eMedicine Specialties > Plastic Surgery > Head/Neck

Ear, Microtia: Follow-up

Author: Samuel J Lin, MD, Attending Surgeon, Plastic Surgery, Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Associate Staff Physician, Otolaryngology, Division of Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School
Coauthor(s): Bruce S Bauer, MD, Professor, Department of Surgery, Department of Surgery, Division of Plastic and Reconstructive Surgery, Northwestern University Medical School; Head, Children's Memorial Hospital; Julia Corcoran, MD, FACS, Department of Surgery, Division of Plastic Surgery, Assistant Professor, Children's Memorial Hospital, Northwestern University
Contributor Information and Disclosures

Updated: Jun 15, 2009

Outcome and Prognosis

Ear reconstruction with autogenous cartilage grafts is well received by patients with microtia. The success of outcome depends greatly on preoperative planning. Placing the auricle in a symmetric position with respect to the facial landmarks and obtaining symmetric projection from the skull are of paramount importance for optimum outcome. The skill and patience of the surgeon in planning and executing this operation determine its success, barring complications.

Reoperation for symmetrical ear positioning

Though discussed above in the section on treatment of auricular dystopia, a final comment seems appropriate regarding the proper positioning of the reconstructed ear. One of the areas of greatest concern to patients seeking further microtia reconstruction is the malposition of the reconstructed ear.

Typically, the ear is positioned anterior and inferior to its normal counterpart (as well as rotated from a normal axis). Some patients may present with dystopia and an incomplete reconstruction and need both correction of dystopia and additional staging of surgeries. Each case needs to be assessed for the extent of surrounding scarring and the distance of movement that is necessary for optimal symmetry. The rich vascular supply in this area will allow a reasonable amount of elevation and movement of the reconstructed ear, but a wide enough pedicle needs to be maintained (with at least as much attachment as is seen at the second stage ear elevation in the routine microtia reconstruction) to avoid vascular compromise. The movement often requires interposition of a skin or fasciocutaneous flap from behind the dystopic auricle to fill the defect anterior and medial to the ear, as is needed in the early transposition of the vestige discussed above.

Each case must be carefully assessed. Certainly, some patients must be counseled that the risk of distortion or loss of the reconstructed ear does not warrant the risk of this movement. They should also be aware of the additional scars that will result from the transposition of skin anterior or inferior to the repositioned auricle in cases where the anterior skin is not lax enough to allow advancement back to the newly-positioned ear. Some patients, while unhappy with the ear position, may not be willing to accept these additional scars, and the surgeon should then counsel acceptance of the current deformity.

Future and Controversies

Building on lessons from the past, today's surgeons have decreased what was a 4-stage operation in the 1950s to a 2-stage reconstruction today. As lessons learned today are applied, even more realistic reconstructions can be expected from future reconstructive surgeons. In the future, tissue engineering and newer alloplasts may replace autologous reconstruction; however, they must measure up to the criterion standard set by autologous reconstruction.

Final thoughts

Successful staged reconstruction of the ear, whether for microtia or major acquired ear deformities, requires meticulous attention to all aspects of the available auricular and donor tissue and the soft tissue environment surrounding the planned reconstruction. Whether one chooses to follow a Nagata, Firmin, or Brent model for the initial microtia reconstruction, careful attention to the vascular supply of the skin flaps minimizes the risk of flap ischemia and cartilage exposure. With considerable variation in auricular remnants, meticulous planning is perhaps the most important factor in reducing complications.

 


More on Ear, Microtia

Overview: Ear, Microtia
Workup: Ear, Microtia
Treatment: Ear, Microtia
Follow-up: Ear, Microtia
Multimedia: Ear, Microtia
References
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References

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Further Reading

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Keywords

ear, microtia, ear microtia, hypoplasia of ear, auricle, auricular vestige, microtia pictures, ear microtia pictures, ear pictures, ear surgery, ear reconstruction, birth defect, ear development, ear repair, ear creation, ear plastic surgery, congenital ear defect, small ear, ear microtia surgery, microtia treatment, ear treatment, external ear, external ear surgery, external ear microtia, external ear reconstruction, auricle reconstruction, prosthetic ear, autologous reconstruction, autologous framework, bone-conduction hearing aid, hearing aid, microtic vestige, prosthetic carving, carving technique, cartilage framework, lobule rotation, conchal excavation, tragus formation, pinna elevation, classical microtia, atypical microtia, classical remnant, atypical remnant, ear remnant, auricular remnant, concha, antihelix, tragus, antitragus, dystopic remnant, distraction osteogenesis, auricular dystopia

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Contributor Information and Disclosures

Author

Samuel J Lin, MD, Attending Surgeon, Plastic Surgery, Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Associate Staff Physician, Otolaryngology, Division of Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School
Samuel J Lin, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, and Triological Society
Disclosure: Nothing to disclose.

Coauthor(s)

Bruce S Bauer, MD, Professor, Department of Surgery, Department of Surgery, Division of Plastic and Reconstructive Surgery, Northwestern University Medical School; Head, Children's Memorial Hospital
Bruce S Bauer, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Pediatric Plastic Surgeons, American Association of Plastic Surgeons, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Society of Maxillofacial Surgeons, and American Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Julia Corcoran, MD, FACS, Department of Surgery, Division of Plastic Surgery, Assistant Professor, Children's Memorial Hospital, Northwestern University
Julia Corcoran, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Cleft Palate/Craniofacial Association, and American College of Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Lawrence Ketch, MD, FAAP, FACS, Head, Program Director, Associate Professor, Department of Surgery, Division of Plastic Surgery, University of Colorado Health Sciences Center; Chief, Pediatric Plastic, The Children's Hospital of Denver
Lawrence Ketch, MD, FAAP, FACS is a member of the following medical societies: American Academy of Pediatrics, American Association for Hand Surgery, American Association of Plastic Surgeons, American Burn Association, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Society for Surgery of the Hand, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Plastic Surgery Research Council
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jaime R Garza, MD, DDS, FACS, Consulting Staff, Private Practice
Jaime R Garza, MD, DDS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Allergan Honoraria Consulting

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Deepak Narayan, MD, FRCS, Associate Professor of Surgery (Plastic), Yale University School of Medicine; Chief of Plastic Surgery, West Haven Veterans Affairs Medical Center
Deepak Narayan, MD, FRCS is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Indian Medical Association, Plastic Surgery Research Council, Royal College of Surgeons of Edinburgh, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

 
 
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