(0535) Unilateral Reductive Otoplasty in an Adult for Congenital Macrotia Complicated by Arteriovenous Malformation

Introduction: We present a case of unilateral reductive otoplasty for congenital unilateral macrotia complicated by arteriovenous malformation in a 28 year old male.

Methods: The patient reports being born with a much larger left ear than right, but also had trauma three years ago which led to chronic left ear pain to palpation. His right ear has normal size, landmarks, and projection. His left pinna was 30% larger in the craniocaudal dimension, hyperemic, pulsatile on cranial and lateral surfaces, and marked by thickened cartilage. Polychondritis, lymphovascular malformation, pseudoaneurysm, and cauliflower ear were all considered throughout work up. Autoimmune workup was negative, there was no bruit or thrill, and no discreet mass along the enlarged pulsatile vessels.

Reductive otoplasty was planned with main goal of conchal setback and craniocaudal reduction for better symmetry. Three enlarged visually apparent and palpable arteries intersected our planned postauricular incision and their course was marked. The three enlarged vessels arborized into smaller vessels and sinusoids but bleeding was easily controlled with ligation, cautery, and pressure. After ligation, the ear’s color appeared more normal. Conchal setback was accomplished with elliptical excision of excess conchal cartilage and craniocaudal reduction was accomplished with full thickness wedge resection. The encountered cartilage was thickened but not deformed or fibrotic.

Results: Although a cotton mold was used as a postoperative dressing, a small hematoma formed in concha cavum which was drained on postoperative day one. A bolster with dental roll and xeroform was placed for one week. Our approach with postauricular incision, ligation of prominent arteries, conchal cartilage excision and re-approximation for setback, and craniocaudal reduction with full thickness wedge resection led to excellent aesthetic results.

Conclusions: We describe the combination of maneuvers that led to successful otoplasty in an uncommon presentation of unilateral macrotia with arteriovenous malformation.