Authors of section

Authors

Scott Bartlett, Michael Ehrenfeld, Gerson Mast, Adrian Sugar

Executive Editor

Edward Ellis III

General Editor

Daniel Buchbinder

Open all credits

Autogenous ear construction

1. Introduction

In Hemifacial microsomia ear deformity is common, varying from a nearly normal ear to complete microtia. If complete microtia is present total ear reconstruction using carved cartilage may be indicated. This is typically performed at age 6 or above, but many experienced surgeons feel that better results can be obtained if the child is aged 10-12.

Hemifacial microsomia (HFM) - Autogenous ear construction

2. Stage 1

A template is traced of the normal ear using clear plastic film.

Hemifacial microsomia (HFM) - Autogenous ear construction

Costal cartilage is harvested from ribs 6-10.

Hemifacial microsomia (HFM) - Autogenous ear construction

The cartilage framework is carved to include the base and helical rim.

Hemifacial microsomia (HFM) - Autogenous ear construction

The template is reversed and positioned on the affected side in the most satisfactory position based on the opposite side ear position, the hair line, and the microtic remnant which may be used to construct the ear lobe.

Hemifacial microsomia (HFM) - Autogenous ear construction

The recipient site is prepared by undermining the skin with or without transposition of the lobe.

Hemifacial microsomia (HFM) - Autogenous ear construction

The cartilage construct is placed subcutaneously together with suction drain.

Hemifacial microsomia (HFM) - Autogenous ear construction

3. Stage 2

After stage 1 healing is complete, and if the lobule has been moved in stage one, the ear is elevated and additional cartilage is used to project the ear. This creates a soft tissue deficiency which is closed with a turnover mastoid flap or temporal parietal flap and a skin graft.

Hemifacial microsomia (HFM) - Autogenous ear construction

4. General wound care

Apply ice packs (may be effective in a short term to minimize edema).

The sterile dressing placed over the incisions is maintained for a minimum of 48 hours. Thereafter routine wound care should be instituted.

Antibiotic prophylaxis is continued for 1-5 days depending on the nature, complexity, and duration of the surgical procedure.

Remove sutures from skin after approximately 5 days if nonresorbable sutures have been used.

Regular follow up examinations to monitor healing are required.

Avoid sun exposure and tanning to skin incisions for several months.