Classification and Algorithmic Management of Constricted Ears: A 22-Year Experience.

Background: The term 'constricted ear' was coined by Tanzer. The classification and corrective methods for these malformations, however, continue to be controversial. To clarify them, we have reviewed and analyzed cases operated at our Center from January 1992 to January 2014. Methods: A total of 164 ear cases (involving 139 patients), showing features of lidded helix, compression of scapha and fossa triangularis, and/or cup-like protrusions were included in our study (constricted ear-featured microtias were excluded) and reviewed through medical records, photographs, analysis of surgical methods, and postoperative outcomes. Results: The deformed ears were classified into four graded types by antihelical tubing test and scapha-helix push test: Type I (n=21), Type II (n=63), Type III (n=38), and Type IV (n=42). Throughout our series, we've continued the improvement and performance of consistent operative techniques. Antihelical tubing, concha cartilage grafting, tumbling concha-cartilage flap, antihelical wrapping, or helical expansion were the preferred techniques. A total of 144 ear cases (88%) were followed up between 1 month and 14 years (an average of 13.2 months). The average score of aesthetic outcomes, rated on a 4-point Likert scale (1=poor, 2=fair, 3=good, 4=excellent) was 3.3 points. Corrective methods and aesthetic outcomes for patients with each graded type of deformity were described. Conclusion: Constricted ears were effectively corrected by a graded surgical approach. All corrections were performed in one stage, without removal of deformed auricular cartilage (though some of them were made with the addition of conchal or costal cartilage). (C)2016American Society of Plastic Surgeons

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