Optimizing Microtia Results in Alloplastic Ear Reconstruction

To analyze which patient and surgeon factors impacted aesthetic outcomes in alloplastic microtia reconstruction.

Retrospective cohort study was conducted of a single microtia team at an academic tertiary care children's hospital. Consecutive patients who underwent porous polyethylene (PPE) microtia reconstruction between October 2020 and September 2023 were retrospectively included in the study. Data including demographics, height, and weight, microtia grade, complications, and surgeon experience was collected. Reviewers (otolaryngology residents) blinded to surgical details provided an aesthetic score for each postoperative ear photograph through a web-based survey.

Fifty-one subjects undergoing primary microtia reconstruction were included: mean age was 9.5 years (range 4-18 years), and 24 (47%) were female. Post-operative photographs were taken an average of 23 weeks following surgery (range 8-42 weeks). Younger age was correlated with better aesthetic outcomes (coef. -0.8, p = 0.02). In a linear regression model controlling for age and sex, both BMI z-score > 1.0 (-6.6, p = 0.004) and need for revision surgery (-9.6, p = 0.003) were significantly associated with lower mean cosmetic scores. Mean aesthetic scores increased with surgical experience, but the trend was not statistically significant.

Certain patient characteristics such as younger age, normal BMI, and uncompromised wound healing were strongly associated with improved aesthetic results in alloplastic microtia reconstruction. Increasing surgeon experience may contribute to improved aesthetic outcomes. These findings can be used to counsel families and help predict results after alloplastic microtia reconstruction.