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The goal of this article is to present our results of surgical treatment of otapostasis. In the period from 2010 to 2016 the Autor operated on 26
patients with prominent ears using radio wave surgery. The average age was 10,4 years old. Surgical procedure was performed in local or general
anesthesia depending on the child’s age. Two hours after surgery patients left the clinic. Antibiotic and analgesic are administered for 8-10 day.
The complications are rare and can be avoided by careful work. In our material complications were in the form of one side bleeding in one case
that require revision. A second child was formed keloid –scaring in both ears two months after otoplasty. There were no other complications.
The technique used by dr Vukoje showed that both early and late results achieved, estimated by the child, parents and surgeon, as excellent in
88,6% and in 11,4% very good. Do not restoration of the auricle in the previous position. Our results indicate that the Radio wave surgery has an
advantage over classical technique especially if BAE electrodes apply. The decision of surgery should be made in agreement with the parents and
present the possible complications (Figure 1).
Keywords: Otoplasty; Otoplastica; Radiofrequency Waves; BAE Electrodes; Children’s Population
One of the most common aesthetic disturbances in childhood
are protruding ears. Because of “prominent ears” about 5% of this
population faces emotional problems. Psychological disorders
occur after six years of life when children go to school and are
bullied by their peers. The usual term they call them is “dumbo”.
The abduction is mainly present at birth and is usually bilateral,
although it may also be unilateral. In addition to this, except
for the overlapping cephalo-auricular angle, the auricles are
predominantly of normal shape and architecture, although the
abscess may be linked with some associated anomalies that relate
to the size of the external ear, such as macrophytes, and microtia.
The shape, relief, and configuration of the auricle can also occur
within the pathology mentioned above. The generally accepted
view is that the standing auricle needs surgical correction if the
auricular-mastoid angle exceeds 35 degrees and if the distance
between the helix and the head is greater than 20 mm. The
problem of solving this aesthetic disturbance is solely operational.
Indications for otoplasty should always be considered together
with parents and the child in order to avoid subsequent problems
The educators should be familiar with potential risks
and possible complications. Otoplasty in pediatric patients
has no significant impact on subsequent auricular growth.
Anthropometric studies have shown that 90% of the auricular growth has already been completed in the age of 12 years.
Actually, the development of the ears compared to transverse
growth has been completed by the age of six, and even then, it can
be recovered. Long-term monitoring of these patients has shown
that otoplasty does not lead to any disorder of auricular growth
and development in later life. A non-surgical correction of the
prominent ears, using various devices during the first months of
life, as well as wearing tape around the head that pulls and fixates
the auricle toward the head, and which parents usually apply, have
Otoplasty can be done under general or local anesthesia
depending on the child’s motivation and age. In children aged 6-
10 years, general anesthesia should be used and at an older age
local. There are various surgical modifications and operational
approaches for “pinning” the ear shell to the head. The choice of
the surgical method is not always simple because of the existence
of arguments for and against each procedure. The decision is
made by a surgeon with the agreement of the patient’s parents.
In children at this age, the auricular cartilage is soft and elastic,
and the surgical procedure is less invasive. It is very important
to accurately evaluate the situation and to choose smaller-sized
procedures with as little trauma as possible. The roughness and
thickness of the auricular cartilage plays a significant role in the
selection of operational techniques. Only the cutting of the back
side of the auricle in the form of a myrtle leaf is not enough to
achieve lasting results of otoplastics due to the elasticity of the
skin. The technique invented by Mustarde [1,2] in this population
provides good cosmetic results. The operation can be carried
out using a classical technique, high-frequency radio wave,
an ultrasound knife, a laser, and others . What technique a
surgeon will use depends on what tools he has. Experience of
the surgeon is important. This type of intervention is done by
general surgeons, plastic surgeons, maxillofacial surgeons and
otorhinolaryngologists. But primarily done by plastic surgeons.
The goal of this thesis is to present our results of surgical
treatment of prominent ears in 26 patients aged 6-12 years using
high frequency radio waves.
Material and Methods of Work
In the period from 2010 to 2016, the author operated on
26 patients with prominent ears. Patients were predominantly
males; average age was 10. 4 years old. Operations performed
were an ambulatory type, of which 19 were in local anesthesia
and 7 in general. The technique used were radio waves with a
specially designed electrode, using the mode of cut-coagulation.
Two hours after surgery, patients left the clinic.
The surgery begins with a retro-auricular cut of the elliptical
shape on the back of the auricle, which can be extended to the
mastoid skin. Then excise the skin with subcutaneous tissue,
make hemostasis, make mosaic plastics on the cartilage of the
concha. A few fixation seams are set through the Perichondrium
cartilage, with absorbable suture thread or polydioxanone. By
tightening the thread, the auricle is attached to the mastoid to the
desired level . It is important to note that the ear shells are not
too attached to the mastoidal extension, which can give an ugly
aesthetic appearance. The skin is sewn with an atraumatic suture
Bandaging is very important. First, the physiological
depressions of the lateral side of the ears are filled with gauze
tampons and antibacterial ointment, then a gauze (as shown in
the picture) is placed retro-auricular and on the outside of the
auricle. The outer side of the auricle is covered with cotton balls
and over that, gauze is wrapped around the head. The next fixation
is done on the second or third day. On the tenth day, the bandage is
removed and at the same time the sutures are removed from the
skin. It is advisable to wear tape around the ears and the head for
another two to three weeks, especially during sleep.
Antibiotics and analgesics are administered for 8-10 days
Postoperative complications following otoplasty may be
early or late and lead to serious auricular deformities. Early are
manifested in the form of hematoma, bleeding, skin infection,
pericarditis, etc., and is delayed in the form of keloid scarring,
granuloma, fistula, deformity of the ears and restoration of the
auricle in the previous position, etc .
The appropriate age for corrective otoplasty in the children’s
population remains controversial. Most surgeons recommend
when the child is 5 years old. Otoplasty in pediatric patients
does not affect subsequent auricular growth and development.
Operation should in principle be done in 5-6 years of age, that is,
before the start of schooling due to the psycho-social aspects of
this phenomenon. At that time, the plasticity of the ear of the ear
is higher 
A number of surgical techniques [1,3,5,7,8] have been
described for correction of the external ears with the aim of
reducing the concha-mastoid and cefalo-auricular angle while
preserving the anatomical structures and architecture of the
auricle. From numerous surgical procedures and their modification
of the three methods independently or in combination proved
their effectiveness in correcting the ears. Mustarde [1,2] Conversu
 and Stenstrom [8,9] had proven their superiority compared
to others in terms of success. Dr Vukoje  is a “mosaic” of the
technique, preferring the use of high frequency radio waves using
Ellman Sugitron, 4.0 Mhz with a specially designed BAE electrode.
The advantage of this technique compared to the classic is seen
in the incision of skin without tissue pressure, minimal lesion of
cartilage and perichondrium, minor bleeding, etc. which results in
shorter duration of the operation and better cosmetic results with less complications. The “Mosaic” technique that Dr Vukoje prefers
allows you to bend and reach the auricle to a mastoid-free tension
with a high degree of patient and parent satisfaction. In fact, the
intention of otoplasty is to preserve the normal morphology of
the ears, bringing the cephalo-auricular angle to a level of 15-
20 degrees with a minimum rate of recurrence [9-12]. It is also
important to correctly place the fixing sutures that are placed at a
distance of 4-6 mm, 2-3 sutures per ear. This is significant because
of the occurrence of postoperative asymmetry of the ear and later
distortion of the ear shell.
Corrective otoplasty is a universally accepted surgical
procedure in solving “protruding ears”. This aesthetic operation
aims to “bring” ear shells to a normal position and achieve
a satisfactory cosmetic result while preserving the auricle
architecture. The operation is desirable to do before the child
begins school. Most authors recommend a fifth year of life. There
are a number of techniques and procedures for which the surgeon
will determine depending on the experience and technique at