Microtia and Ear Reconstruction

Abstract

Microtia is a congenital anomaly where the ear is smaller than normal and often missing its usual architecture. It is frequently accompanied by conductive hearing loss. Severity of microtia is highly variable. It can be an isolated anomaly, associated with other findings, or part of a syndrome. A coordinated approach is warranted to manage both aesthetic and functional concerns. Hearing rehabilitation options include bone conducting hearing aids that can be implanted or worn with a headband, and construction of the auditory canal for suitable candidates. Three treatment options for auricular construction should be considered. First, autologous construction that involves costal cartilage harvest, framework creation and implantation, lobule transposition, tragal and conchal construction, and ear elevation. Brent’s and Nagata’s methods are described, however various modifications exist. Second, alloplastic construction, as pioneered by Reinisch, consisting of a porous polyethylene framework covered by a temporoparietal facia flap, local flaps and skin grafts. Third, auricular prosthesis, mainly those retained with osseointegrated implants, that is an alternative to plastic surgery and suitable for certain microtia patients. Options are reviewed along with their advantages and disadvantages. This review contains 5 tables, 10 figures, and 50 references Key Words: microtia, anotia, ear construction, auricle construction, autologous ear construction, alloplastic ear construction, ear prosthesis, hearing rehabilitation