Titanium Mesh for Correction of Stahl's Ear Deformity

Abstract Background: Stahl's bar is a rare auricular malformation that can bring social stigma to the patient. Stahl's deformity is congenital anomaly, characterized by an accessory third crus in the ear cartilage, giving rise to an irregular helical rim and paradoxically bent scaphoid fossa along its two axes [1]. Correction of such ear deformity can be a challenging task for the surgeons. There are no standard techniques for correcting this deformity [2]. Several different techniques are described in literature which yield unpredictable results. The conventional techniques of correcting this deformity include either excision of the cartilage, repositioning of the cartilage, or scoring techniques, also correction using internal sutures [3]. We studied a new technique for correction of this deformity using titanium mesh. The technical details of the surgery are described along with a review of literature on correcting similar anomalies. Aim of Study: Our aim is to evaluate and discuss the efficacy and safety of using titanium mesh to correct Stahl's ear deformity. Subjects and Methods: A prospective randomized study conducted from June 2017 to March 2019. In all, 7 patients having the Stahl's bar deformity, two bilateral and five unilat-eral (9 ears) included. All patients have been presented and managed at the Department of Otolaryngology, Hearing and Speech Institute. Patients have been managed surgically to correct the deformity. Surgery was by implanting a piece of titanium mesh which has been shaped and tailored to reverse the paradoxically bent scaphoid fossa. The titanium mesh with its new curve was put inside a small sub-perichondrial pocket along the long axis of the deformed bar. Regular follow-up visits were done every month for at least 6 months. Results: The operative time ranged from, 45 to 70 minutes with a mean of 62 minutes. Surgery was easy straight forward, Blood loss was minimal. As regards the final outcome, the affected auricles regained its normal appearance with fine scaphoid fossa and helical rim intraoperatively. The ears that were operated were of normal size and shape. All patients and their families were satisfied with the final result. There were no complications.
Summary: Correction of Stahl's bar deformity can be accomplished easily and safely by implanting a pre shaped titanium mesh forcing the abnormally curved cartilage to regain its normal curvature.