Incisionless Fritsch otoplasty

The Incisionless Fritsch otoplasty is a minimally invasive procedure for pinning protruding ears.

History

Fritsch named his method “Incisionless Otoplasty” and published it under this name in 1995,[1] 2004,[2] 2009[3] and 2013.[4]

Surgical procedure

Through very small skin openings on the back of the ear, permanent, non-absorbable sutures (called by Fritsch" retention sutures") are placed invisibly around the cartilage of the antihelix with a special technique, that was described previously by Kaye,[5] Mouly,[6] and simultaneously by Peled,[7] pulled tight and knotted. When the sutures are tightened, the ear moves towards the head. The small skin openings, beneath which he positions the knots of the sutures, are closed with catgut sutures. Fritsch reported in his first publication, that eight initial patients were operated on using percutaneous placement of retention sutures in conjunction with a post auricular incision. Thereafter, 5 patients were operated on using only the percutaneous incisions technique. Fritsch pointed out that he could not correct all ears satisfactorily with this technique. Therefore, he combined it with a traditional ear pinning method by pulling the upper and middle (conchal) third of the ear towards the head with sutures that were anchored in the ear cartilage and periosteum of the mastoid. This corresponds to the conventional Furnas Method.[8] He also sometimes combined with a technique of the traditional methods for correcting protruding earlobes, by opening the back of the earlobe and removing soft tissue from it. He found that his minimally invasive technique did not produce any satisfactory results in the case of pronounced conchal hyperplasia. This is how Fritsch described his method in 1995.

In his later publications, the cartilage is blindly scratched or scored, sometimes quite deeply. In this way, the Fritsch technique became a combination of a minimally invasive method, such as described in his first publication in 5 patients and later in many cases by Merck,[9] and the scoring technique of the traditional Stenström technique.[10] Kaye, Mouly, Peled and Tramier[11] also scored the cartilage on the anterior side of the antihelix. Fritsch sometimes removed soft-tissue or bone between the conchal bowl and the mastoid. Narrow tunnels on the post auricular cartilage created a scar band to augment the retention sutures and attach to the conchal bowl correction.

Risks and complications

According to Fritsch: Infection; bleeding; hematoma; pain; discomfort; swelling; suture breakage; postauricular suture bridging; epithelial inclusion with cyst formation; during cautery, risk of injuring the facial nerve and blood vessels; during cautery, injury of the facial nerve and bleeding due to the injury of vessels is possible and there is also the danger of injuring the facial nerve and blood vessels, causing bleeding in the latter case.

According to Weerda:[12] Cosmetically disfiguring cartilage edges along the anterior surface of the antihelix if the cartilage is scored too deeply or the perichondrium is injured; post-operative bleeding; hematoma; relapse (ears protruding again); hypersensitivity; pain with pressure and cold, pressure damage (necrosis) from too tightly fitting hard bandages; perichondritis (inflammation of the cartilage); stronger asymmetry of the ears (see also on otoplasty).

References
  1. Fritsch, M.H. (1995). "Incisionless Otoplasty". Laryngoscope. 105, 1-11
  2. Fritsch, M.H. (2004). "Incisionless Otoplasty". Facial Plastic Surgery 20, 267–70
  3. Fritsch, M.H. (2009). "Incisionless Otoplasty". Otolaryngologic Clinics of North America |volume=42 |issue=6 |pages=1199–1208
  4. Fritsch, M.H. (2013). "Ohranlegung ohne Hautschnitt (Incisionless otoplasty. A review)" "J Aesthet Chir", 6, 203-208
  5. Kaye, B.L. (1967). "A simplified method for correcting the prominent ear. Plast. and Reconstr. Surg., 40, 44-48
  6. Mouly, R. (1971). "Correction sans cicatrice des oreilles décollées." Ann. Chir. Plast., 16, 55-59
  7. Peled, I.J. (1995). "Knifeless otoplasty: how simple can it be?" Aesth. Plast. Surg., 19, 253-255
  8. Furnas, D. (1968). "Correction of prominent ears by concha mastoid sutures." Plast Reconstr Surg 42:189
  9. Merck, W.H. (2013). "Dr Merck’s stitch method. A closed minimally invasive procedure for correction of protruding ears (Die Fadenmethode nach Dr. Merck. Ein geschlossenes, minimal-invasives Verfahren zur Anlegung abstehender Ohren)." J Aesthet Chir, 6, 209-220.
  10. Stenström, S.J. (1963) "A natural technique for correction of congenitally prominent ears." Plast. Reconstr. Surg., 32, 509-518
  11. Tramier, H. (1997). "Personal approach to treatment of prominent ears." In: Plastic and Reconstructive Surgery. 99, Number 2,  562–565 PMID 9030170.
  12. Hilko Weerda: Chirurgie der Ohrmuschel. Georg Thieme Verlag, 2004, ISBN 3-13-130181-3.
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