Ear Remnant Incision Expander Method for Conchal-Type Microtia: A 10-Year Study

The aims of the study were to evaluate the clinical efficacy of the ear remnant incision expander method for ear reconstruction in conchal-type (Grade II in Marx classification) microtia and analyze its advantages, limitations, and optimization strategies.

This retrospective study included 159 patients with conchal-type microtia treated between 2013 and 2023. The surgical procedure involved a standardized tissue expansion protocol followed by a 3-step reconstruction process: (1) incision design along the longitudinal axis of the remnant ear and expander removal, (2) selective excision of cartilage tissue from the upper wall of the conchal region of the remnant ear, and (3) carving and implantation of a 3-dimensional ear framework using rib cartilage (6th-8th), with the inferior crus of the antihelix positioned at the site of remnant cartilage removal. Outcomes were evaluated by 2 independent physicians using a validated anatomical scoring system and patient satisfaction assessment, with follow-up ranging from 6 months to 10 years.

Among the 159 patients, 147 (92.5%) reported satisfactory results. Physician evaluation showed excellent outcomes in 127 patients (79.9%), good in 29 patients (18.2%), and poor in 3 patients (1.9%). The highest scores were observed for helix and lowest for triangular fossa. Complications included pigmentation (2.5%) in the conchal cavity and scar hyperplasia (3.8%) on the reconstructed ear. Age subgroup analysis revealed better outcomes in pediatric patients (5-12 years) compared to adults ( P < 0.05).

The ear remnant incision expander method is effective for conchal-type microtia, providing good aesthetic outcomes with high patient satisfaction. This approach is particularly beneficial for pediatric patients, with complications effectively managed through conservative measures. The technique offers a valuable option for auricular reconstruction in selected patients with conchal-type microtia.