Surgical correction of prominent ears: association of the Furnas and Mustardé techniques
Correção cirúrgica de orelhas em abano: associação das técnicas de Furnas e Mustardè

1) Deletion or absence of antihelix, with scapholunate-conchal angle of > 90 º;

2) Excessively deep or hyperdeveloped shell with increased cephalo-auricular angle of > 40 º;

3) Combination of the deformities of item 1 and 2, the most common finding;

4) Protrusion of the earlobe.

1) Resect an ellipse of skin in post-auricular region where the final scar should be hidden in the retroauricular sulcus.

2) Create an antihelix, with rounded contours, avoiding borders with sharp edges.

3) Avoid overcorrection of the antihelix which causes effacement of the helix.

4) Reduction of conchal hypertrophy in selected cases, when indicated.

5) Control the position of the earlobe, which often remains anterior when the ear is positioned posteriorly.

6) Attachment of the concha to the fascia of the mastoid when required.

Figure 1. Demarcation of the antihelix.


Figure 2. Cartilage Weakening.


Figure 3. Demarcation of the area of the concha being resected.


Figure 4. Stitches joining the concha and mastoid.


Figure 5. Final Appearance.

1. With the patient in the supine position, after previous demarcation of the zone of skin to be resected, and with the posterior auricular sulcus as reference, antisepsis of the whole face of the ears and neck was carried out. This allowed visualisation of the whole face in relation to the ears. Prophylactic antibiotics were not used due to lack of data supporting its use for this type of procedure.

2. Local anesthesia with 0.5% lidocaine and epinephrine in a proportion of 1: 100,000. First, the greater auricular nerve was blocked, followed by subdermal infiltration of the entire ellipse that was to be resected, covering the entire posterior surface of the ear, to facilitate resection of the skin and release the antihelix, as well as to reduce the risk of inadvertent cartilage injury. Subsequently, blocking of the auriculotemporal nerve and subdermal infiltration of the concha was carried out to facilitate its resection when removal was required.

3. Resection of the zone of skin, release of the concha and subsequent antihelix exposure. The auricular muscle was sectioned routinely to view the concha more clearly.

4. Marking with dye, using 25 x 7 mm needles, for further demarcation of the new anti-helix (Figure 1).

5. Scoring and weakening of the posterior region of the cartilage was performed for better modelling and preparation of stitches in the antihelix (Figure 2).

6. Making the stitches with 4-0 nylon in the form of a "U" (usually 03 stitches), as recommended by Mustardè, to construct the new antihelix.

7. Economic resection of the concha in cases of severe hypertrophy, where the resection would deform and obstruct the auditory canal ("kidney"-shaped resection) (Figure 3).

8. Fixation and rotation of concha with 4-0 nylon sutures (three stitches) between the concha and the periosteum of the mastoid as recommended by Furnas (Figure 4).

9. Closure of skin with continuous intradermal suture with 4-0 nylon suture. Appearance at the end of surgery (Figure 5).

10. Dressing with cotton soaked with saline in the projections and recesses of the helix and antihelix.

Figure 6. (A and B) Pre-operative female patient, 24 years-old. (C and D) Post-operative female patient, 24 years-old.


Figure 7. (A and B) Pre-operative male patient, 30 years-old. (C and D) Post-operative male patient, 30 years-old.

A) Incorrect placement or insufficient number of sutures. Mustardé5 reports that four is the minimum number of sutures between the concha and the scapha, and at least two sutures between the concha and the mastoid.

B) Excessive removal of skin on the posterior surface of the ear, leaving the skin suture taut, with a greater chance of recurrence of ear protrusion to relieve the tension.

C) Local postoperative trauma.

D) "Memory" of the cartilage, which tends to return to its original position.