Microtia and Aural Atresia Treatment

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See all before and after microtia photos.

Stages of Microtia

  • Stage I – A slightly small ear with identifiable structures and a small but present external ear canal
  • Stage II – A partial ear with a closed off or stenotic external ear canal producing conductive hearing loss
  • Stage III – Absence of the external ear with a small vestige structure and an absence of the external ear canal and ear drum
  • Stage IV – Complete absence of the total ear, also termed anotia

Treatment Options

Prostheses
A silicone prosthetic ear created by a maxillofacial prosthetist looks very similar to a normal ear. One type “sticks” on and the other is an osseointegrated prosthesis that requires surgery to place two or three anchors into the bone around the ear as a fixation device upon which the prosthetic ear snaps into place. A prosthetic ear requires very little surgical risk, can look very realistic and is an excellent option for patients ineligible for reconstructive surgery.

Implant
In this option, a synthetic material is used as the ear framework to be inserted under the skin and covered by one’s own tissue. The implant is usually placed during two outpatient procedures.

rib cartilageReconstruction Using Rib Cartilage
Since ears are naturally made out of cartilage, most surgeons believe in using one’s own rib cartilage to sculpt a new ear, which would be covered by the patient’s own tissue. This is a well studied/tested technique for ear reconstruction using the patient’s own tissue to create a living structure that can stand up to aging, infection and even inadvertent trauma from contact sports.

Reconstruction with rib cartilage is performed in 2 separate stages over 4 to 6 months. Patients must be 9 to 12 years old to begin this type of reconstructive surgery.


STAGE 1:
The first stage of reconstruction involves harvesting several segments of rib cartilage, constructing and inserting the new ear framework in the appropriate position, and usually repositioning the earlobe. Ideally, this surgery is performed when the patient is between the ages of 9 and 12, though exceptions are occasionally made.

The surgery is performed under general anesthesia and takes about 4 hours. Patients typically stay in the hospital for 2 to 3 nights after surgery. Normal daily activities may be resumed after a week to 10 days. Contact sports may be resumed in 4 to 6 weeks, depending on healing.

STAGE 2:
The second stage of reconstruction, which takes place approximately 4 to 6 months after the first stage, involves elevating the new framework from the side of the head and placing a skin graft on the elevated surface. This stage typically takes 2 to 3 hours. Patients typically stay in the hospital for 1 night. Normal activities may be resumed in 7 to 10 days, and contact sports may be resumed in 4 weeks.