Ear reconstruction, using a patient’s own cartilage, provides the best solution for the child who is born with a tiny malformed ear (which is called microtia). It can also be used for the traumatic loss of an ear through an accident.
For children who were born with an underdeveloped ear, cosmetic surgery can begin as early as age six. Older patients can be benefitted immediately following the accidental loss of an ear. In all cases, the most effective method for success will be achieved by carving a new framework from the patient’s own rib cartilage. Atresia refers to the absence of the external canal, which is almost always associated with microtia. If the internal components are developed well enough, an external ear canal can be created. This, however, should not be done until the external microtia repair has been completed.
While there are a number of artificial frameworks available, these are not living material, and the chance that they will erode through the skin is high. When this happens, an infection will occur. The artificial framework will have to be removed, and the patient may have lost their chance for a successful ear reconstruction.
The normal external ear is made of cartilage covered by skin. Our method seeks to recreate the natural ear. A living ear created from the patient’s own tissues, when done well, is preferable to a “stick-on” prosthetic ear or an ear created over a synthetic/artificial framework. The quality of the result for the cartilage-based ear depends upon the surgeon’s artistic ability to carve or sculpt the cartilage.
Reconstruction for Microtia
The patient is a seven-year-old male who has undergone staged procedures for the reconstruction of the undeveloped or microtic ear. It is important to delay surgery until the patient has reached an age when most of the ear growth has been achieved on the opposite side. The surgeon uses the opposite ear as a guide, or template, to achieve an artistic reconstruction. In this patient, the result demonstrates a close-to-normal appearing reconstructed ear. This represents the optimal result available in ear reconstruction.
Microtia/Atresia Before and After Reconstruction
This patient underwent multiple surgical stages using autogenous rib cartilage to achieve a normal appearing left ear. The canal has also been opened so that the patient can hear. NOTE: The before 3 and after 3 images are of the patient’s normal ear and are shown for comparison.
Reconstruction For Microtia
This patient was born with “microtia,” which refers to lack of development of the external ear. She required a multi-staged surgical approach, using her own cartilage and skin grafts, to achieve a natural appearing ear.
Traumatic Amputation/Reconstruction
This patient lost the upper 2/3rds of his left ear in a motorcycle accident. Only the earlobe remained. The defect was originally skin grafted. Subsequently, he underwent reconstruction using a carved cartilage framework from his own rib cartilage.
Helix Reconstruction
This patient suffered the loss of the rim (helix) of her left ear in an accident. In order to rescue the exposed cartilage, the rim was buried under the skin behind the ear. Once this had healed, the ear was released (elevated), and a skin graft was used to achieve a normal looking ear.
Reconstruction After Road Trauma
This patient sustained a severe injury to the right ear as the result of her head striking the pavement and dirt. This resulted in multiple dirt tattoos, and the detachment of the root of the helix. The tattoos were surgically excised and the helix defect was restored using a blood-bearing pre-aricular transposition flap.
Goldenhar’s Syndrome
This patient had under development of the upper half of her right ear as a part of a congenital condition known as Goldenhar’s Syndrome. The ear was reconstructed by creating a carved cartilage framework and joining this to the existing deficient external ear, which was rotated downwards and backwards to provide a more natural look.
Reconstruction Surgery After Trauma
This woman was involved in an automobile accident, which resulted in the amputation of the upper portion of her ear. Reconstruction was achieved using a chonchal cartilage graft, which when placed under the skin matched the shape of the upper ear.
Microtia Repair With Cartilage Grafts
This child was born with the typical deformity of the microtic ear, which is a manifestation of the first and second Branchial Arch Syndrome. Her ear was successfully reconstructed using her own cartilage and skin grafts.
Deformity With Plagiocephaly
Plagiocephaly is a condition in which the cranium is asymmetrical, or flat on one side, and can be associated with other deformities such as microtia. In this case, the existing ear was divided in the center, and the parts were rotated upward and downward respectively. The central portion required a carved cartilage framework from the patient’s own rib cartilage in order to achieve a more natural look.
Grade III Microtia With Atresia
Secondary (Revision) Ear Reconstruction
Secondary ear reconstruction refers to cases which have undergone prior attempts at ear reconstruction. In many instances, Dr. Grant A. Fairbanks has been able to rescue such cases and provide a satisfactory ear. He has presented scientific papers on this subject, both nationally and internationally, and he is highly regarded for his work in this area, as there are few surgeons who will attempt to re-reconstruct the microtic ear that has already been operated on.
Secondary Ear Reconstruction
*All before and after photos are real patients of Fairbanks Plastic Surgery. Identifiable images are used with patient permission.
