Microtia (Ear Reconstruction)
Microtia (small ear) or Anotia (absent ear) may be present at birth either as isolated incident or as part of a spectrum of hemifacial microsomia. Kidney abnormalities may also be present and we recommend a renal ultrasound at the time of diagnosis. In addition to the external ear malformation, the ear canal is often absent which can contribute a conductive hearing loss.
The ear is a beautifully detailed and sculpted appendage and can be very difficult to reconstruct. An polymer implant (such as Medpor) or rib cartilage can be used to re-create the structural frame of the ear. We prefer to use cartilage given its resistance to infection and longevity of the reconstruction. This reconstruction is usually postponed until a minimum age of eight to allow for growth of the rib cage.
A new ear framework is sculpted from the cartilages and buried underneath the skin where the new ear is to be created. Approximately three months later the “new ear” is elevated from underneath the skin and grafted to create the “normal” projection.
Alternatively, prosthetics are also available. The disadvantage is they are prone to fall off and degrade requiring expensive replacements. The cartilage-sculpted ear is the preferred “permanent” reconstruction recommended by most craniofacial surgeons and are more resistant to trauma and infection than synthetic ears.
Medpor Ear Reconstruction
Medpor is a polymer implant that is porous allowing tissue ingrowth within its structure. It has been used in ear reconstruction for over 25 years and can provide consistently good aesthetic outcomes. The Medpor implant offers the ability to perform a 3D ear reconstruction in a one stage procedure (one operation). The medpor is covered by a TPF flap from underneath the scalp as well as skin grafts from the opposite ear and the thigh area. Dr. Bastidas can do this using a minimal access technique with less visible scar.
Ear Reconstruction at Age 3
Since cartilage is not necessary, medpor ear reconstruction can be performed well before your child begins school (around age 3 or older). Since most of the pain in ear reconstruction comes from the cartilage harvest, medpor patients have the benefit of faster recover and less down-time. Patients are most often sent home the same day of surgery and do not require much pain medication. A silicone dressing is placed over the reconstructed ear for 2 weeks after the surgery and afterwards only used at night. The beautiful details of the newly reconstructed ear will slowly appear over the next few weeks to months.
The disadvantage to medpor is that it is an implant and like all implants have a risk of infection as well as being more susceptible to breaking. If the implant breaks a surgery will need to be done (though relatively short) to construct a new implant and replaced the damaged one. If there an infection, the implant may need to be removed and a new operation may need to be performed at a later date after allowing some time to heal.
This reconstruction is usually postponed until a minimum age of eight to allow for growth of the rib cage. During the first stage (operation) a new ear framework is sculpted from the cartilages of the rib cage and buried underneath the skin where the new ear is to be created. One to two days in the hospital is required for monitoring and pain control. Drains may be placed to help prevent fluid from accumulating under the graft and also to create a suction vacuum. Approximately four to six months later (during a second operation) the “new ear” is elevated from underneath the skin and skin grafted to create a 3D ear projecting away from the head.
The benefits of using rib cartilage is that is may be more resistant to infection and injury since we are using your own tissue to make the new ear and not an implant. Sometimes it is difficult to see all the intricate details of the reconstruction due to persistent swelling in contrast to the medpor ear reconstruction.