News Release

With 'paper clip technique,' some infant ear deformities can be corrected without surgery

Peer-Reviewed Publication

Wolters Kluwer Health

March 2, 2023Certain types of ear malformations in infants can be treated by a simple and inexpensive technique – using paper clips to build custom splints to mold the shape of the growing ear, reports a study in The Journal of Craniofacial Surgery. The journal, under the guidance of Editor-in-Chief Mutaz B. Habal, MD, is published in the Lippincott portfolio by Wolters Kluwer.

Hitomi Matsutani, MD, and colleagues of The University of Tokyo report good results with their nonsurgical approach to correcting congenital ear deformities in infants. Their experience shows the best chances of success with treatment before age 6 months of age.

Simple technique avoids surgery for some mild ear deformities

Between 2010 and 2019, Dr. Matsutani and colleagues carried out their paper clip technique for nonsurgical correction in 80 ears of 63 patients, average age four months. Treated infants had relatively mild deformities: either cryptotia, a condition in which the upper ear cartilage is partially buried under the skin; or constricted ear (sometimes called cup ear or lop ear), in which the upper part of the ear is folded over.

The plastic surgeons created customized splints from paper clips, bent into the shape needed to guide the growth of the ear cartilage. After this metal frame was placed and padded with cotton to protect the skin, thermoplastic resin was packed around it, providing a mold to guide further growth of the ear. The splint was worn at all times except bath time.

In addition to improving the appearance of the ears, the technique focused on formation of the space between the upper ear and the side of the head, or "auriculocephalic sulcus" – an important structure for several purposes, including wearing eyeglasses and facemasks.

At several weeks' follow-up, the paper clip technique was highly successful in correcting congenital ear malformations. Independent ratings for before-and-after photographs by experienced plastic surgeons suggested excellent results in 36.5% of ears and satisfactory results in 73.0%.

Best results with treatment before six months of age

In most ears that were successfully treated with the paper-clip technique, an adequate auriculocephalic sulcus was created without the need for surgery. The technique was less effective in infants with certain types of more severe deformities, including those with an insufficient amount of skin over the ear.

While ear-molding is not a new approach to correction of ear malformations, the new technique provides a simple, customizable, inexpensive alternative. The authors note that the necessary materials – paper clips and thermoplastic resin – are readily obtained at a cost of less than two dollars. The article includes illustrations demonstrating the creation of the ear-molding splint and giving examples of the results achieved.

"Early initiation of ear-molding treatment is recommended, preferably before six months of age," the researchers emphasize. That's due not only to the malleability of the growing ear cartilage during infancy, but also because older infants are likely to pull the splint out – the most common for technique failure, in the authors' experience.

Because of the importance of early treatment, Dr. Matsutani and colleagues believe that pediatricians should check for congenital ear malformations as part of the routine one-month checkup. In any case, the researchers believe that treatment for ear deformities is best completed before children start school. They add, "When nonsurgical correction of deformity is unsuccessful, surgical treatment would still be possible before five years of age."

Read [Nonsurgical Creation of an Auriculocephalic Sulcus in Children With Congenital Auricular Deformities]

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About The Journal of Craniofacial Surgery

The Journal of Craniofacial Surgery serves as a forum of communication for all those involved in craniofacial and maxillofacial surgery. Coverage ranges from practical aspects of craniofacial surgery to the basic science that underlies surgical practice. Affiliates include 14 major specialty societies around the world, including the American Association of Pediatric Plastic Surgeons, the American Academy of Pediatrics Section of Pediatric Plastic Surgery, the American Society of Craniofacial Surgeons, the American Society of Maxillofacial Surgeons, the Argentine Society of Plastic Surgery Section of Pediatric Plastic Surgery, the Asian Pacific Craniofacial Association, the Association of Military Plastic Surgeons of the U.S., the Brazilian Society of Craniofacial Surgeons, the European Society of Craniofacial Surgery, the International Society of Craniofacial Surgery, the Japanese Society of Craniofacial Surgery, the Korean Society of Craniofacial Surgery, the Thai Cleft and Craniofacial Association, and the World Craniofacial Foundation.

About Wolters Kluwer

Wolters Kluwer (WKL) is a global leader in professional information, software solutions, and services for the healthcare; tax and accounting; governance, risk and compliance; and legal and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services.

Wolters Kluwer reported 2021 annual revenues of €4.8 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 20,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

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