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.
2. Stage 1
A template is traced of the normal ear using clear plastic film.
Costal cartilage is harvested from ribs 6-10.
The cartilage framework is carved to include the base and helical rim.
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.
The recipient site is prepared by undermining the skin with or without transposition of the lobe.
The cartilage construct is placed subcutaneously together with suction drain.
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.
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.
