Microtia is the underdevelopment or total absence of either one or both ears. Typically beginning when the patient is approximately five years old, reconstruction of the ear requires several staged operations to improve the appearance of the congenitally malformed ear. Both cartilage techniques and the use of a Medpor® framework are available for microtia reconstruction. Dr. Yellin’s currently preferred technique uses a Medpor® framework covered with the patients own vascularized fascial flap and skin. This avoids a rib harvesting procedure, can often be accomplished in 2 stages and provides excellent contours in most cases. Long-term follow-up has shown this technique to be reliable and relatively problem free.
In the first stage, a Medpor® framework is shaped and sized to resemble the existing normal ear unless the microtia is bilateral then a family members ear is used as a template. The existing deformed cartilage of the microtic ear is removed, the Medpor® framework is secured to the head in the natural location of the ear, wrapped in a vascularized temporal-parietal fascial flap, and then covered with skin from behind the normal ear for the front of the new ear and lower abdominal skin to cover behind both the microtic side and the normal (skin donor site) side.
The ear lobule is then moved into a more normal position. After surgery, the patient wears a protective cup over the new ear for 3 weeks and then the ear is allowed to heal for 4 months. In the second procedure, the tragus is reconstructed and the excess skin and soft tissues of the newly constructed ear are contoured.
Occasionally, a third contouring procedure is required. Finally, the patient may have additional surgery to recreate an ear canal if the anatomy of the middle and inner ear are favorable or may be fitted with a BAHA implantable hearing aid.