Microtia Repair

By | May 19, 2016
(Last Updated On: January 6, 2017)

Microtia is a congenital malformation of the external ear. The phrase microtia translates to “little ear.”  It presents itself in a number of forms, starting from an ear only slightly smaller than normal to a complete absence of the ear.  The latter is known as anotia which means “no ear.”  Microtia occurs approximately once in every 6,000 to 12,000 births.  This article aims to cover the various microtia repair options available to those afflicted with this deformation.

  1. Microtia Causes
  2. Microtia Atresia
  3. Bilateral Microtia
  4. Microtia Surgery
  5. Medpor Surgery
  6. Conclusions

microtia repair

1. Microtia Causes

Microtia causes are not well understood, specifically regarding the role of environmental and genetic factors. Genetics are perceived to be a cause in only 5% of all sufferers. A couple of theories have been proposed to provide the cause of microtia at some stage in fetal development, which includes neural crest cells disturbance, vascular disruption, and altitude, however these have not been verified.

It is vital to understand that when a woman becomes pregnant, activities such as drinking coffee, alcohol use and even drug abuse have not been indicated to cause microtia. However, within the first trimester of pregnancy, some medications have been linked to microtia, including: thalidomide and Accutane.

Microtia may also occur in conjunction with different syndromes such as Hemifacial Microsomia, Goldenhar Syndrome, or Treacher Collins Syndrome.  Certain syndromes associated with may also have an effect on the kidneys, the heart, the eyes, the craniofacial bones, and the skeletal system.

2. Microtia Atresia

Most often, microtia is accompanied by atresia. Atresia is Latin for “absence of an opening”, in this case the entrance to the ear canal.  Deformity of the middle ear bones (incus, stapes, and malleus) may likewise be affected together with the narrowing of the ear canal, known as canal stenosis.

3. Bilateral Microtia

Normally, microtia occurs on one side of the ear (usually on the right), however approximately 10% of sufferers have microtia on both sides (bilateral microtia). Children born with bilateral microtia are managed differently than those with unilateral microtia.

Fortunately, children with unilateral microtia have the opportunity to hear sounds with the other side of their ear. Children with bilateral microtia do not have this opportunity. Their hearing loss necessitates amplification with a bone-conduction hearing aid. There are generally three specialists involved in acquiring a bone-conduction hearing aid. The main doctor normally refers the child to an ear, nose and throat specialist. A hearing test is executed by an audiologist and this person is responsible for the dispensation and testing of the hearing aid.

One may ask how a child can hear if both ears are obstructed. The answer is simple: bone conduction. Children living with microtia have their normal internal ears where sound travels through the skull by means of vibrations. To rephrase it, a sound will strike the skull, nose, jaw etc., and vibrations get transmitted immediately to the inner ears, completely bypassing the ear canals.

4. Microtia Surgery

microtia causesAll kinds of ear surgery for microtia are technically difficult to perform. Most plastic surgeons would agree that ear reconstruction is one of the toughest operations to carry out. It requires creative microtia medical surgeons whose profession is devoted to this condition in order to get results with little complications. The reason for this is that the ear must be created to look natural. In recent times, microtia surgeons use two methods to create an ear, which are: rib cartilage ear surgery and medpor ear surgery.

Rib Cartilage Surgery

Rib cartilage ear surgery is the most typically used technique for ear reconstruction. Many microtia surgeons have, at some stage, contributed to the modification of this technique.

The method includes getting rid of the affected part of the patient rib cartilage and carving it to create the framework for a new ear. The framework is then placed in a pocket beneath the scalp skin. Two to four surgeries are required to finish a rib cartilage ear surgery, depending on the surgeon. This surgery cannot be performed until the patient has developed sufficient rib cartilage.

The appropriate age to undergo rib cartilage surgery is 6 years. Some reputable cartilage surgeons prefer a child to be 10 years of age before they have sufficient cartilage to make a symmetric ear.

5. Medpor Surgery

Medpor ear surgery is the latest technique in ear surgery for microtia. This technique was invented because of the dissatisfaction of the of rib cartilage ear surgery. A permeable polyethylene piece , properly matched with living tissue (referred to as Medpor) is used to create the structural framework of the ear. This technique is the only acknowledged surgical alternative to rib cartilage ear surgery.

Unlike rib cartilage, where the framework is placed beneath a tight skin envelope, the Medpor implant is located on the top of the scalp. This permits the creation of an ear with an equal projection and symmetric appearance to the normal ear.

The Medpor framework is protected with a thin “living tissue flap” taken from under the scalp that totally wraps around the implant, permitting this living tissue to integrate into the permeable Medpor. Skin is then embedded on top of the flap.

Medpor surgery can be carried out on children from 3 years of age, due to the fact that the surgery does not depend on the patient having adequate rib cartilage.

An exceptional benefit of Medpor surgery is the possibility for early surgical restoration of hearing because the creation of the ear canal is usually completed earlier than the ear reconstruction.

Few surgeons have been successfully trained to work with Medpor however. It is therefore very important that surgeons using this technique have a wide range of experience due to the technical proficiency needed to perform Medpor surgery.

Before your child undergoes surgery, your prospective microtia surgeon should discuss the dangers, advantages, alternatives, limitations, and complications with you. It is advisable for you to examine before and after picture of patients before choosing your child’s microtia surgeon. Although complications may occur in any operation, surgeons with inadequate experience on microtia reconstruction can create a traumatic experience for the child and the family.

6. Conclusions

Microtia may be an unfortunate birth defect, but thankfully it is treatable. Thankfully, in today’s world, children born with microtia do not have to suffer through their ear deformity.  Microtia repair provides the opportunity for a child to look and feel natural. It is vital to speak to a reconstructive surgeon who has more experience in this field because they will have the skill and expertise to create a solution that is realistic and functional.

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