Reconstruction of Moderately Constricted Ears by Combining V-Y Advancement of Helical Root, Conchal Cartilage Graft, and Mastoid Hitch

Ahmed Elshahat, MD; Riham Lashin, MD


ePlasty. 2016;16(e19) 

In This Article

Abstract and Introduction


Objective: Despite the multitude of corrective procedures described in the literature, adequate surgical correction of the congenital constricted ear remains a challenge. The maintenance of the shape and size of the reconstructed upper neohelix poses a particular problem.

Methods: In the present study, a total of 12 cases of reconstruction were undertaken. All of them were moderate (type IIA Tanzer classification) deformities. A combined procedure was adopted using a V-Y advancement of the helical root, cartilage scoring, and cartilage grafting from the contralateral concha to reconstruct the upper helix. A mastoid hitch was used as an adjunct to these procedures to maintain helical elevation and prevent recurrence. Mean follow-up period was 6 months.

Results: Results were excellent (n = 7), good (n = 4), and fair (n = 1). Paired t test showed a significant increase in the height of the constricted ear postoperatively (P < .001) and a nonsignificant difference between the height of the constricted and contralateral ears postoperatively (P > .05). Apart from dislodgment of the mastoid hitch suture in 1 patient, no complications were recorded.

Conclusion: This combined technique is useful in correcting moderately constricted ear deformities.


Congenital ear deformities range from very mild deformities as accessory auricle deformity to severe deformity as microtia. Constricted ear deformity is one of these congenital anomalies. Its severe form is the microtia. Davis[1] defined the constricted ear as a syndrome affecting all elements of the upper third of the ear in various degrees, whereby it looks like as if the rim of the ear has been tightened by a purse string. Tanzer[2] coined the term "constricted ear" to minimize the confusion of a multitude of descriptive terms, including "lop," "cup," "lidded," "canoe," and "cockleshell ears." This simple term of constricted ear combines the elements of the overhanging upper pole (lop) with the degree of protrusion (cup) to describe a single abnormality with a spectrum of variety. There are 4 main components to this abnormality.[3] Lidding, which is caused by reduced or absent fossa triangularis, scapha, and superior crus that contribute to the flattened and overhanging helical rim. Diminished support to the upper pole by an abnormal auricularis superior muscle facilitates collapse.[1] Flattened antihelix and helical rim deepen the conchal fossa, resulting in protrusion. Decreased ear size is a main component caused by the deformities of the fossa triangularis, scapha, and superior crus. Low ear position is rarely found in a moderately constricted ear deformity.

In 1975, Tanzer[2] classified constricted ears into 3 groups and 2 subgroups according to severity and the reconstructive procedure required. Group I: helical collapse only; group II: deficiency of the scapha, superior crus, and fossa triangularis; group IIa: no supplemental skin needed to expand the auricular margin; group IIb: supplemental skin necessary to expand the auricular margin; and group III: attachment of the anterior helix close to the lobule, the auricle is pouch-like, and the ear is usually low-set.

More than 20 different surgical procedures have been described for the correction of this abnormality.[4] However, none of these procedures are superior.[5] When the helical rim cartilage is slightly deformed, reinforcement can be done by a conchal cartilage graft[6] or a costal cartilage strip from the first or second floating ribs.[7] When both the helix and the scapha are involved, the whole plastic surgical bag of tricks is emptied for this group: Banner flaps,[2,3,8] V-Y advancement,[3,9] or Z advancement[10] of the root of helix, expanding the cartilage by splitting it into interdigitating leaves,[2,3,8,11] conchal cartilage grafts,[2,6,12] T-bar costal cartilage graft,[13] and addition of local skin flaps.[2,3,14] All techniques aim to elongate the upper pole.

A mastoid hitch, whereby the refashioned upper neohelix is sutured to the mastoid fascia, is often used as an adjunct to these procedures to maintain helical elevation and prevent recurrence.[8,10] Groups IIB and III of Tanzer are needed to be placed in a different context and regarded as conchal type microtia and corrected accordingly.[13]

To our knowledge and after revising the literature, there were no previous studies that combined the use of V-Y advancement of the root of helix together with conchal cartilage graft and mastoid hitch as a routine procedure to correct moderately constricted ears. The aim of this study was to investigate the reliability and reproducibility of combining these techniques together to treat the moderately constricted ear deformity.