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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 14  |  Issue : 2  |  Page : 85-88

Surgical correction of cleft earlobes Hassen


Reconstructive and Plastic Surgery Division, Department of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Date of Submission12-Mar-2016
Date of Acceptance16-Apr-2016
Date of Web Publication21-Oct-2016

Correspondence Address:
Ahmed Sabry Hassen
Algawashina, Diarb Nigm, Sharkia, 055
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1687-1693.192646

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  Abstract 

Background
Earlobes are considered as an important element in the cosmetic feature of the entire ear and face. Several techniques have been suggested to repair the torn earlobe. These corrections have been done to restore the natural appearance and shape of the ear for cosmetic, professional, or social reasons.
Aim
The aim of the present study was to present and discuss the technique used in the Unit of Plastic Surgery at Al-Azhar University Hospital, New Damietta, Egypt, for the repair of earlobe clefts.
Settings and design
A prospective study was carried out on the procedures used to repair split earlobes in our hospital.
Materials and methods
We present a personal and geometrical modification of the double-lobed flap carried out on 24 patients with split earlobes.
Results
The anatomical curvature of the earlobe was restored apart from reducing the skin retraction without causing scars or adding skin grafts.
Conclusion
We proved that our technique has many advantages and improved cosmetic results.

Keywords: earlobe clefts, earlobe repair, rectangular flaps


How to cite this article:
Hassen AS. Surgical correction of cleft earlobes Hassen. Al-Azhar Assiut Med J 2016;14:85-8

How to cite this URL:
Hassen AS. Surgical correction of cleft earlobes Hassen. Al-Azhar Assiut Med J [serial online] 2016 [cited 2017 Jun 28];14:85-8. Available from: http://www.azmj.eg.net/text.asp?2016/14/2/85/192646


  Introduction Top


Earlobes represent an important element in the cosmetic feature of the external auricle and face [1]. Earlobes are naturally tapered or round to simplify wearing earrings in females [2]. The ear lobule is considered a soft structure. It is composed of loose aereolar tissue and fat, and the earlobes are pierced for social, religious, and cosmetic reasons. The commonest cause for cleft formation is stretching and tearing of the holes by earrings with time, resulting in increased hole size of several millimeters and total cleft formation [3].

Split earlobe usually results from sudden trauma or continuous use of heavy earrings [4]. Sharma et al. [5] have classified split earlobes into congenital ([Figure 1]a) and acquired clefts, of which acquired clefts can be subclassified into partial ([Figure 1]b) or complete ([Figure 1]c) defects on the basis of the completeness of the lobe margins.
Figure 1: (a) A girl with right complete split ear, preoperative lateral view. (b) A female patient with left incomplete split ear, preoperative lateral view. (c) A female patient with left complete split ear, preoperative lateral view.

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Split earlobes can be again classified into complete or partial. A complete cleft occurs when the earring is acutely pulled out of the original, pierced hole of the earlobe forming a divided medial and lateral limb [6]. A partial cleft occurs when the piercing canal is elongated or deformed, but had not severed through the earlobe. Bianko-Davila and Vasconez have reported a subclassification for partial clefts based on the distance between the original piercing and the inferior margin of the earlobe [7].

The choice of surgical techniques for split earlobe repair depends on the existing split, partial or total, and should offer a lower chance of recurrence. The total split repair can be performed with or without preserving the earring orifice [4].


  Materials and methods Top


Twenty-four patients with split earlobes were admitted to our department at Al-Azhar University Hospital, Damietta, during the period between April 2010 and November 2011. The pattern and size of the cleft, type of the ornament worn, and the duration for which earrings were worn were noted. In cases that were eligible for surgery, an informed consent was obtained before surgery. The ethical committee of Al Azhar University approved the study protocol.

The causes for cleft earlobes were either congenital (three cases) or caused by trauma (21 cases). In this study, we included 24 cases of cleft earlobes, 14 with unilateral clefts and 10 with bilateral clefts, as shown in [Table 1]; therefore, the total number of earlobes (cases) treated was 34. Their ages ranged from 6 months to 58 years with a mean age of 23, 35 years. All of them were females, and the interval between the initial injury and the time of reconstruction was 6 months in cases of traumatic origin. Correction of the cleft was performed without preserving the earring hole. A new hole was pierced after at least 6 months of healing. In cases with partial tearing, we converted the incomplete cleft to a complete cleft.
Table 1: Clinical series

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Operative techniques

After preoperative marking ([Figure 2]a and [Figure 2]b), we administered local anesthesia to the earlobe (lidocaine 1% and 0.3 ml of adrenaline with a concentration of 1 : 100 000); for congenital cases, general anesthesia was used. We made a longitudinal incision on the anterior surface of the medial limb of the cleft ([Figure 3]a) to produce a flap of 2.0 mm thickness and dimensions of 5.0×2.0 mm. The flap was half the thickness of the lobule. In addition, the flap reflected as open book faced posterior based on the edge of the cleft. Longitudinal incision on posterior surface of the lateral limb cleft flap ([Figure 3]b), with a 2.0 mm thickness creating a 5.0×2.0 mm flap. The flap was divided the thickness of the lobule into 2 halves and reflected as open book faced anteriorly based on the edge to the cleft and sutured with mononylon 6-0 suture starting by the lower free margin with mononylon 6-0 in two layers posterior then anterior layer and applied micropore dressing.
Figure 2: A female patient with left incomplete split ear, preoperative lateral view showing marking. (a) Anterior marking on the medial limb of the cleft. (b) Posterior marking on the lateral limb of the cleft.

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Figure 3: (a) Intraoperative view showing reflection of the flap anteriorly. (b) Intraoperative view showing reflection of the flap posterioly.

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The patients returned after 10–15 days for stitch removal and after 30 and 60 days for postoperative follow-up. Cosmetic outcomes and postoperative complications were assessed on the basis of clinical findings and photographic documentation.


  Results Top


Of the 34 cases of cleft earlobes, 24 cases had complete clefts and 10 cases had incomplete clefts; among all, 10 cases had bilateral clefts, six cases had unilateral left clefts, and eight cases unilateral right clefts as shown in [Table 1] and [Figure 4]a, [Figure 4]b.
Figure 4: (a) postoperative view showing the flap anteriorly. (b) Postoperative view showing the flap posteriorly.

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There was no postoperative notching or scar contracture of the earlobes or recurrence.

We followed-up the patients for 1–2 years, and there were no complications.


  Discussion Top


The ancient Egyptian pharaoh Tutankhamen was of one of the earliest known to have stretched earlobes [8].

Bianko-Davila and Vasconez [7] have previously described repairing complete and incomplete acquired clefts. Simple scar excision with reapproximation of skin edges is a simple and short procedure and is sufficient for excellent postoperative results. Even with multiple operative methods available for repairing traumatic cleft earlobes, notable scar contractures and dimpling of the earlobe border are prevalent in some cases.

The use of the Z-plasty, double Z-plasty, L-shaped flap, and lapangular and triangular flap (or V-flap) have become common procedures, either with immediate preservation of the earring canal or delayed secondary placement [9],[10],[11],[12],[13]. Most of these surgeries involve additional flap elevation, including incision and dissection of the normal earlobe tissue, and some procedures involve even sacrifice of healthy tissue and impair the circulation of small earlobes [14].

Niamtu [15] recommended a simple side-to-side closure for small tears in the upper two-thirds of the earlobe and conversion of partial tears to complete tears of clefts involving the lower one-third of the earlobe.

In our study, we overlapped flaps on to one another and sutured them together. The flap was relatively easy to construct and resulted in an automatic Z-shape at the free edge of the lobule, preventing scar contraction and staggering the scar line at the inferior aspect of the lobule.

In our technique, we did not have to excise the edge of the cleft compared with Zoltie who excised the cleft leaving the apical portion intact, creating rectangular flaps on the anterior and posterior aspects of the cleft. We instead overlapped flaps on to one another and sutured them together. Zoltie [16] reported 23 patients who wore earrings continuously after the procedure without cleft recurrence. Rich et al. [17] excised tissue on the anterior face of one of the borders, and then the same amount of tissue was removed from the posterior face of the other border without preserving the lobe orifice.

In our study, we repaired the cleft after 6 months while Watson [18] and Vujevich et al. [6], recommended cleft repair immediately after surgery, waiting 6 weeks to repierce [19]. Repairing the earlobe between 3 and 12 months.

In our sample, 58% of the cases had unilateral clefts, 43% involved the left ear and 57% involved the right ear, and bilateral clefts were present in 42% of the cases. Partial clefts were present in 29% and total clefts were present in 71% of our sample compared with the study of Khilnani and Thaddanee, who reported 42.8% with left ear clefts and 57.1% with clefts in the right ear. In their study sample, partial clefts were present in 54.8% and total clefts in 37.1%, with 69.7% bilateral cases[3].


  Conclusion Top


We concluded that our technique of cleft earlobe repair help to restore a smooth margin without notching and making the earlobe of similar size to the contralateral earlobe. Also, our method obtaining additional tissue from the scar site utilized to increase the width of the lobule.

Recurrence can be prevented by avoiding the scar site for repiercing and use of lightweight earrings.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Shen W, Cui J, Chen J, Chen H, Zou J, Ji Y. Inversion of the flap at the lower ear and restoration of the flap at postauricular skin for reconstruction of the earlobe. J Craniofac Surg 2012; 23:560–562.  Back to cited text no. 1
[PUBMED]    
2.
Lewis JR. Roll-under (or fold-under) flap for release of earlobe contractures. In: Strauch B, Vasconez LO, Hall-Findlay EJ, editors. Grabb’s encyclopedia of flaps. 2nd ed. New York, NY: Lippincott-Raven; 1998. 333.  Back to cited text no. 2
    
3.
Khilnani AK, Thaddanee R. Clinical and demographic profile of cases requiring ear lobe repair in North Gujarat. Natl J Med Res 2013; 3:140–142.  Back to cited text no. 3
    
4.
Ribeiro AA, Lourenço L, Matsuda TMHB, Ferrari NM. Split earlobe repair: literature review and new technique proposal. Surg Cosmet Dermatol 2009; 1:141–144  Back to cited text no. 4
    
5.
Sharma R, Krishna S, Kumar S, Verma M. Rotation flap lobuloplasty: technique and experience with 24 partially torn earlobes. Int J Oral Maxillofac Surg 2014; 43:1206–1210.  Back to cited text no. 5
    
6.
Vujevich J, Goldberg LH, Uzan Obagi S. Repair of partial and complete earlobe clefts: a of 21 methods. J Drugs Dermatol 2007; 6:695–699.  Back to cited text no. 6
    
7.
Bianko-Davila F, Vasconez HC. The cleft earlobe − a review of methods of treatment. Ann Plast Surg 1994; 33:677–680.  Back to cited text no. 7
    
8.
Hawass Z. The golden age of Tutankhamun: divine might and splendour in the New Kingdom. American University in Cairo Press; 2004. 61. ISBN 977-424-836-8.  Back to cited text no. 8
    
9.
Hamilton R, La Rossa D. Method for repair of cleft earlobes. Plast Reconstr Surg 1975; 55:99–101.  Back to cited text no. 9
    
10.
Strauch B, Keyes-Ford M. Repair of the cleft earlobe with an advancement flap and two unilateral Z-plasties. Plast Reconstr Surg 1997; 99:924–926.  Back to cited text no. 10
    
11.
Argamaso RV. The lap-joint principle in the repair of the cleft earlobe. Br J Plast Surg 1978; 31:337–338.  Back to cited text no. 11
    
12.
Fearon J, Cuadros CL. Cleft earlobe repair. Ann Plast Surg 1990; 24:252–257.  Back to cited text no. 12
    
13.
Fujiwara T, Matsuo K, Taki K, Noguchi M, Kiyono M. Triangular flap repair of the congenital earlobe cleft. Ann Plast Surg 1995; 34:402–405.  Back to cited text no. 13
    
14.
Suh H. Traumatic cleft earlobe repair using double triangular flap from epithelialized skin of cleft margin. J Craniofac Surg 2014; 25:976–977.  Back to cited text no. 14
    
15.
Niamtu J. Eleven pearls for cosmetic earlobe repair. Dermatol Surg 2002; 28:180–185.  Back to cited text no. 15
    
16.
Zoltie N. Split earlobes: a method of repair preserving the hole. Plast Reconstr Surg 1987; 80:619–621.  Back to cited text no. 16
    
17.
Rich JD, Gottlieb V, Shesol BF. A simple method for correction of the pixie earlobe. Plast Reconstr Surg 1982; 69:136–138.  Back to cited text no. 17
    
18.
Watson Effendi D. Repair of the torn earlobe. Facial Plast Surg 2004; 20:39–45.  Back to cited text no. 18
    
19.
Effendi SH. Reconstruction of the middle-aged torn earlobe. Br J Plast Surg 1988; 41:174–176.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1]



 

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