By the time a child with microtia reaches the school-age years, they are aware of their ear deformity and may begin to feel self-conscious, embarrassed, or even ostracized. Autologous reconstruction, a form of reconstructive ear surgery, can be extremely beneficial at this stage in life by restoring aesthetic balance to a child’s ears and, in turn, enhancing their self-confidence.
Autologous reconstruction, commonly referred to as the rib cartilage technique, is a life-changing procedure that uses the body’s own tissues to create an ear that closely mimics the shape and appearance of a normal ear. The procedure is broken up into three or four surgeries and performed over the course of a year.
The Ear Surgery Center of Excellence in Los Angeles boasts an expert team of plastic reconstructive surgeons and otolaryngologists for the treatment of microtia. Led by renowned facial plastic surgeon Dr. Carlo Honrado, our doctors are highly skilled in the most advanced reconstructive techniques, and we are committed to providing each patient with comprehensive, individualized care.
To learn more about reconstructive treatments for microtia or to schedule a consultation with one of our ear surgeons, you may contact us at (888) 281-8537.
Stage I of Autologous Reconstruction: Rib Cartilage Harvest
The first stage of autologous reconstruction involves harvesting a section of rib cartilage that will make up the basic frame of the ear. This requires making a 1-2 inch incision in the chest over the sixth, seventh, and eighth ribs. Cartilage from each of these ribs is then removed, sculpted, and sutured together to form the basic shape of an ear.
Once the framework has been constructed, it is sewn into a skin pocket in the scalp beneath the microtic ear. Temporary suctions are placed within the pocket to help the skin adhere to the new cartilage frame. This procedure takes two to three hours to complete.
Stage II: Formation of the Ear Lobe
Approximately three months later, a second surgery will be performed to create a natural-looking earlobe. This relatively short outpatient procedure involves making one incision in front and one behind the microtic ear tissue and rotating it within the framework to form an earlobe.
At this point, the bump of cartilage in front of the ear canal (known as the tragus) can also be formed.
Stage III: Elevation of the Ear
The third surgery will be scheduled two to three months after the second stage. During the third stage of reconstruction, the newly formed ear is elevated to a natural projection from the side of the head. This is performed using either an additional piece of rib cartilage, obtained during the first surgery, or a synthetic (MEDPOR) block.
Next, a small skin graft must be harvested from the upper buttock and secured to the undersurface of the reconstructed ear. The procedure takes approximately two to three hours and is performed as an outpatient procedure, which means patients can go home the same day as their surgery.
Stage IV: Fine-Tuning the Ear
In some cases, a fourth surgery is performed several months after ear elevation in order to fine-tune the shape or symmetry of the reconstructed ear. Within two months of the final surgery, the ear will be fully healed and normal activities – including sports – can be resumed.
Timing of Autologous Reconstruction
Our surgeons recommend that parents begin to discuss the option of autologous reconstructive surgery when their child reaches the age of six or seven. At this time, the rib size is sufficient to harvest a cartilage graft, and the child is old enough to have some understanding and expectations about the procedure.
Individuals with bilateral microtia and atresia must break the first stage (rib cartilage harvest) into two surgeries approximately three months apart. This reduces the risk of respiratory complications that could occur if both sides of the chest were operated on at the same time.
During the second and third stages of reconstruction, each ear can be operated on at the same time to minimize the number of surgical procedures. Children who have significant hearing loss and are candidates for hearing correction surgery (atresiaplasty) often undergo this procedure after the final stage of ear reconstruction.
Advantages and Disadvantages of the Rib Cartilage Technique
Before deciding on autologous reconstructive, it is important for you and your child to consider the possible benefits and limitations of the procedure. Autologous reconstruction has been used since the 1920’s and is considered the gold standard of microtia surgery. The advantages of this method include:
- Safe and established procedure that can have tremendous psychosocial benefits
- Uses the body’s natural tissue rather than a synthetic product
- The reconstructed ear can last a lifetime without need for revisional surgery
Disadvantages of the rib cartilage technique include the need for a chest incision, the multi-stage nature of the procedure, and stricter age requirements that do not apply to other reconstructive techniques. The majority of microtia patients who choose to undergo surgery find that the life-long benefits of ear reconstruction strongly outweigh the risks of procedure.
Contact a Los Angeles Facial Plastic Surgeon
At the Ear Surgery Center of Excellence, our goal is to provide the highest quality of care in a safe, state-of-the-art environment. Our facial plastic surgeons have trained at some of the most prestigious medical institutions in the country and utilize advanced surgical techniques to provide the most natural looking results. Contact us today to schedule your initial consultation by calling (888) 281-8537 or filling out our contact form.
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Next, read about synthetic ear reconstruction.