Unilateral microtia reconstruction: is the position symmetrical?

A method of analyzing the head position of the reconstructed unilateral microtic ear relative to the normal side was developed and applied in the assessment of 78 microtic ear reconstructions. Two groups of patients were assessed. Group I included 58 unilateral microtia patients, some with no clinical evidence of lateral facial dysplasia and others with mild to moderate lateral facial dysplasia, as judged by three experienced clinical observers. Group II included 20 unilateral microtia patients with severe lateral facial dysplasia involvement. Of special interest was evidence of lateral facial dysplasia in 88 percent of the patients reviewed. A reproducible technique was developed to assess the position of the reconstructed ear. Three slides showing the normal ear, reconstructed ear, and anteroposterior views of each patient were projected onto a centimeter grid to provide life-size (5-cm) proportions. The normal side served as the control. Length, angulation, and height were compared between normal and reconstructed ears by using a clear film rhomboid pattern designed by choosing specific reproducible landmarks. In group I, the reconstructed ear was of acceptable length and angulation in 91 and 95 percent of the patients, respectively, and of proper height in 88 percent. The corresponding values in group II were 90, 95, and 90 percent. Efforts should be made at the time of original surgery to ensure that the reconstructed ear is not only aesthetically pleasing but also positioned correctly. The technique used by us is one example of an attempt to evaluate the resultant ear position in microtia reconstruction.