Cosmetic and Therapeutic Otoplasty

The dermis and auricular cartilage that make up the functional anatomic structure of the pinna are very responsive to CO₂ laser application. The great advantage of CO₂ laser energy in this region is the conservation of tissue.

Amputation of a specific area of the pinna using CO₂ laser energy can also be effectively accomplished. This technique should be used only when the mass or area of abnormal tissue cannot be effectively ablated. A tip of 0.4-mm spot size at a power setting of 10 watts efficiently incises both the dermis and the auricular cartilage. The tissue edges can then be sutured similarly to what occurs during ear-cropping tech­niques or by application of surgical-grade cyanoacrylic tissue adhesive.

Ear-cropping procedures have also been enhanced by the use of CO₂ laser energy. The pinna can be sculpted freehand or with a surgical guide. In either case the use of CO₂ laser energy significantly reduces the pain, swelling, and bleeding typically associated with standard scalpel technique. A spot diameter of 0.4 mm at a power setting of 10 to 15 watts produces excellent results. Small-diameter 3-0 or 4-0 nonab­sorbable sutures on a small-cutting-edge needle are used to appose skin edges without involving the cut surface of the cartilage in the closure. Tissue adhesive cyano­acrylics also provide excellent closure and reduced maintenance.

Treatment of a pinna that does not stand correctly or that, due to technique, has an exaggerated curve after ear cropping is in some cases possible using CO₂ laser energy. The objective of this corrective surgery is to contract the overlying dermis so that the pinna either stands up more correctly or curves less severely. To accomplish this procedure, the hair should be shaved away completely over the area to be treated. A spot size of 0.8 mm or larger or a scanning attachment should be used to direct the laser energy. The power setting should be only high enough to produce collagen contraction of the dermis. Full-thickness incisions should be avoided. This technique may also require rigid taping of the pinna after the therapy to ensure that the underlying auricular cartilage learns the new position.

In cases where the pinna is badly damaged or neoplastic spread is too great, complete amputation of the pinna can be accomplished more effectively using CO₂ laser energy. In this area, laser energy allows for more efficient removal of the pinna with less bleeding and postoperative discomfort to the patient. It is recommended that after the pinna has been removed, the auricular cartilage edge be resected about 5 mm from the edge to allow for more complete cosmetic suturing of the incision.