Pediatric Microtia Surgery Workup

  • Author: Arturo Bonilla, MD; Chief Editor: Glenn C Isaacson, MD, FACS, FAAP   more...
 
Updated: May 17, 2011
 

Imaging Studies

A CT scan of the ears is not recommended in children younger than 4-6 years. Obtaining a CT scan at an earlier age does not allow for any earlier surgical intervention, therefore unnecessarily radiating the child's head. Obtaining the CT scan just before the pinna reconstruction is recommended in order to counsel the patient about the candidacy for middle ear surgery.

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Diagnostic Procedures

An auditory brainstem response test is recommended soon after birth to evaluate inner ear function on both sides.

Frequent otologic evaluations are mandatory to rule out other possible problems, such as otitis media in the good ear. Aggressively treat middle ear effusions of the normal ear to optimize the hearing status of the child and avoid speech delay. An auditory brainstem response test is usually recommended approximately 3-6 months later. If the child is cooperative, audiologic testing can then be performed by sound-field testing and eventual bilateral pure tone audiometry. Routine scheduled audiologic follow-up testing must be continued.

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Contributor Information and Disclosures
Author

Arturo Bonilla, MD  Assistant Clinical Professor, Department of Otolaryngology, University of Texas Health Science Center at San Antonio; Founder and Director, Microtia - Congenital Ear Deformity Institute; Consulting Staff, Pediatric Subspecialists of South Texas

Arturo Bonilla, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Orval Brown, MD  Director of Otolaryngology Clinic, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center at Dallas

Orval Brown, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Bronchoesophagological Association, American College of Surgeons, American Medical Association, American Society of Pediatric Otolaryngology, Society for Ear, Nose and Throat Advances in Children, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Alan D Murray, MD  Pediatric Otolaryngologist, ENT for Children; Full-Time Staff, Medical City Dallas Children's Hospital; Consulting Staff, Department of Otolaryngology, Medical Center of Lewisville, Children's Medical Center at Dallas, Cook Children's Medical Center; Full-Time Staff, Texas Pediatric Surgery Center, The Pediatric Surgery Center

Alan D Murray, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American College of Surgeons, American Society of Pediatric Otolaryngology, Society for Ear, Nose and Throat Advances in Children, and Texas Medical Association

Disclosure: Nothing to disclose.

Paul D Petry, DO, FACOP, FAAP  Consulting Staff, Freeman Pediatric Care, Freeman Health System

Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Chief Editor

Glenn C Isaacson, MD, FACS, FAAP  Professor of Otolaryngology-Head and Neck Surgery and Pediatrics, Temple University School of Medicine

Glenn C Isaacson, MD, FACS, FAAP is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Bronchoesophagological Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Society of Pediatric Otolaryngology, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Covidien Honoraria Consulting

References

  1. Craig MJ. Mandibulo-facial dysostosis. Arch Dis Child. 1955;30:391-397.

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

  3. Avelar JM, Psillakis JM. Microtia: total reconstruction of the auricle in one single operation. Br J Plast Surg. Apr 1981;34(2):224-7. [Medline].

  4. 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].

  5. 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].

  6. Cilingir M, Malkoc C, Duman A, et al. Microtia and pectoralis muscle agenesis. Plast Reconstr Surg. Jun 2004;113(7):2222-4. [Medline].

  7. Harris J, Kallen B, Robert E. The epidemiology of anotia and microtia. J Med Genet. Oct 1996;33(10):809-13. [Medline].

  8. Lynberg MC, Khoury MJ, Lammer EJ, et al. Sensitivity, specificity, and positive predictive value of multiple malformations in isotretinoin embryopathy surveillance. Teratology. Nov 1990;42(5):513-9. [Medline].

  9. More V, Ahuja SR, Kulkarni HV, Kulkarni MV. Bilateral anotia with congenital hypothyroidism. Indian J Pediatr. Apr 2004;71(4):369-70. [Medline].

  10. Nagata S. Total auricular reconstruction with a three-dimensional costal cartilage framework. Ann Chir Plast Esthet. Aug 1995;40(4):371-99; discussion 400-3. [Medline].

  11. Shih JC, Shyu MK, Lee CN, et al. Antenatal depiction of the fetal ear with three-dimensional ultrasonography. Obstet Gynecol. Apr 1998;91(4):500-5. [Medline].

  12. Smithells RW, Newman CG. Recognition of thalidomide defects. J Med Genet. Oct 1992;29(10):716-23. [Medline].

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

  14. Tanzer RC. Correction of microtia with autotenous costal cartilage. In: Tanzer RC, Edgerton MT, eds. Symposium on Reconstruction of the Auricle. St. Louis:. Mosby;1974:46-57.

  15. Yanai A, Fukuda O, Yamada A. Problems encountered in contouring a reconstructed ear of autogenous cartilage. Plast Reconstr Surg. Feb 1985;75(2):185-91. [Medline].

 
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Microtia, grade I. The pinna is malformed and smaller than normal. Most of the characteristics of the pinna, such as the helix, triangular fossa, and scaphae, are present with relatively good definition.
Microtia, grade II. The pinna is smaller and less developed than in grade I. The helix may not be fully developed. The triangular fossa, scaphae, and antihelix have much less definition.
Microtia, grade III. The pinna is essentially absent except for a vertical sausage-shaped skin remnant. The superior aspect of this sausage-shaped skin remnant consists of underlying unorganized cartilage, and the inferior aspect of this remnant consists of a relatively well-formed lobule.
Microtia, anotia. Total absence of the pinna.
Normal ear characteristics.
Microtia. Location of rib cartilage harvesting.
The sixth and seventh rib synchondroses form the base framework of the new ear. The eighth rib is used to form the rim or helix.
The 3 pieces of rib are carved, sculpted, and sutured together.
The new framework is inserted into a skin pocket under the microtic ear.
Photograph of the new framework inserted into a skin pocket under the microtic ear.
The second stage consists of forming the earlobe, otherwise known as transposition of the lobule. An incision is made both in front and behind the skin vestige as shown. The skin vestige is then rotated into place via a Z-plasty and spliced to the cartilaginous framework that was sculpted during the first stage.
Sutures are placed, and antibiotic ointment is applied.
The graft is taken from the upper buttock area on the same side as the microtic ear. The graft harvest site is hidden under the bathing suit or underwear region.
An incision is made behind the newly constructed ear, and the undersurface is undermined. The banked cartilage harvested from the first stage is then placed under the framework to provide support and elevation.
This raw tissue is lined with a skin graft.
The reconstructed ear is marked for the future placement of the tragus. An incision is made as shown. At this point, a J-shaped incision is made in the conchal area of the microtic ear.
Once the concha on the microtic ear is excavated, the second skin graft is placed to line the raw conchal tissue. The ear now has the appearance of having an external auditory canal.
Preoperative image of a grade III microtia.
Postoperative image of a corrected grade III microtia (same patient as image above).
 
 
 
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