facial plastic and reconstructive surgery in Winston Salem North carolina
Microtia before and after photos
Microtia is a rare congenital deformity that occurs in approximately 1 in 40,000 births. It is not a hereditary problem but is a problem of development. There are three major classifications of microtia.
- Type I microtias are people who have almost all recognizable parts of the ear present but have a small change in one of the parts. For example, some children have loss of one of the folds of the ear and have protruding ears. For information on how to correct these, please see Otoplasty.
- Type II microtias are when people have some recognizable parts of an ear and some parts of an ear that are entirely absent or completely misshapen. For example, someone may have the lower half of the ear, including the earlobe and the conchal bowl, as well as the flap in front of the ear called the tragus, the top half of the ear is missing or misshapen.
- Type III microtias or "classic microtias" are found in patients who have no recognizable features of an ear but instead may have just a remnant of tissue that looks somewhat like a peanut. They also have no ear canal or eardrum. This type of microtia, a complete microtia, is what we will focus on discussing here.
Children with microtia usually have an intact hearing nerve and some parts of the hearing mechanism even though there is no ear canal. This means that with creation of an ear canal, placement of an eardrum and reconstruction of the tiny ear bones to transmit sound their hearing may improve. We like to avoid doing this surgery until after the reconstructive portion has been completed since surgery and scarring makes the reconstruction more difficult and potentially less successful.
Rebuilding an ear involves a minimum of four procedures and requires understanding and participation of the family and the patient. After each subsequent stage, a minimum of a six-week break is given to allow blood vessels in the ear to regrow.
- The process begins by making a new ear out of cartilage, which is carved from the sixth, seventh and eighth ribs. Only the front part of the ribs is taken but the bone is left intact. These are not necessary for breathing. These ribs are then carved into the shape of an ear. They are then placed in a pocket underneath the skin in the position where we would like the eventual ear to be. After this first stage a graft, in the shape of the ear is buried against the side of the head under the skin.
- In the second stage, the original microtia remnant is transposed and used to make an earlobe. A graft is buried under their skin and an earlobe that was formerly sticking out slightly now is correctly positioned.
- In the third stage, an incision is made behind the framework of the ear, allowing it to come forward. The new ear, which has now had a minimum of 12 weeks to grow new blood vessels, will now support a skin graft, which is placed on the back side.. After this stage, when the ear comes forward, the child will hopefully be able to wear glasses if necessary.
- The fourth stage involves making a small flap in front of the ear (the bump called the tragus) and deepening the bowl that goes down to the eventual ear canal.
Of the four stages, the first one takes the most time and is the most involved both in surgery and recovery. This surgery takes approximately five hours and we usually keep the children in the hospital for four days. The second, third and fourth procedures, however, can usually be done as an outpatient.
The eventual goal is not to make an exact replica of an ear but to get as close to the natural shape, size and position as possible so that children don't have to deal with the psychological trauma of peer pressure during development. Our goal is to maximize the developmental potential of these children who are born a little different. It is challenging enough to grow up and learn without dealing with confidence issues unrelated to their potential as a person.
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