How effective is clinical use of laser-assisted cartilage reshaping (LACR) for protruding ears?
Background: Protruding ears are the most common congenital ear deformity, with a frequency of 13.5% and a well-known hereditary component. Thermal-based mechanisms, such as radiofrequency, electrical current, or lasers, have been investigated to provide cartilage reshaping in place of traditional surgery. In 2006, the first clinical use of LACR for protruding ears was reported.
Study design: Review of seven clinical LACR studies using three different wavelengths, published between 1993 and 2014.
Setting: MEDLINE database.
Synopsis: Three different wavelengths were used: 1,064 nm, 1,540 nm, and 10,600 nm (CO2). Cumulative fluence ranged from 70 J/cm2 to 84 J/cm2. Except in one study in which eight burn events occurred, there were no intraoperative complications. Post-operative complications included mostly dermatitis, asymmetry, and recurrence. In one study using 1,540 nm, incomplete reshaping was observed in three patients and could be correlated to a lower fluence than usual. The studies using 1,540 nm show that this wavelength is ideal for cartilage reshaping due to the wavelength’s penetration depth matching the thickness of the cartilage and contact cooling making the treatment very tolerable. The 1,540-nm absorption produces less injury to surrounding tissue compared to 1,064 nm, at which the skin was burned in more than 50% of the cases.
A third approach, performing ablation to a partial thickness of the medial surface of the antihelixes using the CO2 laser, permitted cartilage reshaping with both vaporization and incisions for a more precise laser application and cartilage suture, providing greater stabilization, but it is a more complicated technique.
Bottom line: The success rate for ear reshaping achieved with LACR appears promising, particularly at a wavelength of 1,540 nm.
Citation: Leclère FM, Vogt PM, Casoli V, Vlachos S, Mordon S. Laser-assisted cartilage reshaping for protruding ears: a review of the clinical applications Laryngoscope. 2015;125:2067–2071.