Advanced Surgical Techniques in Microtia (Small Ear) Reconstruction

Microtia (small ear) is a condition in which a baby’s external and internal ear or ears do not develop properly in the womb. The condition varies greatly in degree and severity, ranging from small abnormalities to the complete absence of ear(s), or anotia. In most cases, only one ear is affected but a small percentage of children may be born with microtia of both ears.

Microtia is relatively rare, occurring in approximately one in 5,000 births. These rates depend heavily on ethnic background and is more common in males. In addition to the external appearance of the ear(s) the hearing may also be affected and will require treatment by our specially trained pediatric ear and hearing team.

Surgical Reconstruction of the External Ear

Cosmetic surgical treatment options for microtia involve reconstruction techniques to create a more symmetrical or less noticeable ear. The following surgical options may be offered when the child is older, typically around the time they enter elementary school.

Rib Cartilage Graft Reconstruction

Reconstruction using a rib cartilage graft is a technique that has been offered for nearly a century. It is a staged reconstruction, meaning multiple surgeries are required to achieve the outcome. The number of surgeries required will depend on the technique that is used.

Our preferred method requires two stages. The first stage uses the patient’s own rib cartilage to construct the ear and place it under the skin. The second stage then lifts the ear up to create the natural sulcus or groove behind the ear. There may be some additional minor stages to achieve some final touches on the ear to improve its shape or position.

Rib graft reconstruction has the advantage of being constructed from your own tissue which decreases risk of failure or rejection. Once healed, the cartilage tends to be more resistant to trauma and infection. The downsides to this surgery is we must create an incision and ultimately a scar over the chest in order to harvest the rib cartilage.

MedPor Implant Reconstruction

Reconstruction using a MedPor graft replaces the need to harvest rib cartilage. For this procedure, we use a synthetic implant that has been prefabricated to match the ear shape and facial structure. We then cover the implant with tissue taken from the scalp.

Because we do not need to harvest rib cartilage and can avoid the incision over the chest, we offer this surgery to patients at a younger age. However, there are some limitations to this procedure, including:

• The implant is not your own tissue – so it depends on the vascular tissue flap from your scalp to heal into place
• The graft is susceptible to fractures and would not heal like your own cartilage, meaning there is a higher risk of deformity, extrusion, and infection
• The reconstructed ear does not have sensation, meaning it can be injured more easily without you noticing

Prosthetic Ear

For this procedure, we engage the services of an anaplastologist, a medical professional who creates prosthetic body parts. In this case, a prosthetic ear that fits the patient’s head is created and anchored to the head during a minor surgery. A prosthetic ear can look very similar to the other ear, made to feel like a normal ear and can withstand routine daily activities including sports. Overall, it is less surgery to achieve a desired outcome.

The main downside to this option is that this ear becomes an accessory rather than a part of one’s body. It must routinely be cared for and replaced as it wears down. Also, because the prosthesis has no sensation, it can be difficult to realize when it is knocked off or loosened.