The difficulty in achieving natural looking ears after corrective surgery (setback otoplasty) is reflected by the great variety of surgical procedure that have been developed to address this problem. These procedures fall into two categories. “Cutting” and “Folding” procedures, referring to what is done with the cartilage which has to be shaped to correct the ear shape. In “Cutting” procedures the deformed cartilage is cut and re-arranged to give the proper shape. In “Folding” procedures the cartilage is folded into the proper shape without cutting it. The proponents of the “Cutting” techniques argue that once the cartilage is cut and re-arranged, it will never be deformed again. They feel and “Folding” procedures have a risk of the cartilage unfolding and deforming again. However, the main argument against “Cutting” is that in these procedures the cut edges of the cartilage leave behind sharp, un-natural folds. For this reason, majority of surgeons today perform “Folding” type of a procedures. Mustarde otoplasty is the most widely used technique where sutures are used to hold a folded cartilage in place. It is believed to give the most natural looking result and have the lowest risk of returning back to the deformed shape. A recent article by Burt Brent, MD, one of the most prominent ear reconstructive surgeons, describes an exciting new technical adjustment to the “Mustarde” technique. In it he injects a small amount of fluid just under the skin to hydrodissect the cartilage prior to the insertion of “Mustarde” sutures. Hydrodissection is a technique that I have extensive experience with when dissecting microscopic blood vessels and nerve, and I believe inclusion of this technique in “Mustarde” otoplasty will lead to longer lasting and better looking results.

Martin Jugenburg,MD, FRCSC
Toronto, ON