Carbon Dioxide Laser-Assisted Cartilage Reshaping Otoplasty

How does the new technique of carbon dioxide laser-assisted cartilage reshaping (CO2 LACR) otoplasty work and what are the outcomes?

Background: With more than 200 different otoplasty techniques, no single technique is considered the standard of care. Otoplasty techniques are cartilage sculpting (cutting), cartilage sparing (suturing) or a composite of the two. Problems associated with these techniques include suture extrusion, loss of correction over time, difficulty reshaping thick cartilage and permanent distortion of the ear.

Study design: Prospective case study.

Setting: Department of Otorhinolaryngology, Menoufyia University Hospital, Shibin Elkom, Menoufyia, Egypt.

Synopsis: Sixteen patients ages four to seven with bilateral prominent ears with unfurled antihelixes and without other associated ear deformities underwent early and final outcome assessments after carbon dioxide LACR otoplasty operations. Assessments included McDowell’s basic goals of otoplasty, patient/parent satisfaction, doctors’ satisfaction and measurements of early and late postoperative degree and change of protrusion. The same doctor performed each procedure, which is described in the article. The average follow-up time was 2.4 years, with no cases requiring revision surgery. In late assessment, 14 patients were pleased and two were “satisfied.” The author said the outcome of laser beams on cartilage depends on the laser wavelength, pulse duration, irradiance and tissue optical and thermal possessions. This retroauricular open approach allocated precise laser application, maintained control of the auricular reshaping process and passed up skin laser interactions. The author commented that there can be multiple negative results with LACR, noting a study by Leclère and colleagues in which LACR was performed without otoplasty surgery, and its drawbacks included prolonged mold use and development of contact dermatitis in six patients.

Bottom line: CO2 LACR otoplasty results in endurance of auricular appearance and symmetry, with good to satisfactory outcomes, but further follow-up is still needed.

Citation: Ragab A. Carbon dioxide laser-assisted cartilage reshaping otoplasty: a new technique for prominent ears. Laryngoscope. 2010;120(7):1312-1382.

—Reviewed by Sue Pondrom