Keep your face to the sunshine and you cannot see a shadow - Helen Killer
Grafting is not necessarily required for all congenital ear deformities. In case of a minor deformity, some cartilage maybe taken from the other ear to replace what is missing or abnormal. This does not cause any deformity in the good ear. Often times, these minor procedures can be performed during the course of one day. The patients can be allowed to go home the very day after surgery and rest.
Some of the minor ear deformities are explained below:
Where there is no development of the external ear or the conducting system.
Anotia : an almost anotic ear
Where almost all the cartilaginous constituents are missing and what is usually seen is a soft tubular structure with the consistency of the ear lobule. Several variations of this are possible. Very often the external auditory canal as well as the rest of the conducting system also fails to develop.
Microtia : Various soft tissue vestiges with some cartilage embedded in them are shown here. Notice none of them have an external auditory meatus.
A “Lop Ear” is a deformity in which,the cartilage of the upper part of the ear is abnormal or bent over. This is caused due to the relative shortage of skin i.e. underdeveloped helicial cartilage and also due to the smaller cartilage framework as compared to the other side. Surgery entails the correction of the cartilage using either the cartilage already existing in the ear or sometimes a cartilage graft from the other ear. Skin cover involves making use of local skin flaps. In case the condition is severe, the correction is made using a rib graft, which is similar to the procedure for Microtia.
A case of Lop Ear. The upper part of the ear is both limp and maybe deficient in skin as well as cartilage. Auriculo-cephalic angle has increased. (Line drawing of a standard lop ear showing an increased auriculo-cephalic angle in the picture on the right.)
Here the cartilage of almost the whole of the ear is deficient together with a deficiency of the skin. The ear does not unfurl and looks like a cup. Here too as in a lop ear deficiencies of the middle ear may or may not be present.
A case of Bilateral Cup Ear. There is deficiency of cartilage in the upper and middle part of the ear together with a corresponding deficiency of skin
Cryptotia is also called “hidden ear”. In this deformity, the upper part or the superior portion of the ear is buried under the skin of the scalp.The cartilaginous frame is usually normal and developed but is contained within a pocket of skin.The ear fails to separate and rise and an auriculo-cephalic sulcus is not produced.Reconstruction in the case of Cryptotia, involves lifting the ear out from under the skin, thus creating a groove behind the upper ear and making use of flaps of the surrounding skin to cover the ear cartilage. This operation is usually carried out in a single stage and is a day procedure.
Two illustrations of Cryptotia contributed by Milind Wagh of Mumbai. In the picture on the left, the cartilage is lmost normal, the picture on the right, the cartilage might be somewhat deficient. The external audicity meatus in both cases is normal.
In this case the deficiency in the cartilage is more severe than in the cases shown on the left side. the external auditory meatus is normal Photo : Nitin Mokal
The ear is developed normally but the auriculo-cephalic sulcus is exaggerated and the normal helical architecture is less pronounced.
A case of left Bat ear with a pronounced auriculo-cephalic sulcus. The cartilages do not have their normal projections but are in place. The right ear is normal. The left should resemble the right ear after reconstruction.