever have ongoing chronic pain issues. i.e. 1 in 1000.

Scarring
With the Earfold® technique ,a <1cm incision is made in the outer rim of the ear and this will form a scar but as it lies in a natural ear fold the scar would not be visible to others. With the open surgical procedure carried out in the operating theatre a longer incision is made behind the ear and in general is the full length of the ear. Again, the scar that results from open surgical procedure lies behind the ear and is thus not visible in a public situation. All scars by their very nature are unpredictable in their outcome but the vast majority will form healed indistinct scars that would not be visible to others and in the very rare situation (less than 1 in 300) a lumpy scar can form which is known as a keloid scar. In the event of developing a keloid scar further treatment in the form of outpatient injections or surgery could be required.


What is the post-operative routine after surgery?


Head bandage?
If the Earfold® procedure is carried out as an outpatient NO head bandaging at all will be required. If a patient prefers or would benefit from open surgical procedure then a head bandage is required for the first 5 to 7 days after surgery. While a head bandage is required the patient may thus need a period of time away from work or school to avoid the social embarrassment that may be incurred by use of a head bandage.

Pain Relief
Normally simple analgesia is required i.e. either Paracetamol and/or Brufen tablets. Analgesia is usually required for a number of days at most but in general there is very little pain issues of significance after prominent ear surgery. Some tenderness may be felt while sleeping and if this is an issue a head bandage with padding is usually sufficient to minimise any discomfort. One would normally expect to have very minimal pain between day 5 and day 7 post op.

Washing/showering
After the Earfold® technique one is able to shower and wash ones hair as normal. After an open surgical procedure a head bandage however is required and then one has to wait until the head bandage is removed 1 week after surgery before showering. Once the head bandage is removed one can resume showering. For the paediatric patient, it is often advisable that a parent washes the child’s hair while the child can hold on to their ears to avoid inadvertent trauma to the ears.

Resumption of full activities
After the Earfold® correction technique is carried out most adults will return to work the next day although there may be a slight degree of bruising which is of a limited nature. Full exercise activity i.e. jogging is not recommended for the first week after the Earfold® technique.

After open surgery, there is a slightly higher risk of having a bleed with significant exertional activity and thus resumption of jogging/gym work should be avoided for the first 2/3 week.

Contact sports (eg rugby) should be avoided for the first 6 weeks after either the Earfold® technique or the open surgical procedure so as to avoid any inadvertent pulling of the ears.

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