A Novel Approach to Upper Pole Correction in Otoplasty: Addressing the Surprisingly Neglected Inferior Crus.

Abstract

Correction of prominent upper pole of ear is challenging, with high recurrence rates. Conventional otoplasty often fails to address the inferior crus, a key anatomical determinant of prominence. This study introduces a surgical technique targeting the inferior crus, a novel Inferior Crus Morphological Grading System (ICMGS) for diagnosis, and a new "upper pole declination angle" for objective assessment. In this retrospective comparative study, 120 ears treated with a new technique were compared to 120 ears in a historical control group (traditional method). The new technique combines superior auricular muscle release, multi-loop inferior crus suturing, conchal reduction, and cartilage graft reinforcement. Outcomes were assessed via objective photogrammetry (including the upper pole declination angle) and blinded subjective scoring. The new technique demonstrated statistically superior results, with significantly greater reductions in upper pole declination angle, L1, and L2 distances (p<0.001). Blinded aesthetic scores were also significantly higher (p<0.001). The technique's efficacy correlated directly with the preoperative ICMGS grade (p<0.001). The revision rate was lower in the new technique group (3.3% vs. 8.3%). Anatomical correction of the inferior crus is a critical and effective strategy for prominent upper pole. The proposed technique, along with the ICMGS and upper pole declination angle, provides a reliable and durable solution with superior objective and subjective outcomes and a lower revision rate compared to traditional methods.