Microtia Management

Options

• Surgery

• No surgery

• Ear prosthetic

• Ear Impant

Goals of auricular reconstruction

• A satisfied patient

• Proper positioning

• Pleasing size and contour

Surgery details

Stage 1 - ~2.5-3.5 hrs

• Rib Harvest – 6th and 7th rib are fused together to form the

base framework of the new ear; 8th rib used as helix –carved, sculpted, and sutured together

• Creation of Skin pocket

• Placement of new ear framework– Negative suction for 5-7 days for skin to co-

apt with the inserted structure

Stage 2 - ~1 hr

• Creation of the earlobe– Rotation of the lobule from the microtia

remnant into position inferior ly on the helical rim

Stage 3 - ~2 hrs

• Creation of auriculocephalic angle with a skin graft

• Elevation of ear

• Split-thickness skin graft– Graft from upper gluteus area– Extra cartilage is placed under the ear to give

it a little protrusion

Stage 4 - ~2 hrs

• Formation of tragus

• Contralateral composite graft

• Deepening of Conchae– Mimics actual opening of the ear

• Microtia with normal movement of stapes, reconstruction of EAM and middle ear improved hearing by 15-50 dB, but long term improvement was not ideal

• In bilateral patients, ~80% with reconstructed EAMsexhibited relapseof stenosis or atresia

• When EAMs are reconstructed first, scar developed around the orifice, affecting the skin flap and auricle reconstruction

• Reconstructing the auricle firstsometimes result in location of EAM orifice deviating from an ideal position

Zou, YH, Zhuang HX, Wang SJ, Xue F, Dai P, Han DY. Satisfactory surgical option for congenital microtia with defects of external auditory meatus (EAM) and middle ear. Acta Otolaryngology. 2007 Jul; 127 (7): 705-10.