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Otoplasty

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Preoperative Considerations

Consent:

  • Scarring, which might be visible depending on the technique used.
  • Asymmetry in the position or shape of the ears.
  • Overcorrection or undercorrection of the ear position.
  • Possibility of revision surgery if the initial outcome is not satisfactory.
  • Changes in skin sensation around the ears.
  • Risks associated with anesthesia.

Anesthesia/Positioning:

  • Supine
  • prep into ears and hair

Other:

  • Tumescent

Armamentarium:

SUPPLIES:

  • 1 Basic Pack
  • 1 Split Sheet
  • 1 Mayo Cover
  • 1 Needle Book
  • 1 Bovie Pencil
  • 1 Bovie Pad
  • 1 Scratch Pad
  • 1 Needle 25 ½ g (Exparel)
  • 1 Raytec
  • 1 Specimen Cup
  • 1 Suction Tubing
  • 1 Yankeur
  • 1 Pack Sterile Towels
  • 3 Gowns
  • 1 Bed Cover
  • 2 Gloves (8)
  • 2 Gloves Scrub
  • 1 Blue Pad
  • 1 BSS
  • 1 Pack 4x4 Gauze
  • 6 Carpules
  • 1 Dental Needle 30g
  • 1 Jelco (pink)
  • 1 10cc Syringe
  • 1 Cotton
  • 1 Kerlix
  • 1 Laser Cover
  • 2 Needle 30 ½ g
  • 1 Blade #10
  • 1 Utah Tip
  • 4 Blades #15
  • 1 TB Syringe
  • 2 Donuts

PREP:

  • Dental Syringe
  • Dental Needle
  • Gloves
  • 4x4 Gauze
  • Specimen Cup
  • 6 Carpules
  • Small Bowl
  • Methylene Blue

MAYO:

  • Deans
  • Browns (2)
  • Senns
  • Frazier Tip
  • Stats (3)
  • Small Needle Drivers (3)
  • Medium Needle Drivers
  • Elevator #7
  • Cottle Elevator
  • Iris
  • Bear Claw

SUTURE:

  • 3 Prolene 4-0 P-3
  • 2 Plain Gut 5-0 P-3
  • 1 PDS 2-0 SH (HOLD)
  • 1 Nurlon 0

DRESSINGS:

  • Ointment
  • Cotton
  • Telfa
  • Kerlix

Instruments:

  • Light Handle
  • Large Bowl
  • Mag Pad
  • Rhino set

NOTES:

  • Marcaine 25% Plain & Exparel
  • LASER with Bleph Tip Set UP
  • Make Sure You Have 3 STATS

Technique

Postoperative Considerations

Immediate:

Follow Up:

Operative Note

Surgeon(s): ***

Assistant Surgeon(s):  ***

Preoperative Diagnosis: ***

Postoperative Diagnosis: Same

Procedure(s): Otoplasty - Conchal bowl reshaping (Furnas maneuve; Otoplasty - Antihelical folds (Mustarde maneuver)

Anesthesia: General

Implants: None

Specimen:***

Drains: None

Fluids: See anesthesia record

EBL: Minimal

Complications: None

Counts:  Correct x2

Indications: ​***

Findings: As expected

Procedure in Detail:

The patient was seen in the preoperative holding area with a H&P was updated, consents were verified, surgical site marked, and all questions and concerns related to the proposed procedure were discussed in detail.  The patient was transferred to the operating room by the anesthesia team.  The patient underwent general anesthesia with endotracheal intubation. Tegaderms were placed over the eyes. The patient was prepped and draped in the standard fashion for maxillofacial procedures.  A time-out was performed and the procedure began.

The face, ears were prepped with chlorhexidine scrub.

Otoplasty Conchal bowl reshaping: (Left)

The ears were then anesthetized with 5 cc 2% lidocaine with 1:100,000 k epinephrine. A 15 blade was used to make a curvilinear incision along the posterior ear. A full thickness subperichondral flap was then elevated. Attention was then directed to the post-auricular tissue. Dissection proceeded down to mastoid fascia. Posterior auricularis was encountered and excised to create space for the ear to recess into. Excess conchal bowl cartilage was shaved and the ear examined for appropriate projection.

Otoplasty antihelical folds: (left)

The antihelical fold was then addressed.. 4-0 prolene sutures were then placed x 1 in the Mustarde fashion. Closure with 5-0 plain gut on the posterior incision

Otoplasty Conchal bowl reshaping: (Right)

The ears were then anesthetized with 5 cc 2% lidocaine with 1:100,000 k epinephrine. A 15 blade was used to make a curvilinear incision along the posterior ear. A full thickness subperichondral flap was then elevated. Attention was then directed to the post-auricular tissue. Dissection proceeded down to mastoid fascia. Posterior auricularis was encountered and excised to create space for the ear to recess into. A strip of full thickness cartlidge was removed to help with excess projection. 3-0 PDS was used to place Furnas sutures for the conchal bowl to the mastoid periosteum.

Otoplasty antihelical folds: (left)

The antihelical fold was then addressed.. 4-0 prolene sutures were then placed x 2 in the Mustarde fashion. Closure with 5-0 plain gut on the posterior incision Attention directed to the bilateral earlobes. An elipse of skin was taken posteriorly from each ear lobe to help reduce projection. Closure with 5-0 fast gut.

At the end of the procedure the ears has decreased projection as planned without evidence of telephone deformity. VPS was placed into the ears in the conchal bowl and posteriorly behind the hear and allowed to harden. The ears were then dressed with guaze and kerlex.

The patient's face was then cleaned and the posterior pharynx was suctioned. An OG tube was used to suction out the contents of the stomach. Tegaderms were removed from the eyes. Dressings were placed. The patient was then transferred back to the care of the anesthesia team for extubation and recovery.

Coding

  • CPT 69300 - Otoplasty, protruding ear, with or without size reduction. This code is used for the cosmetic correction of protruding ears. It can be applied whether or not there is a reduction in the size of the ears as part of the procedure.
  • CPT 69399 - Unlisted procedure, external ear. This code may be used for otoplasty procedures that do not fit the description of other specific CPT codes, such as more complex reconstructions or those involving atypical techniques.

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