Total Ear Reconstruction

Total ear reconstruction pertains to any surgical or non-surgical otoplasty procedure that aims to correct the damage, defects, or total absence of the external ear. There are three main causes of ear damage or deformity:

• Congenital which means that the patient was born with a deformed ear. Normally, the ear is partially there and this condition is called microtia. Patients with this condition may also have an associated deformity on one or both sides of the jaw. The congenital jaw deformity may or may not affect hearing.
• Trauma can be related to everything from fights to accidents.
• Cancer is also a big cause of ear damage. The ears, particularly on men, are frequently exposed to the sun. Over time, sun damage can lead to the development of certain types of cancer like squamous cell carcinoma, basal cell carcinoma, and melanoma (on a rare basis). Once cancer develops, the affected part of the ear has to be removed.

Besides the three main causes discussed above, there is actually a fourth category which is patient-induced ear damage.  This is often seen in patients who have piercings such as the large gauges in the earlobes.

PROSTHETIC EAR

One of the new trends in total ear reconstruction is the use of a prosthetic ear. The prosthetic ear is made of latex or silicone rubber and is held onto the side of the head with a magnet or clips which fit onto a titanium implant inserted into the bone. The advantage of reconstruction using prosthetic ears is if the patient suffers from hearing loss, a hearing aid can be added into the prosthesis.

EAR RECONSTRUCTION PROCEDURES

Three types of ear reconstruction procedures exist:

1. Otoplasty which is the reconstruction of prominent ears.

2. Reconstruction of defects caused by trauma or cancer. This procedure involves taking what is left of the ear and shaping it. Grafting may sometimes be required. The surgeon borrows cartilage from the rib or from the ear on the opposite side.

3. Microtia repair which is done on children (and sometimes adults) with congenital ear deformity. This is the most common type of ear reconstruction surgery. This surgical reconstruction involves several stages usually started at about age seven. The first stage of the surgery involves the creation of a skin pocket on the area of the ear, harvesting of the rib cartilage that will form the framework of the ear, and burying the framework underneath the skin. The skin is suctioned down over the framework for a certain period of time to allow the framework to shapes the skin. The first stage of surgery takes at least four hours and the patient is required to stay in the hospital for seven days. The second stage of the surgery is where the new ear is put on its normal position by elevating the ear off the side of the head with a skin graft. The third and final stage involves the construction of the earlobe.

CANDIDACY

An ear reconstruction surgery is not recommended for patients below seven years of age. The reason for this is that a child’s ear at age seven has nearly grown close to adult size. Also, the rib cartilage is large enough by then and can accommodate a full-size carving for the new ear. The rib cartilage is basically the only tissue area where the surgeon can take grafts from because the surgery needs significant grafting material that is about the size of an ear. There are not a lot of places in the body that have that specific kind of cartilage. If the rib cartilage is not available for the grafts, the nose and the opposite ear may be used for the surgery.

LIMITATIONS

As long as the patient has enough sufficient tissue for grafting, the results that can be achieved by ear reconstruction have few limitations.  If the availability of good tissue is a problem, which happens in some cases of trauma or burn injuries, the results will not be as successful. The other techniques can swing tissue from one place over to another but it is also the lack of available tissue that can make it difficult.

The use of the patient’s own graft is the preferred method of doing ear reconstructions but there is also an option which calls for the use of an implant material called Medpor. Medpor is a beaded polyethylene that can be shaped into an ear and implanted in the ear area. The advantage of this option is that surgeons do not have to take a graft from a rib while the disadvantage is that they tend to extrude and create a scar. Scarring limits the ability of further reconstruction.

RISKS

The complications associated with surgical ear reconstruction are similar to that of any other kind of surgery. The most common ones are infection, nerve injury, and scarring. With regards to harvesting cartilage from the ribs, there is a slight risk of causing the lungs to deflate which can result in a condition called pneumothorax. This can be managed by putting a tube in and pulling the affected lung back up.

RECOVERY

Children are typically advised to limit their activities for a couple of weeks. During the first week, suction will be placed under the ear to suck the skin down over the cartilage. A bandage will also be put on the area for three to four days to protect the wound. The recovery for trauma cases depends on the severity. Most of the time, the stitches are in for a week and there will be some swelling and pain for a couple of days. The area will also have to be monitored for infection. The patient must keep the incisions clean. Usually, showering can resume a day or two after surgery. Overall, a recovery period of at least two days is required.

RESULTS

With regards to results, the final results will never be perfect. No matter how well the operation was done, the patient can only get in the 50% to 60% range of what a natural ear would look and feel like. A reconstructed ear will always be a little thicker than the natural ear. It will never be as soft because the rib cartilage is heavier and stiffer than the elastic cartilage of the natural ear. But the good thing is that patients now have an ear. An ear reconstruction procedure may also help restore hearing in patients with congenital loss if it is done in conjunction with an inner and middle ear surgery.

MAINTENANCE

It is not uncommon to have multiple ear reconstruction surgeries to get the optimal results. In fact, it takes at least three surgeries to do a total ear reconstruction. Sometimes a fourth, or even fifth, operation is required. These multiple operations are spread out in regular intervals over a period of one to two years.

FINAL THOUGHTS

Ear reconstruction surgery is said to be one of the most challenging plastic surgery operations. With the innovations in reconstructive surgery, the procedure is now easier to perform and can provide patients with excellent results.

Written by Cosmetic Town Editorial Team- AA

Based on an exclusive interview with Randolph C. Robinson, MD, DDS in Lone Tree, CO