Personal Experience in Microtia Reconstruction

In facial esthetics, an anatomically normal external ear is integral in maintaining facial proportions, balance, and symmetry. The shape and size of the ear can have a considerable effect on confidence and self-esteem. When the external ear is significantly underdeveloped at birth, as in microtia, many aspects of the child's life are impacted. Microtia can negatively alter body image and disrupt personal and social development. Reconstructing the ear will enable the child to feel 'normal', thereby preventing the psychological and social challenges associated with the condition. Autologous costal cartilage reconstruction for microtia is extremely challenging. The technical difficulty is compounded by the rarity of the condition and the unforgiving consequence of a suboptimal result. A poor reconstruction will increase the challenges for the child, which will become lifelong. It is, therefore, essential that high standards in reconstruction are strived for and attained in primary surgery. This will require consistent exposure to cases, meticulous training, and comprehensive sub-specialization in the field. In this article, the author sets out his approach to autologous costal cartilage reconstruction for microtia, which he has developed over the past 2 decades. The author will highlight central points in planning and performing the surgery, which must always be based on the understanding that microtia is a spectrum of conditions. The paper discusses important practical aspects based on a 2-stage surgical approach. The following points are reviewed: surgical timing, preoperative planning, types of skin incisions, rib harvest and framework fabrication, and options for the second stage. The aim is to provide an overall view of microtia correction using autologous rib cartilage.