Otoplasty for prominent ear: A systematic review of surgical techniques

Prominent ear is a common auricular malformation that can have long-term psychosocial consequences on affected individuals. Otoplasty remains the standard surgical corrective treatment; however, the optimal technique has long been debated, with >200 methods described in the literature. This systematic review, conducted in accordance with PRISMA guidelines, aimed to evaluate the available evidence on the most effective otoplasty approach. The outcomes assessed across different techniques (exclusive suture, exclusive cartilage-scoring, incisionless, suture + flap, suture + cartilage-scoring, and cartilage-scoring + flap hybrids) included: a) number of patients suffering a complication, b) recurrence, c) reoperation, d) infection, e) keloid or hypertrophic scar formation, and f) haematoma. A search of PubMed and MEDLINE identified 412 papers. Following PICOT framework-guided screening, application of inclusion and exclusion criteria, and quality assessment, 22 studies were included: 19 retrospective and three prospective cohort studies. Current medical literature suggests that suture + cartilage-scoring and cartilage-scoring + flap hybrid methods, may be associated with lower rates of recurrence, and reoperation when compared to single-technique or suture + flap approaches. However, high-quality, long-term randomised control trials are required to determine the superior technique for otoplasty.