Pediatric Microtia Surgery Clinical Presentation

Updated: Nov 08, 2018
  • Author: Arturo Bonilla, MD; Chief Editor: Ravindhra G Elluru, MD, PhD  more...
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Presentation

Physical Examination

Consultation regarding a patient born with microtia and atresia ideally should occur soon after birth. This allows the ear surgeon to discuss the options with the parents and to calm their fears and anxieties.

The initial examination consists of a detailed head-and-neck examination. The most important things to be determined in this examination are as follows:

  • Type of microtia
  • Presence or absence of atresia
  • Size and location of the normal ear (in unilateral cases)
  • Level of the hairline on each side

Although severe conductive hearing loss usually results from lack of an ear canal, the inner-ear function is almost always normal, resulting in some ability to hear on the affected side.

Because approximately 90% of children with microtia are affected only on one side, the contralateral ear is almost always normal, resulting in relatively normal speech development. During the initial consultation, the ear reconstructive surgeon should reassure the parents and outline the future management of their child's condition.

If microtia is the only developmental anomaly, the initial workup consists of evaluation of the child's hearing status. As previously stated, the inner-ear function is usually normal in patients with microtia and atresia. Also, the middle-ear status of the nonaffected ear is usually normal, resulting in overall normal hearing in the nonaffected ear.

Next:

Classification

Microtia is classified into four grades along a spectrum that extends from less severe (grade I) to total absence of the external ear (anotia).

Grade I

In 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 (see the image below).

Microtia, grade I. Pinna is malformed and smaller Microtia, grade I. Pinna is malformed and smaller than normal. Most characteristics of pinna (eg, helix, triangular fossa, and scaphae) are present with relatively good definition. Patient is also lacking ear canal (atresia).

Grade II

In grade II, the pinna is smaller and less developed than it is in grade I. The helix may not be fully developed. The triangular fossa, scaphae, and antihelix (anthelix) have much less definition (see the image below).

Microtia, grade II. Pinna is smaller and less deve Microtia, grade II. Pinna is smaller and less developed than in grade I. Helix may not be fully developed. Triangular fossa, scaphae, and antihelix have much less definition.

Grade III

Grade III is considered the "classic" microtia. 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 (see the image below).

Microtia, grade III. Pinna is essentially absent, Microtia, grade III. Pinna is essentially absent, except for vertical sausage-shaped skin remnant. Superior aspect of this sausage-shaped skin remnant consists of underlying unorganized cartilage, and inferior aspect consists of relatively well-formed lobule.

Anotia

In anotia, total absence of the pinna is observed (see the image below).

Anotia (total absence of pinna). Anotia (total absence of pinna).
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