Pulling Strings: Otoplasty Complicated by Wound Dehiscence in the Setting of Prolonged Mask Wearing

Abstract

Summary: Improved understanding of the psychosocial effects of prominent ears has led to increased intervention in early school-aged children. Cartilage-sparing otoplasty procedures are commonly used in this population, given the effectiveness of sutures in remodeling the pliable pediatric ear. In addition to their efficacy, another advantage of these techniques is their low overall complication rates, with complications beyond 3 months being particularly uncommon. We present the clinical case of a 5-year-old female patient who experienced wound dehiscence 9 months after her cartilage-sparing otoplasty. Before experiencing her atypical complication, she had been wearing an ear-looped mask daily to comply with guidelines developed to reduce the transmission of SARS-CoV-2 in schools. The use of masks would previously not have been a concern in this age group, but given the longevity of the COVID-19 pandemic and the importance of masking as a public health tool, this needs to be a consideration for otoplasty patients going forward. Pressure and friction on an immature surgical scar impede healing and expose the patient to increased risk of complications. Therefore, we discuss options for decreasing exposure to COVID-19 and complying with local face-covering policies while avoiding the direct contact associated with traditional ear-looped masks. Additionally, we explore the role permanent suture material may have played in predisposing our patient to mask-related irritation.