Functional and esthetic reconstruction of the auricle for microtia and atresia

Abstract

Two stage otoplasty has been common procedure for microtia patients: rib cartilage graft in the first stage, and ear elevation in the second stage operation. We have developed combined surgery in the 2nd stage operation, combined surgery of ear elevation and canal plasty. The possibility of getting hearing ability is estimated utilizing Jahrsdoerfer’s score from the temporal bone CT scan. When the patient’s middle ear is well developed and the patient and family desire to do canal plasty, we plan combined ear elevation with canal plasty for the second stage operation. For patients who are not candidate for ear canal plasty, we have developed a simple procedure for ear elevation making a TPF pocket to cover the cartilage buttress. The details of our surgical techniques and the results of this procedure are described.

Between 1999 and 2015, 200 cases underwent this combined surgery. 67cases of them are bilateral microtia cases and the rest of 133 cases are unilateral cases. Improvement of hearing ability more than 15 dB has achieved in 58% cases. None of the cases accompanied necrosis of the constructed ear. As the complication, necrosis of the retroauricular skin graft has occurred in 6 cases, and facial paralysis occurred in 5 cases. But we have experienced late complication such as the contracture in the entrance of the ear canal, and lateralization of the tympanic membrane. We think further revision of the surgical details should be developed.