Microtia and Anotia Surgery
Option 1: Costal Cartilage-Based Reconstruction
Option 2: Medpor and Supor-Based Microtia Reconstruction
Costal Cartilage-Based Reconstruction
This approach is also known as a “natural” way to reconstruct the ear because only the patient's own tissue is used, not an implant. This method involves using cartilage from the patient's own rib to create a new framework for the future ear.
This is typically done in two stages. The first stage can require overnight admission for observation, and the second stage is an outpatient procedure. On occasion, a single stage rib cartilage-based surgery can be performed.
The Surgical Steps
Stage I
Creating the Ear Framework
The surgical approach typically happens at age 8, but can begin earlier depending on the patient's size.
Patients typically stay overnight for observation and go home the next day. Optimal management of discomfort is paramount and a key part of the protocol for treatment at this stage.
Stage II
Elevating the Ear Framework
This stage will typically happen 4-6 months after Stage I and involves elevation of the framework to create an ear that is projected relative to the other side. Patients go home the same day.
Medpor and Supor-Based Microtia Reconstruction
This approach uses an implant (such as Medpor or Supor) that is shaped like the framework of an ear, avoiding the need for rib cartilage.
Implant or porous polyethylene-based surgery is typically performed around 8 years of age as well, but can be performed earlier when indicated.
The Surgical Steps
Typically Single Staged (Sometimes Multiple)
Implant or Porous Polyethylene-Based Reconstruction
Revision Costal Cartilage
For situations where a reconstructed ear using rib-cartilage failed or does not look as great as you would like, revision surgery may be indicated.
The approach can depend on the severity of the problem. The reconstructed ear can be revised in certain situations or it can be completely rebuilt. More common issues treated include an under-projected ear (does not stick out as far as one would like for symmetry) and loss of ear definition.
Revision Medpor and Supor
As with rib-based surgery for microtia, implants can also require revision surgery. The approach can depend on severity of the problem. The reconstructed ear can be revised in certain situations or it can be completely rebuilt.
More common issues treated include an under-projected ear (does not stick out as far as one would like for symmetry) and loss of ear definition.
Laser hair removal after surgery
On occasion, scalp and skin graft hair growth on the newly reconstructed ear can happen. This can occur in both rib- and implant-based surgery. This can be treated in different ways, including laser hair removal. Our team has experience with this and can help.
Post-Operative Recovery
This approach uses an implant (such as Medpor or Supor) that is shaped like the framework of an ear, avoiding the need for rib cartilage.
Implant or porous polyethylene-based surgery is typically performed around 8 years of age as well, but can be performed earlier when indicated.
Rib-Cartilage or Implant-Based Microtia Surgery
Which One is Better?
Rib-based microtia surgery provides a “natural” means of reconstruction since the patient’s own tissue is used. Rib-based microtia surgery has been around the longest out of all approaches to microtia surgery. Rib-based cartilage does resemble normal ear cartilage and possesses more flexibility than other materials. Sensation (feeling) to the new ear can be preserved with traditional rib-based surgery for microtia, which is very important and often underemphasized.
Implant-based reconstruction for microtia can be great options for patients.The implant can look like a normal ear with good projection. The downside is that it is an implant, and the “lifespan” is unknown. While the body would not “reject” an ear implant, complications such as implant exposure from a breakdown in the skin or incision can be more difficult to treat. Additionally, because of how the implant is reconstructed, it is far less likely to result in sensation. This approach can be an option for those who are older, those who are unable to undergo a rib-based procedure.
Otoplasty and Ear-Pinning
This surgery involves placement of permanent sutures to create normal ear shape and symmetry as well as modification of the skin and cartilage of the ear.
This is an outpatient procedure that typically takes under 2 hours. Many different differences of the ear can be treated with these common techniques. For older patients who prefer to avoid going to sleep for the surgery, this can be done while patients are awake and comfortable (i.e. numb from topical and local numbing medication).
Conditions that we treat with an Otoplasty include:
- Lidding or Lop Ear
- Prominent Ears
- Buried Ear
- Stahl's Ear
- Macrotia
- Ear tags, duplications, and other conditions
Reconstructive Ear Surgery
The required procedures vary and typically involve a combination of local tissue and cartilage or implant-based reconstruction. On occasion, free tissue transfer (also known as microsurgery or free flap surgery, involves transferring tissue from one part of the body to the other) or tissue expansion.
Ear reconstruction can be performed for both adults and pediatric patients. Adults typically require ear reconstruction following skin cancer surgery, traumatic deformities, or similar conditions.
The best way to determine what the optimal procedure for one may be is to be evaluated in a formal consultation.
Ear Molding: A Non-Surgical Option for Babies
For young babies (2 weeks of age to 4 months of age), many ear differences can be treated with molding. There is a small window of opportunity to get the best result possible. This is because baby’s ears are moldable up to a certain age.
There are different ways to mold the ear. One common way is with the Earwell system, which is used by our team.
To learn if your baby is a candidate, reach out to us to schedule a consultation.
Other conditions we treat
As a craniofacial surgeon, we treat many other conditions of the face and facial skeleton.
Below is a list of a few other procedures performed.
Our team is commited to delivering expert care.
For all other ear conditions and to learn more
Schedule a Consultation