1. What is microtia?
Microtia is a birth deformity of the ear that occurs about one in 5,000-7,000 births, depending on varying statistics in different countries and in different ethnic races. When broken down in Latin, the term “microtia” is easy to understand. Micro=small; Otia=ear. Typical microtia, grade 3, looks like a little sausage-shaped Wrinkle of skin. A grade 2 microtia is a less severe form and often looks like a miniature ear. Grade 1 microtia is a minimally deformed ear. (see Fig. 5 in the “Variations of Microtia” section of the web site). In 90 percent of microtia, only one side is involved. There are twice as many right-sided microtias than left; microtia involves boys 65 percent of the time and girls 35 percent (see Table 1 in the web site).
Atresia is absence or underdevelopment of the ear canal and middle ear structures. Microtia is almost always accompanied by atresia because the outer ear and the middle ear develop from one common block of tissue at the same time of development in the womb. About 15 percent of my microtia patients have what appears at first look to be a normal canal, but many of them are a “blind alley.”
The exact cause (etiology) of microtia is somewhat obscure, but one sure thing is that the parents did not cause it and should not feel guilty. Although feelings of guilt are common amongst parents with a child having microtia, they certainly had nothing to do with the occurrence of the microtia, which is merely a “roll of the dice.” Children with microtia are great little kids who will lead normal productive lives with the support of their parents, family, physicians and friends. (See “Possible Cause and Incidence” in the web site)
When two people first conceive a child, the risk of that child’s having microtia is basically the same as any child born—one in 5-7,000. However, now that their child has microtia the risk jumps up to five percent, or put another way, 1 in 20 for subsequent children. These statistics are derived from the families of the first 1,000 children whose microtia I have repaired. One in every 20 of these children has a member of the immediate family (parents, siblings, aunts, uncles, or grandparents) with microtia. The risk of a child with microtia eventually having a child of his/her own with microtia is also one in twenty.
The majority of patients with microtia have no other problems aside from the ear. Approximately one-third have underdeveloped bony and soft tissues on the involved side of the face (hemifacial microsomia) and 15 percent have facial nerve weakness. Other general abnormalities such as cleft lip, cardiac, or urological problems are encountered much less frequently (see fig. 3 and Table 2 in “Associated Deformities” section of the web site).
Children with microtia become aware of their differences at approximately 3 - 3½ years of age. Typically, they start comparing sides in a mirror and begin referring to their microtia as their “little ear.”
When the child discovers that he/she has a small ear, parents should tell the child that he/she was born with a small ear, and that the doctor is going to make it larger when the child is older—then treat the child as absolutely normal and not make a “big deal” about it. The only children I have ever seen bothered about their microtia before the age of 7 or 8 are those whose family is very worked up over it and transmits family anxieties to the child (see “Psychology and Function of Outer Ear” in the web site).
I don’t operate on children with microtia before the age of six for two reasons: the technical reason is to allow the rib cartilage to grow large enough for carving an ear to match the opposite side; the psychological reason for waiting is that a child with microtia is neither concerned about the problem nor very cooperative before then. This makes post-operative care very difficult on the child and all those involved in their care (parents, doctors, nurses). Also, I feel that it is important for the child to be old enough to understand and personally “consent” to having the surgery. (See “Age to Begin Surgical Ear Repair”)
For long-term success in microtia repair, one must create a 3-dimensional ear sculpture from living cartilage in an acceptable time under operating room conditions, then develop a “pocket” under snug 2-dimensional skin to house that framework— without cutting off the circulation to that skin. It is like trying to place 5 lbs. of plaster into a 2 lb. bag, but doing it with living tissue! Furthermore, since cartilage can’t be visualized by X-ray as bone can, one never knows what the rib cartilage configuration will be like before surgery. Therefore, the surgeon must “make do” and sculpt a realistic ear framework with the cartilage encountered at surgery, no matter how difficult that may be.
two main methods for repairing microtia depend upon the material used for
the ear framework. One method
uses a living sculpture from the
patient’s own tissues (rib cartilage) and the other uses a framework
of firm artificial plastic. This spells out the main difference between
the two techniques: one type of ear is created from your own bodily tissues
whereas the other is an ear of foreign material. (See “History
Auricular Reconstruction” in the web site.)
Ears created from the person’s own rib cartilage are alive and actually grow with the child (see Fig. 7). Ear frameworks made from artificial, plastic and synthetic materials obviously can’t grow because they are not alive.
The advantage of correcting microtia with one’s own tissue is obvious. The new ear is sculpted from the patient’s own cartilage and skin and therefore is alive, grows with a child, and heals without problems. This allows a person to resume normal sports, swimming, and PE activities 4-6 weeks after surgery with no particular concerns. I have reconstructed ears for more than 1,500 patients with microtia and have followed a number of them for more than 20 years. Ears constructed by this method retain their form and have withstood the test of time—they should last a lifetime (see Fig.25 in the “Long-Term Results” section of the web site).
13. Are there limitations of sports activities that patients can perform after microtia repair?
Basically, there are no limitations on activities. As stated above, because these ears are constructed from living tissue, I permit the microtia patient to participate in sports and swimming 5 weeks after surgery with no particular extra protection to the ear (or chest). During the years I have seen ears constructed from rib cartilage survive from every type of trauma imaginable. I ascribe this to the fact that they are living sculptures. (See “Durability of Constructed Auricles” in the web site.)
The chest discomfort is handled well with intravenous medications during their one overnight stay (23 hours), and the ear doesn’t bother the child much at all. The morning after the rib cartilage operation, the child leaves the facility with a bottle of Tylenol and codeine syrup, which is required only on an “as-needed” basis for just a few days. There is little if any postoperative discomfort with the subsequent surgical stages, that, of course, only involve the ear itself. These are all done on an outpatient basis.
Because tissue other than your own is a “foreign material,” to ensure success of organ transplants, a patient is required to take special drugs for the rest of his/her life to prevent rejection of those organs. These drugs have some serious side effects which are justifiable for a vital organ that one can’t live without such as a heart or a kidney, but unacceptable for a foreign cartilage transplant when I can instead harvest cartilage from the microtia patient’s own body in 20 minutes and sculpt it into a new ear in another 30 minutes. This makes foreign materials unnecessary.
cartilage vs. synthetic ear frameworks
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his web site provides information about surgical reconstruction of the missing outer ear, absent either from birth (microtia), or from traumatic injury. It is meant also to be a comprehensive information source for the family and patient with microtia and is derived from Dr. Burt Brent's personal experience in surgically repairing ears for more than 1,900 patients during a 30-year period. This information focuses on his total management of over 1,700 congenital microtia patients and the repair of their ears, but also includes relevant supplementary input from experience he has gained by managing more than 200 traumatic auricular deformities.
Dr. Brent strictly limits his practice to repair of the outer ear, and has dedicated his professional life to helping children and other patients with microtia, traumatic ear loss, and cosmetic ear problems.
When an infant is born with microtia, the family has many questions: "Can our infant hear?;" "Did we do anything wrong to make this occur?;" "Will future children have the same deformity?;" and "What can be done about the disfigurement of a missing auricle or gnarled ear remnant that marks our child as abnormal, and invites teasing and probing questions by outsiders?" The information herein will thoroughly address all these questions and more.