Warts

Disease Description (Causes and Symptoms)

• Definition: A condition in which the auricle (helix) is flattened, or the angle formed by the auricle and scalp (auriculocephalic angle) is excessively wide, causing the ear to protrude from the head (prominent ear).
• Main causes and pathophysiology:
  • Cause: Not clearly established, but genetic factors and abnormalities in cartilage development may be involved.
  • Pathophysiology: An underdeveloped posterior fold (antihelix) or an overdeveloped concha (the lower part of the auricle) makes the auricle appear separated from the head.
• Main symptoms:
  • Aesthetic change (the ear appears prominent) — there is no hearing impairment.
  • Psychosocial problems such as teasing and reduced self-esteem may occur for aesthetic reasons.
• Diagnostic criteria (clinical findings):
  • The edge of the auricle is approximately 2.5 cm or more away from the scalp, or
  • The angle between the auricle and scalp is approximately 40 degrees or more; in such cases, it is often judged to be a prominent ear.
  • Evaluation is performed through examination and anterior and lateral photographs (while also checking for asymmetry).

Treatment Methods

• Conservative (nonsurgical)
  • Ear molding/splinting during the neonatal period: Good results may be possible when the ear is corrected with tape or a splint within several days to a few weeks after birth, while the cartilage is flexible. (The effectiveness varies depending on timing and severity.)
• Surgical
  • Indications: Significant aesthetic concerns or psychological problems, or cases that cannot be corrected with conservative methods.
  • Main procedures:
    • Cartilage-sparing suture technique (such as Mustarde sutures): A method of creating an antihelical fold with sutures after making an incision in the posterior skin (minimizing cartilage excision).
    • Conchal setback (e.g., Furnas sutures): A method of securing an excessive concha toward the back of the ear to bring the ear closer to the head.
    • Cartilage excision and incision technique: A method of correcting the shape by partially removing or incising excessive cartilage (posterior surface incision). May be combined with suture techniques when necessary.
  • Anesthesia: Children generally receive general anesthesia; adults receive local anesthesia plus sedation or general anesthesia.
  • Postoperative care: Wear a compression bandage (or headband) during the initial several days; wearing a headband at night is recommended for a certain period (several weeks).
• Medications/supportive therapy
  • Analgesics for postoperative pain management and antibiotics to prevent infection (when necessary), etc.
• Prognosis and precautions
  • Cosmetic improvement is generally excellent. Complications may occur, including hematoma, infection, wound problems, scarring, suture exposure, recurrence, and asymmetry.
  • It is difficult for the ears to become perfectly symmetrical. Recurrence is possible (due to cartilage elasticity, etc.).

Checklist Before an Outpatient Visit (Including Example Questions)

• Items to prepare and information to confirm:
  • List of currently taken medications (especially anticoagulants and antiplatelet agents)
  • Previous surgeries (especially ear or head and neck surgery) and allergies (medications, local anesthetics, etc.)
  • The mother's pregnancy and delivery history (if neonatal taping is being considered), and photographs from birth (if available)
  • Anterior and lateral photographs of the ears (front, 45-degree, and side views) — helpful for evaluation during the visit
  • When the symptoms began and how they have changed, and whether conservative methods (tape or splints) were attempted and their results
  • Information about psychological effects (difficulties at school or in interpersonal relationships)
• Materials to show the doctor during the outpatient visit:
  • Recent photographs from multiple angles, the child's activities (exercise and sports), and sleep patterns (related to postoperative care)
• Example questions (including items to check for yourself during the outpatient visit):
  • Is surgery absolutely necessary? When is the appropriate timing?
  • Is there a possibility of achieving results with nonsurgical methods?
  • How long is the recovery period, and when can normal daily activities be resumed?

Examples of General Questions to Ask the Doctor

• What are the possible complications of this surgery, and how should they be managed if they occur?
• What degree of result can be achieved with surgery, and is patient satisfaction likely to be high?
• How likely is recurrence, and when is the appropriate time for revision surgery?
• Are there any medications or lifestyle habits (e.g., smoking) that should be specifically avoided before or after surgery?
• Where will the surgical scar be located, and will it be noticeable?

Examples of Condition-Specific Questions

• Regarding newborns and infants: "Up to how many weeks after birth can meaningful corrective results be expected from taping (ear molding)?"
• Regarding unilateral prominent ear (one-sided): "If only one side is operated on, can the procedure be performed without making facial asymmetry more noticeable? Is surgery on both sides recommended?"