Psychosocial Outcome of Patients After Ear Reconstruction: A Retrospective Study of 62 Patients

This was a retrospective study examining the psychosocial morbidity of patients before and after ear reconstruction. Semistructured questionnaires were sent to 90 patents with significant congenital or acquired auricular deformity 2.2 years (range 3 months to 5 years) following autogenous or osteointegrated reconstruction. Sixty-two patients (69%) responded. Twenty-two of the patients below 12 years, who had undergone reconstructive surgery, also completed the Childhood Experience Questionnaire. These were compared with a cohort of 362 normal patients. There was significant psychosocial morbidity in both children and adults with auricular deformity. Seventy-one percent of patients reported reduced self-confidence that affected both social life and leisure activity. Teasing was a prominent symptom in both children (88%) and adults (85%) but was a motivational factor for surgery in children only. Dissatisfaction with the appearance (73.1%), on the other hand, was the main reason for treatment in adults. Following ear reconstruction, 74% of adults and 91% of children reported an improvement in self-confidence resulting in enhanced social life and leisure activities in both adults and children. There was no difference between osteointegrated and autogenous reconstruction. Sixty percent of patients reported their result as excellent. The patients scored their result better than the surgeon. We conclude that auricular reconstruction has significant psychosocial benefit in the majority of children and adults despite donor-site morbidity and a range of technical result.

[1]  S. Kristovich,et al.  Self-Perception, Social Skills, Adjustment, and Inhibition in Young Adolescents with Craniofacial Anomalies , 1992 .

[2]  R. Lerner,et al.  Effects of Age, Sex, and Physical Attractiveness on Child-Peer Relations, Academic Performance, and Elementary School Adjustment. , 1977 .

[3]  William Sack,et al.  Developing Minds: Challenge and Continuity across the Life Span , 1995 .

[4]  B Brent,et al.  Auricular Repair with Autogenous Rib Cartilage Grafts: Two Decades of Experience with 600 Cases , 1992, Plastic and reconstructive surgery.

[5]  K. Kapp-Simon,et al.  Psychological issues in craniofacial care: state of the art. , 1999, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[6]  T. Wadden,et al.  The psychology of cosmetic surgery: a review and reconceptualization. , 1998, Clinical psychology review.

[7]  F. C. Macgregor Ear deformities: social and psychological implications. , 1978, Clinics in plastic surgery.

[8]  E. Goodell,et al.  Psychological functioning of children with craniofacial anomalies and their mothers: follow-up from late infancy to school entry. , 1993, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[9]  E. Bradbury,et al.  Psychological and social outcome of prominent ear correction in children. , 1992, British journal of plastic surgery.

[10]  S. Dornbusch,et al.  Cultural uniformity in reaction to physical disabilities. , 1961 .

[11]  D. Harris,et al.  The symptomatology of abnormal appearance: an anecdotal survey. , 1982, British journal of plastic surgery.

[12]  A. Dabbs The social psychology of facial appearance , 1989 .

[13]  I. Munro,et al.  Fact and fantasy: psychosocial consequences of facial surgery in 24 Down syndrome children. , 1986, British journal of plastic surgery.

[14]  T. Wadden,et al.  Body image concerns of reconstructive surgery patients: an underrecognized problem. , 1998, Annals of plastic surgery.

[15]  Dennis J. Simon,et al.  Self-perception, social skills, adjustment, and inhibition in young adolescents with craniofacial anomalies. , 1992, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[16]  E. Bradbury,et al.  The psychology of aesthetic plastic surgery , 2004, Aesthetic Plastic Surgery.

[17]  K. Phillips,et al.  A Review of Psychosocial Outcomes for Patients Seeking Cosmetic Surgery , 2004, Plastic and reconstructive surgery.

[18]  N. Horlock,et al.  5‐Year Series of Constricted (Lop and Cup) Ear Corrections: Development of the Mastoid Hitch as an Adjunctive Technique , 1998, Plastic and reconstructive surgery.

[19]  H. Koot,et al.  Body image, psychosocial functioning, and personality: how different are adolescents and young adults applying for plastic surgery? , 2001, Journal of child psychology and psychiatry, and allied disciplines.

[20]  E. Berscheid,et al.  Physical Attractiveness and Peer Perception Among Children , 1974 .

[21]  T. Wadden,et al.  Psychological investigations in cosmetic surgery: a look back and a look ahead. , 1998, Plastic and reconstructive surgery.

[22]  B Brent,et al.  The Correction of Microtia with Autogenous Cartilage Grafts: I. The Classic Deformity , 1980, Plastic and reconstructive surgery.

[23]  K. A. Hildebrandt The Role of Physical Appearance in Infant and Child Development , 1982 .

[24]  L. Whitaker,et al.  Social and psychological effects of craniofacial deformity and surgical reconstruction. , 1982, Clinics in plastic surgery.

[25]  J. A. Ellis Tissue expansion as an adjunct to reconstruction of congenital and acquired auricular deformities , 1998 .

[26]  R. Strauss,et al.  Self-concept of early primary school age children with visible or invisible defects. , 1989, The Cleft palate journal.

[27]  R. Lansdown,et al.  Facial deformity in childhood: severity and psychological adjustment. , 1991, Child: care, health and development.

[28]  C. Hervé,et al.  Depression, anxiety and quality of life: outcome 9 months after facial cosmetic surgery. , 2003, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[29]  S. Nagata,et al.  A New Method of Total Reconstruction of the Auricle for Microtia , 1993, Plastic and reconstructive surgery.

[30]  B. Brent,et al.  The Correction of Microtia with Autogenous Cartilage Grafts , 1980 .

[31]  K. V. Cook,et al.  The psychosocial adjustment of pediatric craniofacial patients after surgery. , 1989, The Cleft palate journal.

[32]  T. Wadden,et al.  An Investigation of Changes in Body Image following Cosmetic Surgery , 2002, Plastic and reconstructive surgery.