Surgical treatment of congenital deformities of the ears

Abstract

C ONGENITAL deformities of the externa1 ear cover a wide variety of conditions. They may range from a shght change in the normaI contour to a tota absence of the ear. A certain number of patients also have other faciaI defects in addition to the abnormaIity of the auricles. In many cases there is definite asymmetry of the affected side of the face due to arrested growth of the ascending ramus of the mandibIe. This may be complicated by weakness of the seventh nerve affecting the corner of the mouth and eyelid. Reconstruction of the externa1 ear is one of the most difficult procedures in pIastic surgery. In 1937 GiIlies observed that “the study of ours and other surgeons’ actua1 resuIts reveal an undisputed disappointment in the cosmetic result obtained by these methods” [I]. Since then, although much has been written on this subject and considerabIe progress has been made, the results are far from satisfactory. Up to the present no standard procedure has been deveIoped. Our present resuIts are acceptabIe onIy in that they give the patient a feeting of facia1 symmetry and baIance. FortunateIy, the two ears are on opposite sides of the face and close comparison is avoided. In this paper, the discussion is limited to the treatment of onIy one type of congenital deformity of the ear with speciaI emphasis on reconstruction of the concha, a typical exampIe of which is seen in Figure I. Here, we have a rudimentary mass of soft tissue in the auricuIar region, cIose examination of which reveals that onIy part of the IobuIe is present. The rest of the auricIe is usuaIIy an UnderdeveIoped, shapeIess mass of skin and cartilage with an absent ear cana1. X-rays show that the external auditory cana is not deveIoped and operation usuaIIy reveaIs the maIIeus and incus fused. Hearing by air is at the so-60 decibeIs IeveI. The inner ear, being of different developmental origin, is aIways normaIIy deveIoped. In the reconstruction of an auricular deformity of this type, there are three general