Reverse (Convex) Conchal Bowl: Report of Eight Cases and Its Correction by Modified Conchoplasty Technique

Abstract

Many different congenital malformations of the external ear are encountered in otology and plastic surgery practice. However, there has been only one report in the literature of reverse (convex) conchal deformity in otherwise normal ears. Eight such cases were encountered in the combined otology and plastic surgery practice at the authors’ institution. The condition was bilateral in two patients and unilateral in six patients; these patients had no other otological abnormalities. Two patients sought surgical correction. Modified conchoplasty, done by excising and replacing the conchal cartilage in reverse fashion, is presented. Controversies surrounding the embryogenesis of concha are also addressed.

Bilateral Anteverted Conchal Bowls: Surgical Correction of a Rare Anomaly

“…Auricular deformities are common with 30% of neonates having some degree of auricular anomaly [ 7 ]. In a majority of cases, the helix or antihelix is affected [ 3 ], and isolated conchal bowl deformity is rare with only a handful of published reports in the literature [ 1 - 3 , 8 ]. Management among the reported studies varied according to the patient’s age at presentation.…”

“…Management among the reported studies varied according to the patient’s age at presentation. A conservative approach was favoured in younger patients versus surgical correction in older patients [ 1 - 3 , 8 ].…”

“…For older patients seeking correction of anteverted conchal bowls, for instance, due to functional problems or concerns regarding cosmesis, surgery should be considered. A review of the literature identified seven patients who were managed surgically, with ages ranging from three to thirty-three years [ 1 , 2 , 8 , 10 , 11 ]. Various operative techniques have been described.…”

“…Various operative techniques have been described. Some studies reported good results with simple excision of the conchal cartilage [ 1 , 10 ], whereas others would then replace it in a reverse fashion as an autologous graft, thereby reversing the convexity [ 8 , 11 ]. Alternative methods include scoring the inverted cartilage via a posterior approach, reversion, and suturing to the mastoid periosteum to secure [ 2 ].…”

“…Alternative methods include scoring the inverted cartilage via a posterior approach, reversion, and suturing to the mastoid periosteum to secure [ 2 ]. All studies reported good results with these various methods [ 1 , 2 , 8 , 10 , 11 ]. In our patient, a unique method of incising the cartilage was utilised.…”