Nonsurgical Correction of Stahlʼs Deformity: An Inexpensive, Short-Term, Reproducible Method of Splinting

Sir: Stahl's ear is a congenital deformity characterized by a third crus that extends from the antihelix to the helix margin, running transversely across the scapha.1,2 This third crus results in unfurling of the helical rim.3 Currently, nonsurgical splinting in infancy is preferred over surgery; however, controversy exists regarding splinting materials used and the length of splinting needed for long-term correction. A variety of splinting materials have been described. Matsuo et al. describe using dental material and surgical tape and conclude that correction was achievable only if initiated within 3 days of birth.4 Tan et al. used soldering wire threaded into polyethylene tubing.5 Splints were applied between 1 day and 10 weeks of age. The mean duration of splinting was 9.1 weeks. We present our experience using an inexpensive and easy-to-use splinting method for correction of Stahl's ear in the neonate. All patients who had splinting for Stahl's deformity were reviewed. Approval for this study was granted by the University of Western Ontario (Health Sciences Research Ethics Board review no. 16483E), and informed consent was obtained from parents before study participation. The splinting method performed uses an 8-French red rubber catheter, Mastisol liquid adhesive (Ferndale Laboratories, Inc., Ferndale, Mich.), and Steri-Strips (3M, St. Paul, Minn.). The catheter is trimmed and positioned on the anterolateral aspect of the ear perpendicular to the abnormal third crus and adjacent to the helical rim. The helical rim is then folded over the catheter, flattening the third crus and recreating the superior crus of the antihelix. The catheter is secured using Mastisol and Steri-Strips. Splinting is initiated during the first week of life. First follow-up occurs 1 week after splint application. At this visit, splints are removed. After 10 minutes, if there is no evidence of recurrence, splinting is discontinued. If complete correction has not been achieved, the splint is reapplied for an additional week. Splints were applied to 22 neonates with 33 affected auricles. Splinting was initiated on day 2 (range, days 1 to 7). The average duration of splinting was 8 days (range, 5 to 14 days). Average follow-up was 14 months (Figs. 1 and 2).Fig. 1.: Image of the ear before molding shows classic Stahl's deformity with the characteristic abnormal third crus, running transversely across the scapha, resulting in unfurling of the helical rim.Fig. 2.: After molding, at long-term follow-up at 2 years, no residual abnormality of the auricle is seen.Thirty-two of 33 auricles achieved complete correction. One patient was judged to have improvement but incomplete correction after 14 days of splinting. Complete correction was maintained at over 1 year after splint removal, with no evidence of recurrence in any of the patients. No patients required resplinting for recurrence once correction was deemed to be successful. All parents reported satisfaction with the results and found the splint easy to maintain, and no complications were seen during the splinting period. Our splinting method is inexpensive and reproducible and uses materials that are found in any hospital without the need for a custom prefabricated splint. Splinting can start at the initial consultation in the neonatal period and is required for only a short duration. Application of the splint within the first 7 days of life for an average of 7 to 8 days resulted in complete elimination of Stahl's deformity in 97 percent of patients. Fourteen-month follow-up confirmed maintenance of the correction. DISCLOSURE Dr. Matic receives fellowship support from Synthes Canada. Dr. Boyd received a fellowship bursary from Mentor. Neither of the authors has any commercial associations or financial disclosures associated with this publication. Damir B. Matic, M.Sc., M.D. Kirsty U. Boyd, M.D. Division of Pediatric Surgery London Health Science Centre, and University of Western Ontario London, Ontario, Canada

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