Ear Reconstruction

Microtia occurs once in about every 7,000 to 8,000 births in the general population. It occurs more often in right ears and males, especially in unilateral microtia. The occurrence in general is more often in Hispanics and Asians than blacks and whites. The cause of microtia is multifactorial. Fewer than 15% of the cases have a positive family history.
 

And it is fairly common for microtia to be associated with other congenital abnormalities. Among associated malformations, facial cleft and cardiac defects are the most common followed by anophthalmia or microphthalmia, limb reduction defects, severe renal malformation and holoprosencephaly.
 

And it has long been felt that microtia represents the mild end of the spectrum of hemifacial microsomia, with Goldenhar syndrome being the severe end of the spectrum.
 

There are many classification systems for microtia. One widely adopted system assigns a grade from I to III based on the severity of the deformity. Grade I represents a pinna with all anatomic subunits present but misshapened. Grade II represents a pinna with some recognizable subunits but is rudimentary and malformed. Grade III includes the classic "peanut" ear, which is severely deformed with an inferior fibroadipose lobule and a nubbin of cartilage in the superior remnant.
 

Reconstruction

The age of reconstruction is generally started at 5-6 yrs of age. This is the age when the majority of ear growth has occurred and when the child starts school, two important milestones. There are two common methods used today for ear reconstruction. The first method and gold standard is the autologous method where a rib graft is used top make an ear. This method requires 4 stages to complete. I preferred this technique for over 10 years, but now I prefer use of the second method which uses an artificial material called medpore to serve as the cartilage framework or a patients rib cartilage and it is covered by a thin flap of tissue called the temporoparietal fascial flap and a skin graft. This method is generally a 1 stage technique unless an ear canal is required which requires a second stage.

 

Doctor's Note

"If you are considering reconstruction, it is my view that you have been through enough already. You don’t need the added difficulty of a doctor who is less than compassionate about your ordeal. I hope that you will find my entire staff to be fully understanding of your challenge and responsive to your concerns. Remember, I am here for you. I try to model my patient relationships around a mutual relationship of trust and confidence. If you have concerns or anxieties about any part of the process, I want to hear about it!"
 

MICROTIA AND CONGENITAL AURAL ATRESIA: CLINICAL REVIEW AND GUIDANCE FOR PRIMARY HEALTH CARE PROVIDERS -
January 2010 Courtesy of KMA

Courtesy of KMA

"Microtia (pronounced mī-krō’shē-ə) is a rare birth defect involving the abnormal development of the outer ear with the end result being a malformed auricle..."