Microtia Ear Reconstruction: An Introduction

Ear reconstruction surgery is a specialized field of surgery that typically deals with correcting congenital ear deformities, ear tissue trauma or partial ear loss. Unlike standard Otoplasty (ear-pinning surgery), which is a cosmetic procedure, Microtia ear reconstruction is a corrective form of ear surgery.

Microtia is a congenital ear deformity that can range from slightly disfiguring, to very severe and impairing—some Microtia patients literally have no ear tissue whatsoever. Read on to learn more about Microtia ear reconstruction, and how this condition can be corrected through plastic surgery.

More About Microtia

According to eMedicine data, Microtia occurs in roughly 3 in 10,000 live births. Not a large portion of the population, but unless Microtia is treated early for these individuals, the condition can lead to serious self-esteem problems, low self-image, and auditory deficiencies in severe cases. Microtia occurs most often in males, and tends to affect the right ear more than the left—however, Microtia has been known to develop in the left ear, or in both ears.

The actual causes of Microtia haven't been fully identified yet. Some doctors and researchers estimate that Microtia can be caused by decreased blood flow to the ear during in-utero development. Others claim that certain medications taken by the mother during pregnancy, such as Accutane or Thalidomide, or a maternal case of rubella during the first trimester, can cause Microtia in newborns. Microtia is also commonly found in infants suffering from inherited craniofacial development disorders like Treacher Collins Syndrome (TCS).

Identifying Microtia

The severity of Microtia will greatly determine when ear reconstruction methods must take place, and which surgical techniques must be employed. Here are the four classifications of Microtia as identified on Microtia.net:

Grade I Microtia: the most minor level of Microtia, Grade 1 patients often possess a majority of the normal outer ear components and features. However, the ear is usually smaller in size, and it may or may not have an auditory ear canal (ear opening).
Grade II Microtia: Many of the components of a normal outer ear are missing, excepting the lobule (ear lobe), and the helix (outer ear rim).
Grade III "Classic Microtia": The auricle (outer ear structure) consists of only a narrow appendage of skin and cartilage with some deformed lobule tissue. No external auditory features are present.
Anotia: literally meaning “no ear,” this type of Microtia is the most severe. There is no auricle (external ear structure) present, and the inner ear canal/auditory elements are often completely absent (Atresia) or compromised.

Ear Reconstruction Techniques and Microtia Surgery

Unless the deformities present are very severe—like with Anotia or Classic Microtia—it's recommended that children with Microtia don't undergo ear reconstruction surgery before the age of 6 or 7. Some plastic surgeons even insist that the patient reach 9 or 10 before performing Microtia surgery on them. While it's important to correct major auditory issues early on, putting off Microtia surgery for a few years can allow more natural cartilage and tissue to develop, for utilization during ear reconstruction surgery.

Two straight-forward fixes for Microtia and other ear deformities are a prosthetic ear or an ear implant. Both of these reconstruction options require very minor surgery, however their results may not look as realistic as those achieved with other ear surgery techniques. Plus, ear implants and prosthetics can be more susceptible to accidental removal, and may not be a correct skin tone match. And as with other prosthetic limb attachments, a prosthetic ear will always feel unnatural and separate from the body—many children might be uncomfortable with them.

Standard Microtia surgery has 4 stages to be completed:

1: Rib cartilage harvesting and carving
2: Shaping the lobule
3: Elevation or lifting of the ear
4: Forming the external ear canal

These 4 steps to Microtia surgery are completed separately; usually spaced apart by 2-3 months so that proper healing can take place before the next phase of the process. The Microtia surgery timeline will be stretched even further for patients with Bilateral Microtia, or Microtia of both ears. If surgery needs to be performed on the middle or inner ear, this is done after the outer ear reconstruction is finished.

Choosing a Qualified Ear Reconstruction Surgeon

If you have a child with Microtia, or are an adult requiring ear reconstruction surgery, it's absolutely essential that you find an expert ear reconstruction surgeon to complete the procedure. Ear reconstruction is a highly delicate and specialized field, and Microtia surgery is very difficult for inexperienced plastic surgeons to perform.

However, a cosmetic Otoplasty procedure like ear pinning surgery—which is both more straightforward and less invasive than Microtia surgery—is offered and successfully performed by many board-certified plastic surgeons today. Lastly, be sure to consult in depth with your plastic surgeon about all ear reconstruction risks, side effects, costs and details before pursuing this procedure for you or your child.