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

[BACKGROUND] 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.

[METHODS] 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.

[RESULTS] 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%).

[CONCLUSIONS] 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.