Most plastic surgeons will agree that ear reconstruction is one of the most challenging operations to perform. All types of ear surgeries for Microtia are technically difficult to perform. It takes a very experienced Microtia surgeon to get consistent results with few complications. The reason for this challenging operation is the very complex shape that must be created for the ear to look natural.
Reconstructed ears cannot bend or be flexible because they are not made up of the thin flexible cartilage that supports the natural ear. The framework needs to be able to withstand the forces of scar tissue that would distort a more flexible framework.
There are 4 options that can help you can choose from to treat Microtia. They are mentioned below.
Rib Cartilage Ear Surgery
Rib Cartilage Ear Surgery is the most commonly used method for ear reconstruction. Over the years, many Microtia surgeons across the world have made their fine contributions to the refinement of this technique and as a result of which individual differences within Microtia Rib Cartilage Surgery have emerged.
Rib Cartilage Ear Surgery involves removing a portion of the patient’s rib cartilage and molding it to create a framework for a new ear. The framework is then placed in a pocket under the scalp skin. 2 to 4 surgeries are needed to complete a Rib Cartilage Ear Surgery. The number of surgeries depends entirely on the surgeon. This surgery technique is age dependent, as the surgery cannot be carried out without the patient having developed sufficient rib cartilage. The earliest age to commence a Rib Cartilage Surgery is 6 years old. If a child happens to have a smaller or a larger ear on the opposite side, the surgery might be delayed until 7 to 9 years of age. Some experienced surgeons are of the view that a child must be at least 10 years old before the surgery takes place so that there is enough cartilage at their disposal to create a symmetric ear.
Due to the nature of Microtia surgery, it is imperative that surgeons using this technique have extensive experience.
Before your child undergoes surgery, your surgeon should discuss all the aspects of the surgery like; the risks involved, benefits, limitations, complications and alternatives with you.
We strongly advise you to review “before” and “after” pictures of patients before choosing your surgeon and this type of Microtia Surgery.
The Advantages of Rib Cartilage Ear Surgery:
• The body’s natural tissue is used instead of a manufactured product
• Very safe
• The chest incision made for the surgery can be very small
• Has been the standard procedure for Microtia surgery for decades
• Optimum results with the right experienced surgeons
• The cartilaginous ear lasts a life time
• Playing sports are of little or no concern
The Disadvantages of Rib Cartilage Ear Surgery:
• The surgery should be performed only by experienced Microtia surgeons
• An incision is required over the rib area
• Technically difficulty
Medpor Ear Surgery
Medpor ear surgery is the newest technique on the block when it comes to Microtia ear surgery. Disappointed with the limitations of the traditional Rib Cartilage Ear Surgery, Dr. John Reinisch pioneered the invention of Medpor. Medpor deals with using porous polyethelene that is compatible with living tissue (Medpor) to create a structural framework for the new ear.This method is the only other widely accepted surgical alternative to Rib Cartilage Ear Surgery. Contrary to Rib Cartilage, where the framework is placed under a tight skin envelope, the Medpor implant is place on top of the scalp. This enables the creation of a new ear with an equal projection and symmetric look to the normal ear in a single outpatient surgery.
The Medpor framework is enveloped with a very thin “living tissue flap” taken from beneath the scalp that completely wraps around the implant allowing this living tissue to amalgamate into the porous Medpor. The skin is then embedded on top of the flap. The advantage of this surgery is that it can be performed on children as young as 3 years old, because the surgery is not dependent upon the patient having enough rib cartilage.
In the year 2006, Dr. Lewin developed a ground breaking surgical method wherein the living tissue could be retrieved without the need for any incisions in the scalp. This innovation has led to the elimination of many criticisms about Medpor Ear Surgery, as the technique is now less invasive than the Rib Graft Ear Surgery.
An added benefit of Medpor Ear Surgery is the possibility for early surgical restoration of hearing as the creation of the ear canal is usually achieved before ear reconstruction. Contrary to Medpor, the canal is created after the ear is reconstructed in the case of Rib Cartilage procedure. Medpor gives your child a functional and natural looking ear well before kindergarten.
The Advantages of Medpor Ear Surgery:
• This surgery can be performed at an early age
• Avoids chest incision
The disadvantages of Medpor Ear Surgery:
• The Medpor will not develop or grow with the patient
• The skin may look different because most of the implant is covered by skin from another part of the body
• Using the temporal fascia flap is an invasive procedure
• Placing a skin graft on the front part of the ear does not give the same sensation as normal skin
• The scalp has to be split above the ear to obtain a tissue flap in order to cover the implant
• There are chances of hair loss at the site of the incisions that might be very noticeable if the child has short hair
• A large scare may also be noticeable above the ear as a result of the flap obtained to cover the implant
Ear Prosthesis is a non-surgical alternative to the two methods of Microtia Ear Surgery explained in detail above. A specialist known as an Anaplastologist is the one who creates custom made prosthetics to match the normal ear. The prosthesis for the ear is made out of silicone from a mold of the normal ear and then hand painted to match the skin tone of the patient. If the patient suffers from Bilateral Microtia, then the molds are made from the parents ears. The prosthesis can be attached to the head by an adhesive or by clips or magnets which require a surgical procedure to implant these into the scalp.
The advantages of Ear Prosthesis are:
• A good anaplastologist can create a very realistic looking ear
• No need for surgery if the Adhesive method is used
• A small surgery is needed if clips or magnets are used
The Disadvantages of Ear Prosthesis are:
• Skin color cannot match the other ear because the prosthesis cannot acclimatize to natural changes in skin color from exposure to the sun
• There is a very visible transition between normal skin and the prosthesis
• The prosthesis needs to be cleaned daily along with the removal and application of it, reminding a patient that it is not a part of their body
• An artificial ear is devoid of any sensation that develops with a reconstructed ear.
Having normal hearing capacity in the good ear, can enable a child to live a relatively normal life. There are many adults suffering from Microtia who choose to avoid reconstruction and yet go on to live normal lives. But there also those who are prone to develop psychological scars.