The First Surgical Stage

The material in this section, "The First Surgical Stage," presents my current approach to total auricular construction by methods which have evolved through thirty years of personal experience with more than 1,700 operated patients. This experience is comprised of: (a) congenital microtia -- 1,602 completed ears in 1,457 patients (145 are bilateral); and (b) traumatic injuries -- 152 completed cases of total ear reconstruction for patients who have lost their ears to dog bites, automobile accidents, tumors, burns, etc.

Initiating the Surgery

In review, the age at which one begins surgery is governed both by physical and psychological considerations. It is best to initiate the repair before the child is traumatized by cruel teasing, but the surgeon must not be pressured to begin until rib growth provides substantial cartilage for framework fabrication.

As mentioned before, my experience reveals that these children become aware that their ears are different between ages three and four, but teasing with psychological overtones generally does not become manifest until ages seven to ten. Generally, there is substantial cartilage for the repair by age six, by which time the child is aware of the problem, usually wants it resolved, and is surprisingly cooperative regarding the surgery.

If the opposite, normal ear is large and the child is small, one may have to postpone the surgery for several years. On the other hand, a large child with a small normal ear may permit one to occasionally begin by age five-and-a-half. However, in my experience, beginning surgery earlier than six merely invites technical handicaps and poor patient cooperation.