Otoplasty

 Definition

Correction of a congenital defect that causes the ears to protrude prominently from the side of the head (lop ears).

Discussion

• The procedure is usually performed bilaterally, but it can involve only on ear. The procedure may also refer to the correction of microtia and other congenital deformities of the ear. The ideal time for the corrective procedure to be performed is usually around 4 years of age or before the child enters school, in order to prevent ridicule by the child’s peers.

Positioning

• Supine; arms may be tucked in at the side. If unilateral, the affected ear is up, and the other is supported on a soft headrest to avoid damage. For a bilateral otoplasty, the head is placed in a accommodating position by the surgeon.

Packs/ Drapes

• Head drape with ears exposed
• Split sheet with basic pack

Instrumentation

• Plastic procedure tray
• Small rasps

Supplies/ Equipment

• Headrest e.g. doughnut or shea
• Basin set
• Suction
• Blades
• Needle counter
• Local anesthetic
• Syringes
• Solutions
• Sutures

Procedure

1. A variety of techniques are used to correct this defect. A common approach involves incising the skin on the posterior side of the concha.
2. The underlying cartilage is then incised or scored.
3. Interrupted sutures (absorbable or non absorbable) are placed through the cartilage to tighten it.
4. The resulting effect “pins” the ears closer to the head.
5. The incision is closed with fine interrupted sutures and a bulky dressing is applied.

Perioperative Nursing Considerations

1. For a unilateral procedure, keep the lowermost ear well padded to avoid pressure injury.
2. The table may be turned for easier access.
3. Do not allow preparation solution to pool in or around the ear.
4. A sterile cotton pledget may be placed in the ear to avoid solution dripping into the ear.