The ideal auricular protrusion – An interactive perceptual pilot study

Purpose: Excessive ear protrusion (prominauris) can negatively affect facial appearance. Because the concept of an ideal auriculocephalic angle is controversial, however, it is difficult to define when an obtrusive auricle requires surgical intervention. It is often assumed that angles exceeding 30 degrees require corrective surgery. However, little is known about public perception of ear protrusion. This study aimed to assess perceptions of different degrees of auricular protrusion. Materials and methods: We conducted an interactive panel survey. Male and female evaluators assessed digitally processed cloned images of a male and female model that depicted various ear protrusions ranging from 0 degrees to 90 degrees. Predictor variables were the sex of the evaluator, the sex of the clone and the extent of auricular protrusion. The outcome variable was the overall attractiveness of auricular appearance. Results: Forty-four evaluators (students of dental medicine, mean age 25.43 years) participated in the study: 22 women and 22 men. The study results revealed sexual dimorphism, with the attractiveness of corresponding male and female clones rated differently. Male evaluators favoured female ear positions that fitted closer to the head; preferred alignments for female clones were: 18 degrees (Mean) +/- 9.38 degrees (SD), p = 0.006; for male clones: 30 degrees +/- 7.94 degrees, p = 0.003. Ear protrusion starts to negatively affect aesthetic appearance for male evaluators at positions of 42 degrees +/- 4.87 degrees (female clone) and 54 degrees +/- 8.22 degrees (male clone), p = 0.001. The panel of evaluators agreed to perceive angles of 21-24 degrees +/- 8.10 degrees (female clones), +/- 8.33 degrees (male clones), as the ideal degree of protrusion in both sexes (p = 0.158). Conclusion: In this study, perception of ear appearance depended on the sex of both the evaluator and the clone being assessed. Obtrusive ears were more readily accepted in male faces than in female ones. Nevertheless, the overall panel perception shows a preference for rather close fitting, unobtrusive ear alignments. For planning of corrective ear surgery, a target angle of approximately 22 degrees can be considered as a desirable result. (C) 2020 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.