Issues on aural atresia for the facial plastic surgeon

Rehabilitation of hearing in the child with congenital microtia and aural atresia is a fundamental part of the total reconstructive process. Not all children with microtia, however, are candidates for atresia repair. A grading scheme to evaluate a patient's candidacy for atresia surgery has been developed and facilitates the selection process. If aural atresia surgery is to be undertaken, the reconstructive surgeon planning microtia repair must be aware of certain concepts. We present our recommendations on the chronology and timing of surgeries, the relation of microtia repair to atresia repair, expectations after atresia repair, the importance of the conchal bowl and tragus, and the possibility of injuring an aberrant facial nerve. We stress close coordination of efforts between reconstructive surgeon and otologist to achieve the best possible functional and cosmetic outcome.