Ear Reconstruction for Microtia
Fairbanks Plastic Surgery: The Professional Artist of Plastic Surgery
Microtia is a condition characterized by an undeveloped external ear in a newborn child. It occurs as the result of a growth interruption during the embryonic stages of development. It is a manifestation of what in broader terms is called the first and second branchial arch syndrome. It is from these embryonic structures that the recognizable human ear forms. This is a much rarer congenital deformity than cleft lip or cleft palate. What results is a small nubbin of tissue on the side of the head with a variable amount of tiny twisted cartilage, attached to a high riding earlobe. The external ear canal is usually absent.
Fortunately plastic surgery techniques have been developed by which an ear can be reconstructed using living cartilage. If the surgeon has expert sculptural ability, the patient’s own cartilage, taken from a portion of the rib cage , can be carved into a framework which closely matches an original ear cartilaginous framework. The pioneer surgeon of this technique was Dr. Radford Tanzer. Although refinements to Dr. Tanzer’s technique have been added, the concepts which he proposed have stood the test of time, and provide the best reconstructed ears possible today by modern plastic surgery techniques. Your sculptor/ surgeon may even make castings of the opposite ear and model a plan for the new ear in preparation for the surgery.
If you have a child who has microtia, there are certain facts you need to consider before choosing a course of treatment for reconstruction. First and foremost, you must avoid ANY reconstruction in which the surgeon recommends using a synthetic material (plastic, silicone, polyethylene, etc.). Although the initial result may be pleasing to the eye, the material will eventually extrude through the thin skin layer and an infection will ensue. The synthetic framework will have to be removed in order to clear the infection.
You may ask how then could a surgeon recommend using such a device. The answers are simple. The devices are marketed, and the surgeon lacks the sculptural ability to carve a cartilage framwork at the operation table. The carving process is tedious and exacting, and –face it– few surgeons have the ability to do it. The synthetic route is quick and easy, but it eventually leads to an infection when it extrudes. This generally slams the door shut on doing a living reconstruction. Think about it; afer removal of the synthetic feamework and curing the infection, what are you left with? You guessed it ; a dense mass of unworkable scar tissue.
What are your options after a failed ear reconstruction? The patient must either live without an external ear or get an an external “stick-on” prosthesis, or fake ear. You must consider the fact that you have ONE chance to get a good result, and that is the first time. Revisionary procedures are fraught with problems which –except for rare exceptions– cannot be overcome. This is not an operation to be performed by by the untrained, the inexperienced, or the less than skillful surgeon. It is important that you as parents of a child born with microtia do your homework carefully before choosing a program, because it is your decision which will affect your child’s ultimate result.
Fortunately you have time to do your research. The sequence of operations for microtia do not begin before the child is six or seven years of age. It is at this age when the specific area of rib cartilage has grown large enough to create an ear framework. Fortunately there is an area in the rib cage where two rib cartilages fuse. This is called a synchondrosis; it is this specific area which can provide the necesary width to create a living ear. The reconstructive process requires three or four stages depending upon how complete and detailed you as a parent want the reconstruction to be. If your child has an inner ear capable of receiving sound waves, and transmitting them, surgery for making an external ear canal, and any middle ear surgery should be delayed until after the external reconstruction is complete.
Remember to do your homework and choose your surgeon wisely. You may need to travel out of state to do this. Decline the services of any surgeon who recommends the use of synthetic materials. Do not allow someone to casually amputate your child’s microtic ear, and tell you to get a prosthesis. A prosthetic ear is the Last resort, not the first. There will be financial considerations, but you have time to save for your child so that he or she can lead a normal life.