[Our experience of otoplasty based on the study of the cartilaginous frame, especially the tail of the helix (about 244 cases and 22 anatomical dissections)].
Twenty-two anatomical dissections revealed interesting characteristics of the tail of the helix: first, this cartilage shows a ninety degrees' rotation so that its distal extremity finishes sagittally, setting the lobule location. Secondly it revealed the presence of a medial root going upwards under the anthehelical fold. Deformity of this root can impede the natural curling of the cartilage. These observations emphasize that the tail of helix is the key to otoplasty. The first surgical step consists in resecting the hypertrophic part of the helix tail, allowing its retroposition on the concha. A single Ethibond 4-0 suture is required to fix it in good position. This should correct the lobule protrusion and also nicely initiate the anthehelical fold. However, this anthehelical fold and its superior crus are to be completed by cartilage anterior scoring, carried upward and downward from a separate incision located on the anterior skin, at the top of the future superior crus of anthelix. The last step is a correction of the abnormal conchomastoid angle by resection of the redundant soft tissue and muscles. A single non-resorbable suture is also necessary to fix the concha to the mastoid tissue. Results of 244 otoplasties reported here show that it is a safe procedure associated with a high satisfaction score and a very low complication rate.