An algorithm was developed through an evolution of refinements in surgical technique with the goal to minimize risk and morbidity in otoplasty. Key principles were avoidance of cartilage incisions and transections and the use of multiple surgical techniques to distribute the "surgical load" evenly among these techniques. The present retrospective study was designed to test safety and efficacy of the concept in 100 consecutive patients and to discuss the results in light of the literature. Data detailing the surgery, preoperative, and postoperative period were extracted from the record and during patient interviews. Patients were contacted to complete a questionnaire to rate the postoperative pain and their satisfaction with the final outcome on a 6-point visual analog scale (VAS). An expert and a lay panel assessed preoperative and postoperative frontal-view photographs, using the same VAS. Pain in the postoperative was rated as minor (pain level VAS average score, 2.33) and patients' satisfaction was excellent (satisfaction level VAS average score, 1.82). The assessment by the panels of expert and lay evaluators paralleled these outcomes with a postoperative average VAS score of 1.69 and 1.87, respectively. Cartilage incision and transection can be effectively avoided in otoplasty. Even distribution of the surgical load among multiple techniques avoids the problems associated with "overload" of a single technique. The innovative technique of cortical mastoid drill-out is described. High satisfaction with the results, excellent patient comfort, and a favorable safety profile are associated with the present algorithm.
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