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 -90 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.