Oto-Facial Plastic Surgery

 

698. Oto-Facial Plastic Surgery
Oto-facial plastic surgery is not just about correcting the ears—it’s a comprehensive facial surgery concept that considers the harmony of the midfacial side profile and overall facial proportions.

The ears significantly influence the side view of the face. While they’re barely seen from the front, they complete the facial image when viewed at a 45-degree angle. Folded ears may appear youthful but can lack maturity. Protruding ears make the face look inward or narrower from the side. The ears’ size, position, and angle are closely linked not only with the eyes, nose, and mouth, but also with the skull contour and jawline.

Uneven ear height can make wearing glasses or sunglasses difficult. Ear asymmetry can further highlight facial asymmetry. In flat-head syndrome (plagiocephaly), one ear may be more forward and the other more backward, exaggerating imbalance.

The ears are closely related to the jaw. Smaller ears often accompany smaller jaws because both originate from the first pharyngeal arch during embryonic development. That’s why people with microtia often also have a recessed chin.

For example:

• Treacher-Collins syndrome features bilateral microtia, receding chin, and underdeveloped cheekbones.

• Goldenhar syndrome shows unilateral microtia with one-sided chin deficiency and facial asymmetry.

• Nager syndrome presents with microtia, chin and cheekbone deficiencies, and limb deformities.

• CHARGE syndrome can involve microtia with mandibular hypoplasia, heart defects, coloboma, choanal atresia, and genital abnormalities.

Underdeveloped ears often correlate with smaller temporomandibular joints (TMJ), which play a vital role in chewing. If TMJs are small or dysfunctional, chewing becomes inefficient—affecting digestion and energy intake.

Thus, oto-facial surgery may include:

• Chin advancement surgery for recessed chins,

• Orthognathic surgery for facial asymmetry,

• Ear reconstruction with rib cartilage for microtia,

• and fat grafting for facial volume enhancement.

In summary, smaller or painful ears tend to be associated with smaller jaws and more convex facial profiles, while larger, healthy ears are often linked with larger jaws and concave profiles. Ear development directly affects facial volume and shape, forming one of the two structural axes of the side profile along with the jaw.

[Oto-facial surgery is about correcting ear-related and side-profile facial issues together.]
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