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Ear reconstruction: Microtia

The greek word “microtia” means, in English, “small ear”. The condition occurs in 1 in 6000 babies around the world which means something around 80 children a year are born with the condition in the UK. Mostly, it presents without any other detectable problem, but it can be linked to conditions such as Hemifacial Microsomia, Goldenhar’s Syndrome, Treacher Collins Syndrome and other rarer conditions.

Microtia reconstruction necessitates recreating the ear’s contours with a resilient framework for which the ideal material is the patient’s own rib cartilage. Surgeons who are experienced  in sculpting rib cartilage can reliably reproduce the contours of the ear. While there will be a small scar of around 6cm on the chest, the rib is reconstructed during surgery so no deformity results.

In microtia surgery, two operations are usually necessary: The first stage involves removing the rib cartilage and sculpting a framework from it. The framework is then placed in a skin pocket at the site of the new ear.

In the second operation, performed around six months after the first, the ear framework is released from the pocket, to give it prominence and create the sulcus behind it with symmetry with the other ear being the aim of the surgery.

It is advised not to be tempted or persuaded into surgery before a child is around 8 years of age. Synthetic reconstructions are generally reserved for cases in which rib cartilage cannot be use, for example when it is damaged or calcified. In such cases, a prosthesis can be placed under the skin or can sit outside the skin while being attached to the head with bone anchors. But the gold-standard treatment for a durable, stable ear involves using the patient’s own tissues, and other techniques are advised only when rib cartilage reconstruction is not possible.
Click here to watch a video of Ethan’s ear reconstruction performed at the Royal Free London NHS Foundation Trust: