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Published on: February 29, 2020
Vertebral Anomalies in Microtia Patients at a Tertiary Pediatric Care Center
Nicole L Alexander1, Alexandra McLennan2, Rodrigo C Silva3
1Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA.
Objective:
Microtia is a congenital condition known to be associated with vertebral anomalies and congenital syndromes, most prominently hemifacial microsomia. There is controversy, however, on whether to screen with spinal imaging. Additionally, microtia ear reconstruction utilizes rib harvesting that could potentially worsen pre-existing vertebral and rib anomalies, specifically scoliosis. We report on the prevalence and characteristics of vertebral anomalies among microtia patients at a tertiary pediatric center.
Study Design:
Retrospective case review with literature review.
Setting:
Tertiary pediatric referral center.
Methods:
A review of 425 children with microtia was conducted, characterized as either syndromic or nonsyndromic. Data included demographics, spinal imaging performed, indications, anomalies detected, and microtia repair.
Results:
Among 425 microtia patients, 24.5% were syndromic with an average age of 9.7 years. Only 18.4% of all patients had spinal imaging performed (50% syndromic vs 8.1% nonsyndromic). Overall, 10.6% had a vertebral anomaly with a 57.7% detection rate (67.3% syndromic vs 38.5% nonsyndromic). The most common anomaly was scoliosis, with a prevalence of 7.8%. Fusion defects and rib deformities were the next most prominent. Microtia repair, most commonly with an autologous rib graft, was performed in 21.6% of the cohort. However, only 19.2% had spinal imaging and 16.7% with a vertebral anomaly.
Conclusion:
Children with microtia are at a greater risk of vertebral abnormalities. Scoliosis prevalence in isolated microtia is comparable to the general population (2%-3%) but greatly increased with genetic syndromes. Screening for vertebral anomalies should be considered when planning microtia reconstructions, especially in the syndromic population.
Insights
Children with microtia have a higher risk of vertebral abnormalities, particularly scoliosis. Screening for these anomalies is recommended before microtia reconstruction, especially in syndromic cases.
Area of Science:
- Pediatric Orthopedics
- Congenital Malformations
- Medical Genetics
Background:
- Microtia, a congenital ear anomaly, is often associated with vertebral and craniofacial abnormalities, including hemifacial microsomia.
- The necessity of spinal imaging screening in microtia patients remains debated.
- Ear reconstruction in microtia may involve rib harvesting, potentially exacerbating existing spinal or rib deformities like scoliosis.
Approach:
- A retrospective case review of 425 microtia patients was conducted at a tertiary pediatric center.
- Data collected included patient demographics, syndromic status, spinal imaging details, detected anomalies, and microtia repair procedures.
- A literature review supplemented the case analysis.
Key Points:
- Vertebral anomalies were identified in 10.6% of microtia patients, with a higher prevalence in syndromic cases (67.3% detection rate).
- Scoliosis was the most frequent anomaly (7.8%), followed by fusion defects and rib deformities.
- Spinal imaging was performed in only 18.4% of patients, highlighting a gap in screening, especially for non-syndromic individuals.
Conclusions:
- Microtia patients exhibit an increased risk for vertebral abnormalities, with syndromic cases showing significantly higher rates.
- Scoliosis prevalence in isolated microtia is similar to the general population but escalates with genetic syndromes.
- Preoperative spinal screening is advised for microtia patients, particularly those with syndromic conditions, to inform surgical planning and mitigate risks.
