Analysis of 42 bilateral microtia reconstruction: Comparative study and surgical characteristics

Microtia reconstruction is a demanding procedure owing to the structural complexity of the ear. Ten percent of microtia patients have bilateral involvement, which complicates the reconstructive procedure because of the limited amount of donor tissue and necessity for ear canal reconstruction. We conducted a comparative study between patients with unilateral and bilateral microtia as well as a detailed analysis of patients with bilateral involvement to clarify the features of bilateral auricular reconstruction. Patients who underwent ear reconstruction for congenital microtia between June 2001 and December 2022 were retrospectively reviewed. Patient demographics, subtype of microtia, concurrent syndromes, and postoperative complications were collected. Surgical history related to ear reconstruction including the age at the time of surgery was reviewed. Of 774 microtia patients, 42 (5.4%) had bilateral involvement, and 816 ears were classified according to Nagata's classification. Of the patients affected unilaterally, 58.1% had lobule-type, 40.9% had concha-type, and 1.0% had anotic microtia. In contrast, in the bilateral group, 7.1% had anotic, 25% had concha-type, and 67.5% had lobule-type microtia. When surgical histories were compared, bilateral microtia cases required frequent tissue expansion and external auditory canal reconstruction compared with unilateral cases. Although bilateral cases underwent additional surgeries, the complication rate and need for esthetic or therapeutic revision was not greater than that of unilateral cases. No surgical or patient factor had a significant association with complications in the analysis of patients with bilateral microtia. The average number of surgical procedures was 6.91 (range, 4-12, SD=1.89) per patient. Mean age at completion of surgery was 18.93 (range, 10-40) years.