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Houston Cranio Facial

Microtia

What is Microtia?

Microtia is the incomplete formation of the ear on one or both sides of a child’s head

How often does Microtia occur?

There have been several studies that estimate microtia occurring between 1 in 2500 to 1 in 5000 depending on the ethnicity.

What Causes Microtia?

Microtia is a failure of ear formation while a child is growing in the womb.

Does Microtia affect a child’s hearing?

The formation of the external ear that one can see is a separate process from formation of the inner ear which is responsible for transmitting sound to a child’s brain. In cases where a child has a syndrome diagnosis, such as hemifacial microsomia, both the external and inner ear may not form correctly.

How is microtia corrected?

Dr. Eric Payne, our extensively trained craniofacial plastic surgeon, treats Microtia in a variety of ways. The original approach was to take pieces of rib cartilage to fashion an ear framework. The framework is placed below the skin where the child’s ear would normally appear. In the last several years artificial material including silicone, rubber, and porous polypropolene (Med-Por) have been used to create the framework. In some cases small screws are fixed on the side of a child’s head and a prosthetic ear is then attached to the screws

How does the Craniofacial and Plastic Surgery Center approach Microtia?

The reconstruction involves two to three procedures depending on the severity of the ear deformity. At our center, we choose to use a child’s own tissue to assist in the reconstruction of their ear. We remove rib cartilage from the chest and sculpt an ear framework. The framework is then inserted in a pocket underneath the skin which is then closed with stitches. A drain is placed in the pocket to remove any fluid and assist the skin sticking down to the framework. A small catheter is placed in the chest to deliver pain medicine to the area where the rib cartilage was removed. The child spends one night in the hospital for monitoring and then goes home.

Later procedures refine the original reconstruction as necessary. These include elevating the ear off the side of the head, placing a piece of skin behind the ear, and refining the earlobe position.

What are the risks of performing ear reconstruction for microtia?

When removing the rib, there is a small risk that a small hole is made in the covering, pleura, of the lung. If a hole occurs, it is repaired at the time of surgery and monitored with an x-ray immediately after the operation. There is a risk of infection after surgery. If one should occur, the infection must be treated immediately to prevent the loss of the cartilage framework.

Why does your center not use artificial material?

At our center, we believe that for an ear reconstruction to provide the greatest benefit, it must last a lifetime. Artificial materials such as Med-Por, silcone/silastic, and rubber lead to many early and late complications. Complications include extrusion of the artificial material. Extrusion means the skin over the framework breaks down and the material becomes exposed. If this occurs the artificial material must be removed immediately. There is an increased risk of infection anytime artificial material is placed in the body and infection also requires the removal of the artificial material. There is an increased risk of the ear framework breaking if it is made out of artificial material. Should the artificial material break, it has to be removed. Finally, we do not believe placement of permanent screws in a child’s head and prosthetic attachment is appropriate when there are better options, such as using a child’s own tissue, available to us.