A Novel Advantage to Microtia Reconstruction Utilizing Ear Molding: A Case Report of Goldenhar Syndrome's Clinical Presentation and Surgical Reconstruction

This case report describes a unique approach to reconstructing microtia in a patient with microtia and craniofacial microsomia. Microtia is a congenital outer ear deformity that can vary in severity, from minor abnormalities to complete absence of the ear. The traditional methods for microtia reconstruction are autologous reconstruction using the patient's rib cartilage or alloplastic reconstruction using porous polyethylene. Autologous reconstruction typically begins around age six to 10 years of age when the rib cage is sufficiently large enough, while alloplastic reconstruction may be performed as young as three years of age. In this case, the surgeons used ear molding in infancy to alter the shape of the existing skin and cartilage, thus creating a larger surface area for the ear. This approach, which is not commonly used, aims to create a more favorable shape for the microtia remnant to assist in the eventual reconstruction. A subsequent procedure to elevate the microtic ear was performed at the time of the surgical repair of macrostomia (lateral cleft lip). Using ear molding in infancy for microtia reconstruction has several potential benefits. It can lead to a more natural ear appearance as the child ages, which can have positive psychological and social implications. By starting the reconstruction process early, the child may grow up with a less noticeable deformity. Finally, ear molding can also improve the shape of the newborn microtia ear leading to more favorable anatomy prior to surgery. This case report highlights the advantage of early intervention with ear molding for selective patients with grade I or grade II microtia in preparation for their future reconstruction, particularly in patients with associated syndromes who may have more unique anatomy.