eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > External Ear Diseases

External Ear, Aural Atresia: Follow-up

Author: Stephen S Park, MD, Professor and Vice-Chairman, Department of Otolaryngology-Head and Neck Surgery, Director, Division of Facial Plastic and Reconstructive Surgery, University of Virginia Medical Center/Cosmetic Surgery Center
Coauthor(s): David H Chi, MD, Assistant Professor, Department of Otolaryngology, Children's Hospital of Pittsburgh
Contributor Information and Disclosures

Updated: Nov 25, 2008

Outcome and Prognosis

The outcomes of microtia repair are reflected in the psychological benefit and satisfaction of the patient and/or parent. Brent surveyed his patients in 1992 and noted that those grading themselves as severely affected prior to surgery were 100% pleased with the result.11 Among patients who considered themselves moderately disturbed by microtia and underwent the procedure when younger than 14 years, 95.5% were satisfied with the decision to pursue surgery. In regards to the chest donor site, 62% of all people surveyed reported no concern, and 35% noted the scar as a concern but thought the operation to be worthwhile. Few patients (3%) expressed concern about the appearance of the chest scar.

Future and Controversies

The future of microtia repair includes the development of tissue engineering. Restrictions of present techniques include the limited availability of cartilage to repair the defect and the surgical morbidity of autogenous costal cartilage. Investigations have begun in which a small amount of cartilage may be harvested and expanded in vitro and in vivo. The initial procedure, which was proposed by Peer, used diced autogenous cartilage and placed it in a Vitallium ear mold.12 The mold was subsequently banked and harvested, but the results were not consistent.

More recently, investigations have demonstrated the ability to seed bovine chondrocytes on a biodegradable template and implant these molds into an athymic mouse; this process resulted in an auricle-shaped cartilage. Other studies have shown that autogenous transfer of tissue-engineered cartilage is possible in a rabbit model. The cells are placed on a biodegradable template that engineers 3-dimensional morphology and guides the growth of the new cartilage into an anatomic graft (see Image 15). Tissue-engineered cartilage may represent the implant of the future because of its ability to encompass the advantages of alloplastic and autogenous grafts.

 


More on External Ear, Aural Atresia

Overview: External Ear, Aural Atresia
Workup: External Ear, Aural Atresia
Treatment: External Ear, Aural Atresia
Follow-up: External Ear, Aural Atresia
Multimedia: External Ear, Aural Atresia
References
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References

  1. McDowell F. The classic reprint. Ancient ear-lobe and rhinoplastic operations in India. Plast Reconstr Surg. May 1969;43(5):515-22. [Medline].

  2. Gillies H. Plastic Surgery of the Face. London: 1920.

  3. Gillies H. Reconstruction of the external ear with special reference to the use of maternal ear cartilages as the supporting structure. Rev Chir Structive. 1937;7:169.

  4. Tanzer RC. Reconstructive Plastic Surgery. 2nd ed. Philadelphia: WB Saunders Co; 1977.

  5. Brent B. Technical advances in ear reconstruction with autogenous rib cartilage grafts: personal experience with 1200 cases. Plast Reconstr Surg. Aug 1999;104(2):319-34; discussion 335-8. [Medline].

  6. Marx H. Dies Missbildungen des Ohres. In: Denker A, Kahler O, eds. Handbuch der Hals-Nasen und Ohrenheilkunde: Bd VI. 1026. 131-169.

  7. Weerda H. Classification of congenital deformities of the auricle. Facial Plast Surg. Oct 1988;5(5):385-8. [Medline].

  8. Aguilar EA 3rd, Jahrsdoerfer RA. The surgical repair of congenital microtia and atresia. Otolaryngol Head Neck Surg. Jun 1988;98(6):600-6. [Medline].

  9. Fukuda O, Yamada A. Reconstruction of the microtic ear with autogenous cartilage. Clin Plast Surg. Jul 1978;5(3):351-66. [Medline].

  10. Song Y, Song Y. An improved one-stage total ear reconstruction procedure. Plast Reconstr Surg. May 1983;71(5):615-23. [Medline].

  11. Brent B. Auricular repair with autogenous rib cartilage grafts: two decades of experience with 600 cases. Plast Reconstr Surg. Sep 1992;90(3):355-74; discussion 375-6. [Medline].

  12. Peer LA. Reconstruction of the auricle with diced cartilage grafts in a Vitallium ear mold. Plast Reconstr Surg. 3:653.

  13. Aase JM, Tegtmeier RE. Microtia in New Mexico: evidence for multifactorial causation. Birth Defects Orig Artic Ser. 1977;13(3A):113-6. [Medline].

  14. Aguilar EF 3rd. Auricular reconstruction of congenital microtia (grade III). Laryngoscope. Dec 1996;106(12 Pt 2 Suppl 82):1-26. [Medline].

  15. Bennun RD, Mulliken JB, Kaban LB, et al. Microtia: a microform of hemifacial microsomia. Plast Reconstr Surg. Dec 1985;76(6):859-65. [Medline].

  16. Britt JC, Park SS. Autogenous tissue-engineered cartilage: evaluation as an implant material. Arch Otolaryngol Head Neck Surg. Jun 1998;124(6):671-7. [Medline].

  17. Cao Y, Vacanti JP, Paige KT, et al. Transplantation of chondrocytes utilizing a polymer-cell construct to produce tissue-engineered cartilage in the shape of a human ear. Plast Reconstr Surg. Aug 1997;100(2):297-302; discussion 303-4. [Medline].

  18. Davis J. Auricle reconstruction. In: Saad MN, Lichtveld P, eds. Reviews in Plastic Surgery: General Plastic and Reconstructive Surgery. 1994:109-140.

  19. Eavey RD, Monroy A, Nicolau Y, et al. Microtia repair: the case for surgical reconstruction. J Oral Maxillofac Surg. Nov 2006;64(11):1655-63. [Medline].

  20. Farkas LG. Anthropometry of normal and anomalous ears. Clin Plast Surg. Jul 1978;5(3):401-12. [Medline].

  21. Farkas LG. Growth of normal and reconstructed auricles. In: Tanzer RC, Edgerton MT, eds. Symposium on Reconstruction of the Auricle. 1974:24-31.

  22. Firmin F. Ear reconstruction in cases of typical microtia. Personal experience based on 352 microtic ear corrections. Scand J Plast Reconstr Surg Hand Surg. Mar 1998;32(1):35-47. [Medline].

  23. Fukuda O. The microtic ear: survey of 180 cases in 180 cases in 10 years. Plast Reconstr Surg. Apr 1974;53(4):458-63. [Medline].

  24. Gion GG. Surgical versus prosthetic reconstruction of microtia: the case for prosthetic reconstruction. J Oral Maxillofac Surg. Nov 2006;64(11):1639-54. [Medline].

  25. Jahrsdoerfer RA, Kesser BW. Issues on aural atresia for the facial plastic surgeon. Facial Plast Surg. Oct 1995;11(4):274-7. [Medline].

  26. Jahrsdoerfer RA, Yeakley JW, Aguilar EA, et al. Grading system for the selection of patients with congenital aural atresia. Am J Otol. Jan 1992;13(1):6-12. [Medline].

  27. Kaye CI, Rollnick BR, Hauck WW, et al. Microtia and associated anomalies: statistical analysis. Am J Med Genet. Dec 1989;34(4):574-8. [Medline].

  28. Lucente FE, Lawson W, Noveck NL. The External Ear. Philadelphia: WB Saunders Co; 1995.

  29. Nagata S. Modification of the stages in total reconstruction of the auricle: Part I. Grafting the three-dimensional costal cartilage framework for lobule-type microtia. Plast Reconstr Surg. Feb 1994;93(2):221-30; discussion 267-8. [Medline].

  30. Park C, Mun HY. Use of an expanded temporoparietal fascial flap technique for total auricular reconstruction. Plast Reconstr Surg. Aug 2006;118(2):374-82. [Medline].

  31. Park SS, Wang TD. Temporoparietal fascial flap in auricular reconstruction. Facial Plast Surg. Oct 1995;11(4):330-7. [Medline].

  32. Quatela VC, Goldman ND. Microtia repair. Facial Plast Surg. Oct 1995;11(4):257-73. [Medline].

  33. Rueckert F, Brown FE. Microtia. In: Stark RB, ed. Plastic Surgery of the Head and Neck. NY: Churchill Livingstone; 1987.

  34. Tai Y, Tanaka S, Fukushima J, et al. Refinements in the elevation of reconstructed auricles in microtia. Plast Reconstr Surg. Jun 2006;117(7):2414-23. [Medline].

  35. Trigg DJ, Applebaum EL. Indications for the surgical repair of unilateral aural atresia in children. Am J Otol. Sep 1998;19(5):679-84; discussion 684-6. [Medline].

  36. Williams JD, Romo T 3rd, Sclafani AP, et al. Porous high-density polyethylene implants in auricular reconstruction. Arch Otolaryngol Head Neck Surg. Jun 1997;123(6):578-83. [Medline].

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Further Reading

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Keywords

aural atresia, auricular atresia, congenital auricular deformity, small auricle, microtia, anotia, lop ear, cup ear, Stahl ear, peanut ear, anotic ear, peanut deformity, hypoplasia, hypoplastic ear, prominent ear, hemifacial microsomia, Goldenhar syndrome, Treacher Collins syndrome, Franceschetti syndrome, oculoauricular vertebral dysplasia, ear deformity, aural atresia, ear reconstruction

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Contributor Information and Disclosures

Author

Stephen S Park, MD, Professor and Vice-Chairman, Department of Otolaryngology-Head and Neck Surgery, Director, Division of Facial Plastic and Reconstructive Surgery, University of Virginia Medical Center/Cosmetic Surgery Center
Stephen S Park, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Rhinologic Society, Society of University Otolaryngologists-Head and Neck Surgeons, Triological Society, and Virginia Society of Otolaryngology-Head and Neck Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

David H Chi, MD, Assistant Professor, Department of Otolaryngology, Children's Hospital of Pittsburgh
David H Chi, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Robert A Battista, MD, FACS, Assistant Professor of Otolaryngology, Northwestern University Medical School; Physician, Ear Institute of Chicago, LLC
Robert A Battista, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, and Illinois State Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Gregory C Allen, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Gregory C Allen, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Medical Association, Christian Medical & Dental Society, and Colorado Medical Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown

 
 
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