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Folded-over rim deformity

David Gault
Admin 0 months ago

Ear Rim Problems

The folded-over rim deformity is a relatively common ear deformity in which the cartilage of the upper part of the helical rim seems "over-folded" and sometimes almost pinched at the fold line or indented.  The outer border of the rim often has a round outline, but the inner rim of the helix may appear notched.  Another common complaint is that the ear looks pointed from some viewpoints.  

The fold-over rim usually responds to Early Ear Correction with EarBuddies in babies, allowing a permanent solution without surgery.  After the age of between one two years, the cartilage becomes too hard to reshape, and the correction can only be undertaken by means of surgery.

The underlying problem is that the helix (the rim of the ear) is adherent to the scapha (the main part of the top of the ear, just under the rim), and there is no helical sulcus (the groove under the rim of the ear). When looking at the helix in profile, the normal curved roll is not seen because the helix bends over sharply. The deformity usually involves the upper pole of the ear and can shorten the vertical height of the ear. The condition can range in severity from a mild deformity to what has been termed a satyr ear. Embryologically, a defect in hillock 4 may cause this deformity. 

Surgery can be undertaken under local or general anaesthesia, each ear taking approximately 45 minutes to one hour to correct.  Using an incision which is hidden as much as possible, the deformed section is freed from its skin envelope and from its position stuck to underlying cartilage, removed completely, replaced and secured in a more normal position.  The skin envelope is then sewn back in place.

In one-sided problems, the normal ear is used as a template, and the position of the transposed (moved) cartilage is adjusted to match the vertical height of the normal side. A small EarBuddies splint is used to support the moved section to maintain the proper arched curve to the rim until sutures (stitches) are removed one week later.  It is recommended that protective bandages are worn for one week following the procedure.

 

Fees

Fees for surgery below assuming that the problem can be tackled using local (ear) cartilage only and that cartilage grafts from the ribs are not required.  Fees to correct surgery undertaken at another centre which has not met expectation may be higher and can only be estimated when Mr Gault has seen and examined the problem at consultation.  Some rim deformities are best corrected using rib cartilage, in which case fees are significantly higher.

 

Example Fees for surgery - one side only

 Mr Gault's fee for the surgery starts from £2625 including one follow-up.  If you have a general anaesthetic, then there is an additional fee of £395 for the anaesthetist.  If you have a local anaesthetic, then there is an additional fee of £295. The hospital’s fee depends on which one you choose, but in every case a local anaesthetic procedure is cheaper than a general anaesthetic one, and an out-patient procedure (Walk-in, walk-out WIWO) is cheaper than a day case stay. You would need to stay in hospital as a day case (DC) if you chose to have a general anaesthetic, but it would be unusual to require a night’s stay in hospital.  The Clementine Churchill Hospital’s fee for an LA WIWO is £550 approximately.

For an LA, you add together the surgical, anaesthetic and hospital fees; for example, the cheapest is at the Clementine Churchill: £2625 + £295 + £550 approximately.

For a GA, you add together the surgical, anaesthetic and hospital fees; for example, the cheapest is at the Wellington Hospital: £2625 + £395 + £2362 approximately (hospital fees increase by approximately 10-15% per year).

Hospital fees do not include painkillers to take home, but you would be much better advised to buy these over-the-counter because Paracetamol from the hospital is extremely expensive.

 

Example Fees for surgery - both sides

Mr Gault's fee for the surgery starts from £4880 including one follow-up.  If you have a general anaesthetic, then there is an additional fee of £475 for the anaesthetist.  If you have a local anaesthetic, then there is an additional fee of £375. The hospital’s fee depends on which one you choose, but in every case a local anaesthetic procedure is cheaper than a general anaesthetic one, and an out-patient procedure (Walk-in, walk-out WIWO) is cheaper than a day case stay. You would need to stay in hospital as a day case (DC) if you chose to have a general anaesthetic, but it would be unusual to require a night’s stay in hospital.  The Clementine Churchill Hospital’s fee for an LA WIWO is £676 approximately.

For an LA, you add together the surgical, anaesthetic and hospital fees; for example, the cheapest is at the Clementine Churchill: £4880 + £375 + £676 approximately.

For a GA, you add together the surgical, anaesthetic and hospital fees; for example, the cheapest is at the Wellington Hospital: £4880 + £475 + £2362 approximately (hospital fees increase by approximately 10-15% per year).

Hospital fees do not include painkillers to take home, but you would be much better advised to buy these over-the-counter because Paracetamol from the hospital is extremely expensive.

 

 

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