Molding therapy for infants with deformational auricular anomalies
Abstract
Congenital auricular anomalies can be categorized as either malformed or deformational. Auricular deformations most commonly affect the helix and antehelix. Surgical correction involves sutural modeling, wedge excision, reshaping and reversing cartilage segments, and morselization. Since neonatal auricular cartilage is extremely pliable, we used early splinting to correct deformational ear anomalies. Splints were constructed of leadfree, soft soldering wire threaded into polyethylene tubing and held in place with Steri-Strips. From August 1995 through February 1996 we treated 19 infants with 32 deformed auricles: 10 infants were male and 9 were female, ranging in age from 1 day to 10 weeks. Thirteen infants had both ears affected. There were 8 prominent ears, 23 lop ears, 2 Stahl's ears, and 1 infant with an inverted concha. For prominent ears, the helical-mastoid distance decreased from an average of 16.8 to 12.2 mm, after an average of 13 weeks of splinting. Fourteen corrected lop ears had a normal appearance, and 9 were improved with minor residual deformity. There was only one complication: skin irritation requiring adjustment of the prosthesis. Five children had molding started after 3 months of age and all had no significant improvement. In addition, the parents of 5 children refused therapy and 12 children had either poor compliance to therapy or were lost to follow-up. Our experience with auricular molding confirmed that it is easy, effective, and inexpensive. If molded sufficiently early, most auricular deformations should not need surgical correction in childhood.
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Congenital auricle abnormalities are classified into two major categories: malformations and deformations.
“Congenital auricle abnormalities are classified into two major categories: malformations and deformations.”
From Using Ear Molding to Treat Congenital Auricular Deformities (2021) · cites this paper as [2]
Auricle deformations are characterized by a fully developed pinna without missing skin or cartilage.
“Auricle deformations are characterized by a fully developed pinna without missing skin or cartilage (1, 2).”
From Using Ear Molding to Treat Congenital Auricular Deformities (2021) · cites this paper as [2]
Tan et al. believed that non-invasive correction within 3 months of birth had an ideal effect, and that treatment timing was closely related to the duration of the curative effects.
“Tan et al. believed that non-invasive correction within 3 months of birth had an ideal effect, and that treatment timing was closely related to the duration of the curative effects (2).”
From Using Ear Molding to Treat Congenital Auricular Deformities (2021) · cites this paper as [2]
Early diagnosis and treatment have been advised in earlier literature, and multiple articles in this review have echoed this.
“Early diagnosis and treatment have been advised in earlier literature.24,41,42 Multiple articles in our review have echoed this.”
From Non-surgical Correction of Congenital Ear Anomalies: A Review of the Literature (2020) · cites this paper as [41]
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Ear Molding in Newborn Infants with Auricular Deformities
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“Results: The types of deformities managed, and their relative occurrence, are as follows: (1) prominent/cup ear, 373 ears (45 percent); (2) lidding/lop ear, 224 ears (27 percent); (3) mixed ear deformities, 83 ears (10 percent) (all had associated conchal crus); (4) Stahl’s ear, 66 ears (8 percent); (5) helical rim ab…”
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“of ears 158 (100) Sex Male (total ears) 85 (54) Female (total ears) 73 (46) First born Yes 96 (61) No 62 (39) Ears Bilateral 62 (65) Left 24 (25) Right 10 (10) Age at placement <1 wk 130 (82) <2 wk 20 (13) 2–6 wk 8 (5) Family history Yes 14 (9) No 144 (91) Baby comorbidities Hip dysplasia 2 (1) Tethered tongue 2 (1) O…”
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ResultComparison of 2 Ear Molding Systems for Nonsurgical Management of Newborn Auricular Deformities
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Chen, Y., Wang, W., Wang, Y., & Mao, X. (2021) · Frontiers in Pediatrics · doi:10.3389/fped.2021.752981 · Cited by 15 · see citing works
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“Moreover, in the first few weeks of life (up to 6 months), nonsurgical molding or splinting techniques can be effective, while the cartilage remains pliable.(8,9) However, after 6 months (and certainly after 5 years), the auricular cartilage becomes increasingly rigid and more resistant to This is an open access artic…”
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“When diagnosed early, the majority of ear deformations can be treated conservatively(3,6) by molding or splinting, with satisfactory results in the first weeks of life.(7) Some believe this non-surgical treatment modality is possible up to age 3 months,(8) yet we know that estrogen, which is responsible for plasticity…”
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“The auricular cartilage is amorphous in the early neonatal period; hence, modified external forces and splints can be used to mould it into a required shape.(5) With time, however, the auricular cartilage loses its malleability, and correction of Stahl ear in the older child or adult requires surgery.”
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“In the literature, there are studies in which cartilage shaping applications, which are started within the first 3 days after birth and continued for 6 months, yield successful results [4, 12].”
BackgroundComparison of two conchal formers for nonsurgical correction on Conchal Crus
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Hyaluronic Acid Dermal Filler Promotes Cartilage Reshaping in Rabbit Ears
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“High capacity of cartilage pliability and plasticity after birth have been attributed to the high levels of circulating maternal estrogens, which are the highest in the first 3 days after birth and decrease to normal levels by 6 weeks of age [3, 4].”
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“The hyaluronic acid-collagen ratio unique to neonatal cartilage contributes to shorter time and better outcomes, which are achieved when moulding is implemented as early as possible (2,6,7).”
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EarWell Infant Ear Molding Device: Experience and Parent Survey
Ahmed, M., AlSaadawi, G., & Mendonca, D. A. (2023) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000009574 · Cited by 2 · see citing works
“Infant auricular deformities are classified either as malformation or deformation, and malformations are characterized by a partial absence of the skin or cartilage, resulting in a constricted or underdeveloped pinna, whereas deformations are characterized by a misshaped but fully developed pinna.(3) Common deformatio…”
Minimally Invasive Method for Correcting Reducible Cryptotia
Shin, H., Shin, J. H., Song, J. K., Ko, J. G., & Lee, J. Y. (2020) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000006475 · Cited by 2 · see citing works
Comparative study between Mustarde and Stenström techniques in treatment of prominent ear
Hariry, M. N. E., Bahrawy, M. M. E., & Abu‐Elsoud, A. (2021) · Al-Azhar Assiut Medical Journal · doi:10.4103/azmj.azmj_106_20 · Cited by 2 · see citing works
Cugno, S., & Bulstrode, N. (2015) · Wiley eBooks · doi:10.1002/9781118655412.ch19 · Cited by 2 · see citing works
Should Constricted Ear Be Treated as Auricular Malformation or Deformity?
Wang, D., Lin, L., Pan, B., Yang, Q., & Jiang, H. (2018) · Annals of Plastic Surgery · doi:10.1097/sap.0000000000001553 · Cited by 1 · see citing works
Aktuelle Diagnostik und Therapie bei Ohrmuscheldysplasien und Gehörgangsfehlbildungen
Brandt, H. H., & Bodmer, D. (2023) · HNO · doi:10.1007/s00106-023-01386-8 · Cited by 1 · see citing works
Takada, A., Kuwahara, H., Tsuge, T., Ogawa, R., & Akaishi, S. (2024) · Plastic & Reconstructive Surgery Global Open · doi:10.1097/gox.0000000000006193 · Cited by 1 · see citing works
“10,11 Many reports have shown the effectiveness of conservative treatment within the first 3 months of age, 2,12 but one report has also shown corrective effects, even when conservative treatment is initiated after 1 year of age.”
BackgroundDoğan, R., Erdem, T., & Özturan, O. (2024) · Comprehensive ENT · doi:10.1007/978-3-031-76173-7_13 · Cited by 1 · see citing works
A Novel Ear Molding Technique for Conchal Crus and Stahl Ear Deformities
Mejía, M., Bercu, C. H., Baaj, H., Agudelo, M., Policherla, R., & Steinberg, J. P. (2025) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000011799 · Cited by 1 · see citing works
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Cosmetic Otoplasty and Related Ear Conditions
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Nonoperative treatment of congenital deformities of the ear
Bauer, B. S. (1997) · Operative Techniques in Plastic and Reconstructive Surgery · doi:10.1016/s1071-0949(97)80003-0 · Cited by 1 · see citing works
Spielmann, P. M., & Neeff, M. (2013) · Springer eBooks · doi:10.1007/978-3-642-35431-1_4
Combined Technique in Otoplasty
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Congenital earlobe cleft: Five case presentation
Mancera, J. C., Hernández, D., Bretón, M. Á., & Lima, A. (2008)
A prospective study on non-surgical correction of protruding ears: The importance of early
van Wijk, M. P., & Kon, M. (2012)
Defect-based reconstruction: ear
Yap, L. H., & Jose, R. M. (2011) · CRC Press eBooks · doi:10.1201/b13389-51
Treatment of Auricular Deformities with the EarWell System in Three Newborns
Kim, J. H., Sheen, Y. H., Kim, K. E., Heo, J. S., Jeon, J. H., & Chung, S. H. (2017) · Neonatal Medicine · doi:10.5385/nm.2017.24.3.129
- Authors
- Tan, S. T., Abramson, D. L., MacDonald, D. M., & Mulliken, J. B.
- Affiliations
- Harvard University (US)
- Venue
- Annals of Plastic Surgery
- Published
- 1997-03
- Volume
- 38
- Issue
- 3
- Pages
- 263-268
- ISSN
- 0148-7043 (ISSN-L)
- OpenAlex
- W2016167543
- Cited by
- 116
- References
- 0
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 6 · 2023: 8 · 2022: 9 · 2021: 10 · 2020: 12 · 2019: 2 · 2018: 6 · 2017: 8 · 2016: 4 · 2015: 3 · 2014: 2 · 2013: 5 · 2012: 3
- FWCI
- 1.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Plastic Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Reconstructive Facial Surgery Techniques
- Health Sciences › Medicine › Genetics › Congenital Ear and Nasal Anomalies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Craniofacial Disorders and Treatments
- Keywords
- prominent ears, lop ear, auricular cartilage, infants, conservative treatment, ear deformity
- MeSH terms
- Ear, External, Female, Follow-Up Studies, Humans, Infant, Infant, Newborn, Male, Splints, Treatment Outcome
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