The condition often is of one ear and is seen in children in varying severity. There are four grades of microtia- ranging from small, malformed ears to complete absence of outer ear (anotia). If there is an underdeveloped or missing ear canal, microtia ear can be associated with impaired hearing ability. The condition even ruins the facial aesthetics and can have psychosocial implications. But, there is a hope of treating it with ear reconstruction surgery.
Children suffering from microtia seek microtia ear reconstruction treatment, especially if having hearing loss and resulting speech difficulty. A microtia ear surgery using rib cartilage is a popular approach for treating microtia that affects appearance and/or is associated with a hearing loss complication. It overall involves 2 to 5 separate surgeries to reconstruct the microtia ear with exclusive use of the patient’s rib cartilage. It is recommended only when the child has a fully developed ear and enough rib cartilage to create an adult-size ear. The ideal age is between 6 and 10 years.
A microtia ear surgery using rib cartilage is a multi-stage/steps procedure. The steps and stages involved may vary from one patient to another depending on the techniques used and the grade of microtia the patient is suffering from. All stages are usually spaced months apart to allow for the re-establishment of blood supply between the surgeries. Keep reading to learn in detail what to expect from the surgery procedure.
Stage 1: Rib Cartilage Harvesting, Creation of Ear Framework, and Placement.
Harvesting of rib cartilage graft- The surgeon makes a small, oblique cut on the chest, just above where the 6,7, and 8 ribs lie, close to the sternum, to remove cartilage from these ribs. The ribs chosen for cartilage harvest are usually on the side opposite to the side of the microtia ear. For a thin child, the chest incision is only around 1 inch in length.
Sculpting of ear framework- Using their skills and expertise, the surgeon meticulously shapes and carves the harvested rib cartilage to get into the desired form of a normal, external ear. The fused 6th and 7th ribs cartilage pieces are used to form the base of the new ear framework and the 8th rib cartilage piece is used to form the helix- the rim of the ear. For this, the surgeon takes the patient’s normal, opposite ear as a template.
Placement of the sculpted cartilage ear framework- The surgeon marks the ear at the microtia site and makes an incision in the ear’s front, over the temporal bone. Under this small skin pocket, the framework is placed and then the incision is sutured. A drain is placed in the skin pocket to allow skin suction over the cartilaginous ear framework. The operated ear is left to completely heal, typically for 3-4 months, before going to the next stage.
Stage 2: Lobule, Tragus, and Concha Formation
Earlobe creation- To create an earlobe, the surgeon inferiorly rotates the auricular remnant or makes use of a separate cartilage graft.
Tragus and Concha bowl reconstruction- The surgeon even creates the tragus- the fleshy skin flap present in the front of the ear canal and deepens the concha or bowl- the curve on the ear’s inside.
The patient needs to wait for two months to undergo the next stage of the surgery- the final separation procedure.
Stag 3: Elevation and Postauricular Sulcus Creation
Elevation- The surgeon elevates the new cartilage ear framework away from the scalp, often using a tissue expander, placed before the stage. This step results in an ear with an excellent protrusion.
Postauricular Sulcus Creation- The elevation of the framework by the surgeon creates a natural groove behind the ear- a postauricular sulcus that mimics the natural ear structure.
Skin grafting- The surgeon covers the newly created postauricular sulcus with a skin graft harvested from the patient’s scalp or groin region.
Stage 4 (Optional): Additional refinements
The surgeon may further perform surgeries to refine the shape of the new ear or address any remaining issues with the ear. Further procedures may include:
Creation of new tragus
Creation of simulated ear canal (pseudomeatus).
Eager to learn more?
Dr. Parag Telang is an exceptionally, well-qualified reconstructive, plastic surgeon with expertise and experience in performing microtia ear reconstruction surgery with rib cartilage. Patients come from near and faraway places to The Microtia Trust in Mumbai to consult Dr. Parag Telang. To schedule a consultation, contact The Microtia Trust today!
