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Plastic Surgery - Congenital Ear Deformities 
 
 

Microtia

What is Microtia?
Treatment of Microtia

Prominent Ear

What is Prominent Ear?
Treatment of Prominent Ear

Congenital ear deformities cover a wide range of defects concerning the outer ear, the part we see. Some abnormalities include defects in the shape of the ear cartilage, extreme protrusion of the ear, and complete absence of the entire ear cartilage shape often with only a small bit of earlobe and tissue present. The unique nature of a child’s ear deformity will determine the timing and type of reconstruction necessary. Below are some of the more common congenital ear deformities and their treatment.

Microtia

What is Microtia?

Microtia is a congenital (from birth) absence of the ear. Microtia, or “small ear,” can exist in a variety of forms. In some cases the ear is relatively well formed but undersized. In more severe cases, any recognizable ear cartilage and structure is absent; all that typically remain is a piece of an earlobe.

Children with microtia often lack most of the external form of the ear as well as the external ear canal. They also usually have malformations of the bones of the middle ear that lead to conductive hearing loss on the affected side. The internal ear is usually unaffected, and therefore bone conduction hearing aids are a possibility to help improve hearing, especially if both ears are affected.

Because of the possibility of more than 50% hearing loss your child’s hearing in both ears should be tested early on by an audiologist with a referral to an otolaryngologist (an ear, nose, and throat surgeon). Early recognition of the amount of hearing loss and development of treatment and surgical strategies helps ensure proper speech development for your child.

Treatment of Microtia

Treatment of microtia is focused on rebuilding the external ear, creating a more normal ear shape and position. We use natural materials from the child’s body to improve long term durability of the ear and to avoid complications. Some complications can include infection or extrusion, when the body rejects the implants and procedures.

Treatment is carried out in multiple stages usually beginning after the age of 10. This allows for enough of the body to mature so as to be able to produce enough strong, extra cartilage and skin needed for the procedures. Also, being older than 10 will help your child achieve his/her desired results with the fewest amount of surgeries, which means less time invested in doctors’ visits, surgeries, and follow ups. 

During the first stage, rib cartilage is removed and reshaped to match the non-deformed ear. This “new ear” shape is then inserted underneath the hairless skin in the area of the affected ear. At this time, the earlobe may be moved into a position to better suite the ear later on. Any unnecessary, remaining bits of ear will be removed during this process. This stage ends with an ear with a good shape located below the skin, against the side of the child’s head.

The second stage of treatment can be performed 4-6 months after the first treatment has adequately healed. During this surgery the ear is lifted from its previous position. Extra cartilage, saved during the first surgery, is used to help prop the ear out from the head, giving it a more normal position. A skin graft either from the chest or from behind the ear is used to make sure the extra cartilage is properly covered.

After this stage, the projection and shape of the ear has been established. The reconstructed ear will be thicker and stiffer than a normal ear in order to keep its shape. You or your child may want further adjustments on the reconstructed ear after these initial surgeries; this usually involves minor procedures that can be carried out under local anesthesia.

Because the nature of ear reconstruction is so closely linked with the option to improve hearing, surgery should not first be undergone without a consultation with an otolaryngologist, an ENT (ear, nose, and throat) surgeon. Surgery can and should sometimes be delayed based on the work done by the ENT and the progress achieved by the child.

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Prominent Ear

What is Prominent Ear?

Prominent Ear exists when a portion of or the entire ear structure sticks out from the head more than is typical. Although this is a relatively common deformity, it can still be a subject of frequent teasing in childhood, and is readily corrected by a surgery called otoplasty. 
The cause of a Prominent Ear deformity is unknown. However, it commonly runs in families which may indicate a genetic connection to how and when the ear is formed. When looking at the anatomy of a prominent ear, the excess projection is usually caused by two elements.

  • First, under-development of the antihelical fold, or area of the ear cartilage where a natural bend should occur, causes the top of the ear to stand out.
  • Second, overgrowth of the concha, or bowl shaped portion of the ear, causes the entire ear structure to be pushed away from the side of the head.
  • In addition, the shape of the head and overall size of the ear can affect its appearance as well.

Treatment of Prominent Ear

The surgical treatment for Prominent Ear (otoplasty) focuses on correcting both the “fold area” as well as removing a portion of the “bowl area,” which should improve overall ear position and shape while keeping a natural appearance. Otoplasty is usually performed around age 5 or later. This allows enough cartilage strength to develop to adequately hold sutures and also ensures the child is old enough to cooperate after surgery.

The otoplasty procedure is one that involves just a few incisions, removal of excess skin, and placement of shaping sutures. An incision is made in the shadowy area at the base of the concha, and a small crescent of skin and cartilage is removed to allow setback of the ear.

Next, an incision is made on the back of the ear to remove a small amount of excess skin and provide access to the cartilage surface. Permanent shaping sutures are then placed to create the natural bend of the antihelix and reduce prominence of the ear. When the incision is closed, the earlobe is repositioned to reduce any excess projection.

All of this is done with the intent of creating a natural bend and reducing the prominent ear. Adjustments are typically done on both ears to achieve the most symmetrical results and to correct any preexisting differences in head shape. Rarely, further revision is required.

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