Microtia (small or absent ear)

Picture for plastic surgery ears article

Ear reconstruction, can provide a positive solution for cases where a child is born with a tiny, malformed ear (which is called microtia), and also the traumatic loss of an ear through accident.

For children who were born with an underdeveloped ear, cosmetic surgery can begin as early as age six. Older patients can be benefitted immediately following the accidental loss of an ear. In all cases, the most effective method for success will be achieved by carving a new framework from the patient’s own rib cartilage. Atresia refers to the absence of the external canal, which is almost always associated with microtia. If the internal components are developed well enough, an external ear canal can be created. This, however, should not be done until the external microtia repair has been completed.

While there are a number of synthetic frameworks available, these are not living material, and the chance that the will erode through the skin is high. When this happens, the artificial framework has to be removed, and the patient will have lost their chance for a successful ear reconstruction.

A living ear created from the patient’s own tissue, when done well, is preferable to a stick-on prosthetic. The quality of the result depends upon your surgeon’s artistic ability to carve, or sculpt the cartilage.

7 year-old girl with classic Grade III Microtia with Atresia

Picture of a young girl who has undergone microtia surgery

The left ear is the reconstructed ear

The process begins by using a mirror image of the patient’s normal ear as a template. Measurements, patterns, molds, and plaster casts are made from this mirror image, and the surgeon carefully chooses where the new ear will be created under the existing skin.

During surgery, a carefully carved cartilaginous framework of the patient’s own cartilage is implanted beneath the skin. If an earlobe is present, it will be rotated into the proper position. Once this has been allowed to heal, the ear is elevated, and a skin graft is placed behind the cartilage in order to create the space behind the ear, and help bring the reconstructed ear out. Finally, the central cup, or concha, is deepened and the protective door over the canal, or tragus, is created.

If the patient has sufficient internal hearing structures, it may be desirable to create an external auditory canal. Creation of the external ear, however, must be completed before a canal is made.

A patient can be missing an ear as the result of congenital causes, trauma, or malignancy. Congenital, or developmental absence or deficiency of an ear can be the result of a number of syndromes. This includes Hemifacial Microsomia, the First and Second Branchial Arch Syndrome, Goldenhar's Syndrome, Plagiocephaly, and other syndromes. Microtia from the above causes is best reconstructed using a framework made from the patient's own rib cartilage. Non-living materials for ear reconstruction, although readily available, MUST be avoided. They will fail. When extrusion of these non-living materials occurs, it results in infection, intense scaring, and severe deformity. Reconstruction following this situation is difficult, if not impossible. At Fairbanks Plastic Surgery, however, we have been able to salvage a good percentage of failed ear reconstructions.

For the traumatic injury, many reconstruction techniques are available, including the rib cartilage approach that is standard for microtia. Local flaps and cartilage grafts from the opposite ear can also be used where appropriate. For ears lost from malignancy, the resulting scarring usually precludes reconstruction surgery and a prosthesis (a detachable, non-living, plastic ear) is generally required.

Your plastic surgeons at Fairbanks Plastic Surgery Center have extensive experience and expertise in performing total ear reconstruction using autogenous living tissues. As a result of their artistic background and ability, they have successfully produced some of the most natural appearing results available in ear reconstruction today. As a result, patient satisfaction is high.

All post-operative pictures are of real patients of Fairbanks Plastic Surgery. Identifiable images are used with patient permission.

Reconstruction for Microtia

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The patient is a seven-year-old male who has undergone staged procedures for the reconstruction of the undeveloped or microtic ear. It is important to delay surgery until the patient has reach an age when most of the ear growth has been achieved on the opposite side. The surgeon uses the opposite ear as a guide, or template, to achieve an artistic reconstruction. In this patient, the result demonstrates a close-to-normal appearing reconstructed ear. This represents the optimal result available in ear reconstruction.

Microtia/Atresia Before and After Reconstruction

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This patient underwent multiple surgical stages using autogenous rib cartilage to achieve a normal appearing left ear. The canal has also been opened so that the patient can hear. NOTE: The before 3 and after 3 images are of the patient's normal ear and are shown for comparison.

Reconstruction For Microtia

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This patient was born with "microtia," which refers to lack of development of the external ear. She required a multi-staged surgical approach, using her own cartilage and skin grafts, to achieve a natural appearing ear.

Traumatic Amputation/Reconstruction

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This patient lost the upper 2/3rds of his left ear in a motorcycle accident. Only the earlobe remained. The defect was originally skin grafted. Subsequently, he underwent reconstruction using a carved cartilage framework from his own rib cartilage.

Helix Reconstruction

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This patient suffered the loss of the rim (helix) of her left ear in an accident. In order to rescue the exposed cartilage, the rim was buried under the skin behind the ear. Once this had healed, the ear was released (elevated), and a skin graft was used to achieve a normal looking ear.

Reconstruction After Road Trauma

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This patient sustained a severe injury to the right ear as the result of her head striking the pavement and dirt. This resulted in multiple dirt tattoos, and the detachment of the root of the helix. The tattoos were surgically excised and the helix defect was restored using a blood-bearing pre-aricular transposition flap.

Goldenhar's Syndrome

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This patient had under development of the upper half of her right ear as a part of a congenital condition known as Goldenhar's Syndrome. The ear was reconstructed by creating a carved cartilage framework and joining this to the existing deficient external ear, which was rotated downwards and backwards to provide a more natural look.

Reconstruction Surgery After Trauma

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This woman was involved in an automobile accident, which resulted in the amputation of the upper portion of her ear. Reconstruction was achieved using a chonchal cartilage graft, which when placed under the skin matched the shape of the upper ear.

Microtia Repair With Cartilage Grafts

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This child was born with the typical deformity of the microtic ear, which is a manifestation of the first and second Branchial Arch Syndrome. Her ear was successfully reconstructed using her own cartilage and skin grafts.

Deformity With Plagiocephaly

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Plagiocephaly is a condition in which the cranium is asymmetrical, or flat on one side, and can be associated with other deformities such as microtia. In this case, the existing ear was divided in the center, and the parts were rotated upward and downward respectively. The central portion required a carved cartilage framework from the patient's own rib cartilage in order to achieve a more natural look.

Grade III Microtia With Atresia

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Secondary (Revision) Ear Reconstruction

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Secondary Ear Reconstruction

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Your surgeons at Fairbanks Plastic Surgery Center of Utah have extensive experience and expertise in performing these procedures. Every care and attention will be taken to maintain your health and well-being while providing you the optimal result from your Cosmetic Plastic Surgery operation.

For more information and to schedule a consultation, please call the Fairbanks Plastic Surgery Center at (801) 268-8838.