Surgery to set back prominent ears (pinnaplasty) is the most common paediatric plastic surgical procedure in the UK. About 5% of the population have ears which stick out more than 20mm from the side of the head, although in a recent study, over 20% of adults admitted embarrassment about the shape of their ears to the extent that it affected their hairstyle or their behaviour.
Pinnaplasty is perceived as a simple procedure by doctors and the public alike. Mr David Gault's organisation, the British Association of Aesthetic Plastic Surgeons (BAAPS), states on their website that "the vast majority of patients... are well pleased by the result, and the procedure has a high satisfaction rate" but a detailed review shows a steady incidence of problems including:
- Pain and discomfort 4%
- Recurrence (ears sticking out again) 7%
- Haematoma (a collection of blood beneath the skin) 1%
- Infection 1% and keloid (raised and itchy) scars 1%
Whilst it is true that those that are pleased are very well pleased, those that are not are often devastated.
However there is an alternative. Neonatal moulding of ears has been around for at least 20 years, but early splintage has yet to become routine despite excellent results and few complications. Controlling the very soft cartilage of a newborn ear using a splint can reshape it as it hardens over the first few months of life, such that prominent or otherwise deformed ears are cured within a few weeks, but the technique is underused.
There are great advantages in splinting to correct ear deformity. There is no teasing to prompt a referral for surgery. The cost of splinting is a mere fraction of the cost of surgery at £50 versus at least £800 within the NHS, assuming that funding is available, and around £4000 including surgical, anaesthetic and hospital fees for a general anaesthetic, day case stay in private practice. Almost 98% of splintage is performed by the parents themselves. Anaesthesia is not required, nor surgery, nor admission to hospital, nor is there a risk of post operative complications.