Comparative Analysis of Mustardé, Fascioperichondrial Flap, and Combined Otoplasty Techniques: Clinical Outcomes and Recurrence Rates in 365 Patients.

[BACKGROUND/OBJECTIVES] Prominent ear deformity is one of the most common congenital anomalies and may lead to substantial aesthetic and psychosocial distress, particularly in children and young adults. This study evaluated the clinical outcomes of three frequently used otoplasty techniques, Mustardé sutures, fascioperichondrial flap, and their combination, concerning recurrence rates, complications, and patient satisfaction.

[METHODS] This retrospective analysis included data from 365 patients who underwent otoplasty between 2017 and 2023 at a single institution, with all procedures performed by the same surgeon. Patients were categorized into three groups based on the surgical technique employed: Mustardé ( = 71), fascioperichondrial flap ( = 232), and a combined technique ( = 62). The primary outcome was the recurrence rate, while secondary outcomes included the type of suture material, complication rates, and aesthetic satisfaction.

[RESULTS] The lowest recurrence rate was observed in the fascioperichondrial flap group (6.5%), followed by the combined group (8.5%) and the Mustardé group (29.6%). Logistic regression analysis revealed that the flap technique was associated with a 3.79-fold reduction in recurrence risk compared with the Mustardé method ( = 0.033). Overall complication rates were low across all groups. Hematoma occurred only in the flap group (1.3%), while suture extrusion and granuloma formation were exclusive to the Mustardé group. The highest aesthetic satisfaction was reported in the combined technique group.

[CONCLUSION] The fascioperichondrial flap method demonstrated statistically superior outcomes in minimizing recurrence and complications in prominent ear surgery. While the Mustardé technique demands careful patient selection due to its higher recurrence risk, the combined approach appears particularly beneficial for complex auricular deformities. The robust sample size and surgical standardization in this study provide valuable insights for surgical decision making in otoplasty. To our knowledge, this is one of the largest single-surgeon case series evaluating recurrence and complication outcomes in otoplasty.