Ear Reconstruction

Reconstruction of the ear is one ofthe most challenging problems fac-ing a reconstructive surgeon as itdemands precise technique com-bined with artistic creativity.Microtia is a congenital deformity ofthe external ear where the auricle(the external ear) is severelydeformed. There may be a spectrumof external ear deformities with var-ious degrees of involvement of themiddle and inner ear. This type ofear deformity is commonly seen inpatients with hemifacial microsomiaand Treacher-Collins syndrome.

Psychological effects of an eardeformity play a significant role intiming of reconstruction. Most sur-geons prefer to initiate treatmentwhen the patient is between 5 and 7years of age since this early inter-vention will reduce anxiety as aresult of peer pressure. This alsoallows for sufficient rib growth toprovide the quantity of cartilageneeded by the surgeon for adequateframework fabrication. Surgery atthis time can give a more consistentresult than earlier intervention dueto the fact that the child has had achance to grow, thus making it easi-er for the surgeon to balance the sizeand shape of the reconstructed earto the child’s normal ear.

MICROTIAThe treatment of microtia

involves surgical reconstruction ofthe external ear framework. Ear

EAR RECONSTRUCTION

Preoperative Postoperative

Costal cartilage harvestedfrom left chest wall.

Cartilage carved into ear framework.

Microtia

reconstruction requires a carefully planned, stagedreconstruction that involves 3-4 operative procedures.The first procedure involves the construction of the car-tilage framework for the ear. Under general anesthesia,donor cartilage for the frame is obtained en bloc from the

Tennessee Craniofacial Center 1(800) 418-3223 ©1997 Erlanger Health System

rib area contralateral to the ear being recon-structed to take full advantage of the carti-lage’s natural curvature. Working frompre-surgical templates that have been drawnas well as from photographs, the surgeon thencarves the cartilage into its new shape andcarefully positions the graft into position. Theoverlying skin then redrapes to the newlycarved cartilage framework. Subsequent oper-ations are required to rotate the lobule and toelevate the framework into its final position.

Costal cartilage harvested fromchest wall.

Cartilage carved into earframework.

It is of significance to note that if there isnormal hearing in one ear, surgery to improvehearing in the abnormal ear is not recom-mended. Almost 90% of all patients withmicrotia have only unilateral involvement andquickly adjust to this condition followingbirth. Potential gains from working on themiddle ear are outweighed by the inherentrisks of the surgery itself. Therefore, middleear surgery should be performed only on thetrue bilateral microtia patient or the patientwith significant hearing loss in both ears.

Nine year old with left microtia.

Microtia

Postoperative result after staged ear reconstruction.

Tennessee Craniofacial Center 1(800) 418-3223 ©1997 Erlanger Health System

Tennessee Craniofacial Center 1(800) 418-3223 ©1997 Erlanger Health System

Preoperative Postoperative

Reconstruction of traumatic ear deformity

TRAUMATIC EARDEFORMITIES

The traumatic amputation ofan ear is another circumstance inwhich this type of staged carti-lage reconstruction can be effec-tively used. The amount of earloss determines the types andstages of reconstruction needed.If only a small part of the ear islost from trauma or tumor resec-tion, then helical or rim advance-ment flaps may be used toreconstruct this portion. If largersections are lost then a stagedreconstruction is necessary.Effective ear reconstruction isdependent upon meticulous sur-gical technique and careful pre-operative planning.

Microtia

Four year old born with right microtia.

Appearance of ear after first stagereconstruction.

Postoperative result after stagedreconstruction.

Tennessee Craniofacial Center 1(800) 418-3223 ©1997 Erlanger Health System

Aquired Deformity (Human Bite to Ear)

Human bite to ear with loss of middle third.

Helical rim flap reconstruction. Postoperative result.

Protruding Ears

Eight year old with bilateral protruding ears.

Postoperative result after otoplasty.

OTOPLASTYAnother congenital deformi-

ty of the ears is called prominentor protruding ears. The ear’sprominence is due to lack ofdevelopment of the antihelicalfold. The primary reason to cor-rect this deformity is to elimi-nate the psychological traumathat this condition can cause.Peer ridicule can be severe withthis particular deformity. Theoperation designed to correctthis problem involves recreatingthe antihelical fold curling orsetting the ears back closer to thehead. With experience, consis-tently good results can beobtained.