Reconstruction of the microtic ear

Although microtia occurs in only 1:7000 to 8000 births, this major congenital ear deformity can result in significant psychological trauma for the affected child. Reconstruction of this complex deformity represents one of the greatest challenges to the reconstructive surgeon. Based on the pioneering work of Tanzer and Brent, the techniques have matured to the point that consistently good results can be obtained and many of the resultant problems associated with the deformity avoided. In classic microtia, a sausage-shaped vestige is made up of a rudimentary lobule and various additional remnants. The external canal is usually absent. Where hearing is normal in the opposite ear, it is not necessary to reconstruct the middle ear or external canal on the affected side, and these procedures may compromise the result of the external ear reconstruction. The staged reconstruction of the microtic ear, which can begin at 5 years of age, involves: placement of an autogenous cartilage framework; rotation of the lobule, formation of a conchal depression and tragal reconstruction; limited elevation of the helical rim; and minor final adjustments. The cartilage is placed during the first stage to make maximal use of the non-scarred elastic skin in the area of the skin pocket. This allows better splicing of the lobule in the second stage. The use of a very thin skin flap over the framework allows heightened definition of cartilage detail, better skin-cartilage coaptation, and at appears to play a vital role in preventing late deformation of the cartilage framework.(ABSTRACT TRUNCATED AT 250 WORDS)