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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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In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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
Byrd, H. S., Langevin, C.-J., & Ghidoni, L. A. (2010) · Plastic and Reconstructive Surgery · doi:10.1097/prs.0b013e3181e617bb · Cited by 178
“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…”
Janis, J. E., Rohrich, R. J., & Gutowski, K. A. (2005) · Plastic and Reconstructive Surgery · doi:10.1097/01.prs.0000156218.93855.c9 · Cited by 159
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Self-citationThe postauricular fascial flap as an adjunct to Mustardé and Furnas type otoplasty.
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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…”
Backgroundvan Wijk, M. P., Breugem, C. C., & Kon, M. (2009) · Journal of Plastic, Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2009.01.020 · Cited by 88
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“001‡ Deformation 45 (98) 1 (2) Malformation 16 (64) 9 (36) Age at application, days Mean ± SD 18.”
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Anstadt, E. E., Johns, D. N., Kwok, A. C.-M., Siddiqi, F., & Gociman, B. (2016) · PEDIATRICS · doi:10.1542/peds.2015-2831 · Cited by 44
Correction of Congenital Auricular Deformities Using the Ear-Molding Technique
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“A completely developed but distorted pinna is characteristic of congenital ear de-formities, whereas soft tissue or cartilage is deficient in ear malformations [10].”
Petersson, R. S., & Friedman, O. (2008) · Current Opinion in Otolaryngology & Head & Neck Surgery · doi:10.1097/moo.0b013e328304b40d · Cited by 36
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“Congenital auricular deformities are characterized as having a normal chondrocutaneous component, that is, no deficiency of skin or cartilage, with an abnormal architecture [1].”
BackgroundInfluentialNonsurgical Management of Congenital Auricular Anomalies
Lennon, C., & Chinnadurai, S. (2018) · Facial Plastic Surgery Clinics of North America · doi:10.1016/j.fsc.2017.09.001 · Cited by 28
Non-surgical Management of Congenital Auricular Deformities.
(2016) · PubMed Central · Cited by 29
Anthropometric research of congenital auricular deformities for newborns
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“, 2014) and in external ear moulding (Tan et al., 1997; Doft et al., 2015).”
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Self-citationNon-surgical Correction of Congenital Ear Anomalies: A Review of the Literature
Feijen, M. M. W., van Cruchten, C., Payne, P. E., & van der Hulst, R. R. W. J. (2020) · Plastic and Reconstructive Surgery - Global Open · doi:10.1097/gox.0000000000003250 · Cited by 22
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“The conclusions were congruent with limited prior case reports suggesting an association between poor outcomes and initiation at older ages (>3 months).(15) More recently, Doft et al conducted a prospective study of 158 ears in 96 consecutive infants treated with the EarWell system.”
ResultComparison of 2 Ear Molding Systems for Nonsurgical Management of Newborn Auricular Deformities
Xiong, H., Wang, X., Li, G., Xu, J., Zhai, J., Chen, S., Lu, Y., Chen, Y., Zheng, Y., & Yang, H. (2020) · Ear Nose & Throat Journal · doi:10.1177/0145561320901398 · Cited by 21
“Auricle with deformities is fully developed, but misshapen pinnae caused by external forces.(1,2) The correction for malformation requires operative procedures to rebuild a new auricle, whereas deformed auricle can be treated not only with otoplasty but also with nonsurgical management, including ear molding, with few…”
BackgroundInfluentialManagement of the prominent ear
Gantous, A., Tasman, A.-J., & Neves, J. C. (2018) · Facial Plastic Surgery Clinics of North America · doi:10.1016/j.fsc.2017.12.010 · Cited by 20
Aki, F. E., Kaimoto, C. L., Katayama, M. L. S., Kamakura, L., & Ferreira, M. C. (2000) · Aesthetic Plastic Surgery · doi:10.1007/s002660010062 · Cited by 18
A systematic review of congenital external ear anomalies and their associated factors
Acosta-Rodríguez, A., Reza‐López, S. A., Aguilar-Torres, C. R., Hinojos-Gallardo, L. C., & Chávez‐Corral, D. V. (2025) · Frontiers in Pediatrics · doi:10.3389/fped.2025.1520200 · Cited by 17
“A deformed ear is presented with fully developed components, with a misshaped auricle or pinna with intact cartilage and skin; while a malformed ear shows auricle alterations due to a partial or complete absence of cartilage and/or skin, because of underdevelopment during embryogenesis (8, 9).”
Nonsurgical Treatment of Auricular Deformities in Neonates and Infants
Furnas, D. W. (1999) · Pediatric Annals · doi:10.3928/0090-4481-19990601-10 · Cited by 16
Frascino, L. F. (2009) · Annals of Plastic Surgery · doi:10.1097/sap.0b013e318195bfdd · Cited by 16
“Prominent ears can be defined as a deformational anomaly resulting from the combination of anatomic deformities in 2 basic cartilaginous structures—concha and antihelix.(1,2) The concha may present an “insertion” defect represented by a concha-mastoid angle greater than 30 degrees,(3) or a shape deformity, in the post…”
BackgroundUsing Ear Molding to Treat Congenital Auricular Deformities
Chen, Y., Wang, W., Wang, Y., & Mao, X. (2021) · Frontiers in Pediatrics · doi:10.3389/fped.2021.752981 · Cited by 15
“believed that noninvasive 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).”
BackgroundBasat, S. O., Askeroğlu, U., Aksan, T., Alleyne, B., Yazar, M., Orman, Ç., Üsçetin, İ., & Akan, M. (2014) · Aesthetic Plastic Surgery · doi:10.1007/s00266-013-0269-z · Cited by 14
“This could be due to the increased auricular cartilage elasticity in this age group [5, 6].”
BackgroundNuances of Otoplasty: A Comprehensive Review of the Past 20 Years
Nuara, M. J., & Mobley, S. R. (2006) · Facial Plastic Surgery Clinics of North America · doi:10.1016/j.fsc.2006.01.007 · Cited by 14
“Several investigators have applied splinting to prominent ears that were identified at birth with promising long-term results when applied within the first 3 days of life [45–50].”
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Vu, G. H., Azzolini, A., Humphries, L. S., Mazzaferro, D. M., Kalmar, C. L., Zimmerman, C. E., Swanson, J. W., Taylor, J. A., & Bartlett, S. P. P. (2020) · Plastic & Reconstructive Surgery Global Open · doi:10.1097/gox.0000000000002902 · Cited by 15
Nonsurgical Treatment for Congenital Auricular Deformities: A Systematic Review and Meta-analysis
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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…”
BackgroundCryptotia recurrence lowering technique with additional acellular dermal matrix graft
Lee, D., Kim, Y. S., Roh, T. S., & Yun, I. S. (2019) · Archives of Craniofacial Surgery · doi:10.7181/acfs.2019.00269 · Cited by 13
“The congenital anomalies of the ear auricle can be divided into malformational disease and deformational disease, and cryptotia is included in the latter [2].”
BackgroundEfficacy of Classic Ear Molding for Neonatal Ear Deformity: Case Series and Literature Review
Kim, J.-H., Jo, T., Choi, J., Kim, J., & Jeong, W. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11195751 · Cited by 12
“4 Tan 1997 [4] Splinting and taping 32 Concha (3.”
BackgroundOne-Year Outcomes of Ear Molding for Infants with Constricted Ear
Chen, P., Yang, J., Yang, L., Liu, Y., Gao, M., Li, S., Wang, D., & Zhao, S. (2022) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000009781 · Cited by 12
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Zhou, Z., Chen, C., Bi, J., Jiang, A., Dai, J., Chen, W., & Fu, Y. (2018) · International Journal of Pediatric Otorhinolaryngology · doi:10.1016/j.ijporl.2018.12.022 · Cited by 12
Anteverted concha: A new ear deformational anomaly
Schönauer, F., Martino, A. D., & Gault, D. T. (2015) · JPRAS Open · doi:10.1016/j.jpra.2015.06.004 · Cited by 11
Congenital anomalies of the external ear
Liaw, J., Patel, V. A., & Carr, M. M. (2017) · Operative Techniques in Otolaryngology-Head and Neck Surgery · doi:10.1016/j.otot.2017.03.012 · Cited by 13
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The Role of the Antitragicus Muscle in Plical Folding of the Pinna
Bennett, S. P. H., Dagash, H., & McArthur, P. (2005) · Plastic & Reconstructive Surgery · doi:10.1097/01.prs.0000156773.69631.52 · Cited by 9
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Feijen, M. M. W., van Cruchten, C., & van der Hulst, R. R. W. J. (2021) · Plastic & Reconstructive Surgery Global Open · doi:10.1097/gox.0000000000003562 · Cited by 9
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“Actually, up to one-third of ear anomalies will correct themselves (1, 2), and thus, many children may lose the valuable opportunity for early noninvasive correction.”
BackgroundA new surgical correction of cryptotia with superior auricular myocutaneous flap
Sakamoto, Y., Nakajima, H., Kishi, K., et al. (2010) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2010.02.026 · Cited by 8
Dinis, J., Junn, A., Long, A. S., Phillips, S. M., Reategui, A. A., Kaplan, A., & Alperovich, M. A. (2021) · Aesthetic Plastic Surgery · doi:10.1007/s00266-021-02610-y · Cited by 8
Nonsurgical Treatment of Protruding Ears: A Case Report and Review of Literature
Smith, W. G., Toye, J., & Smith, R. (2003) · Plastic Surgery · doi:10.1177/229255030301100202 · Cited by 7
Ear Deformations in Preterm Newborns: Non-Surgical Treatment
Olshinka, A., Ad‐El, D., Yaacobi, D. S., & Ashkenazi, M. (2020) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000006784 · Cited by 7
“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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Temel, M., Şamil Kahraman, Ş., Berber, Ö., Çevik, C., & Akoğlu, E. (2016) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-016-3898-4 · Cited by 6
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Posterior Z-plasty and J-Y antihelixplasty for correction of Stahl's ear deformity
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Otoplasty: Surgical Correction of the Prominent Ear
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Cosmetic Otoplasty and Related Ear Surgery
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Neonatal ear splinting for congenital ear deformities✰
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Stahl Ear Deformity Associated with Finiay-Marks Syndrome
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Correction of Stahl Ear Deformity Using a Suture Technique
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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
Zou, Q., Zhao, S., Wang, D., Chen, P., Yang, L., Gao, M., Liu, Y., Zhao, C., Li, S., & Yang, J. (2022) · Laryngoscope Investigative Otolaryngology · doi:10.1002/lio2.987 · Cited by 2
“Tan et al.(3) corrected conchal deformities with coiled-up splint or shaped silicone mold.”
BackgroundPediatric Otoplasty and Auricular Molding
Vella, J. B. (2023) · Facial Plastic Surgery Clinics of North America · doi:10.1016/j.fsc.2023.07.006 · Cited by 3
Hyaluronic Acid Dermal Filler Promotes Cartilage Reshaping in Rabbit Ears
Gümüş, N., Acaban, M. B., & Demirbağ, H. O. (2022) · Aesthetic Plastic Surgery · doi:10.1007/s00266-022-02873-z · Cited by 3
“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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Manji, I., Durlacher, K. M., & Verchere, C. G. (2020) · Paediatrics & Child Health · doi:10.1093/pch/pxaa102 · Cited by 4
“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).”
BackgroundMethodvan Cruchten, C., Feijen, M., Lazaâr, S., Piatkowski, A., & van der Hulst, R. R. W. J. (2024) · Journal of Plastic, Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2024.03.002 · Cited by 3
Bilateral Anteverted Conchal Bowls: Surgical Correction of a Rare Anomaly
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“Traditionally, external ear anomalies have been classified into either malformations or deformations [3].”
InfluentialNonsurgical Creation of an Auriculocephalic Sulcus in Children With Congenital Auricular Deformities
Matsutani, H., Park, S., Ishikawa, Y., & Kamochi, H. (2023) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000009180 · Cited by 2
Update on congenital ear molding
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Objective evaluation of nonsurgical treatment of prominent ears: A systematic review
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Management of congenital deformities of the external and middle ear
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Aesthetic Alteration of Prominent Ears
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“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
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
Cugno, S., & Bulstrode, N. (2015) · Wiley eBooks · doi:10.1002/9781118655412.ch19 · Cited by 2
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“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.”
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Metadata
- 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 (clinical) › Congenital Ear and Nasal Anomalies
- Health Sciences › Medicine › Surgery › 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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