Reconstructive Options

When children  are born with Microtia and Atresia, it is important to teach them to be confident and accepting of their Microtia ears and how to advocate for themselves with their hearing loss. However, if your child believes that he or she would be happier with a reconstructed ear and improved hearing, the Microtia and Atresia Clinic at Vanderbilt Medical Center offers all of the current options for ear reconstructive surgery, hearing restoration, and ear prosthesis.

There are four options for surgically reconstructing the outer ear:
1.  Rib Graft surgical technique – is the gold standard for reconstructing an outer ear and has been available since the 1920’s. Rib Graft surgery utilizes the body’s own biological materials to create an ear framework using rib cartilage and a series of skin grafts. The rib graft technique is achievable between 2 and 3 separate surgery stages where the ear framework is created, then tucked into the scalp, and then eventually elevated away from the head to give the ear projection. A newly reconstructed rib graft ear requires time to heal in between surgery stages and can take up to a three month period each time. Ear placement may be affected by a low lying hairline (such as in patients who have Treacher Collins Syndrome or Hemifacial Microsomia).

2.  Medpor and OmniPore surgical techniques – are surgical techniques for reconstructing an outer ear using a preformed polyethelene porous ear framework. There are two common polyethelene materials used for reconstructing an ear and they are Medpor and OmniPore. The Medpor and OmniPore surgical techniques are achievable in 1-2 stages of surgery. A newly reconstructed Medpor or OmniPore ear quickly begins healing and begins showing definition within just a few weeks following surgery. Ear placement may be affected by a low lying hairline (such as in patients who have Treacher Collins Syndrome or Hemifacial Microsomia). 3D Printing for Porous Polyethelyne (PPE) ear frameworks – Vanderbilt University Medical Center partners with MatrixSurgical and other companies to produce 3D printed PPE implants that are customized for each patient using the data found in the CT scan of the shape of their opposite ear.

3.  Reconstructive Otoplasty – a surgical technique that can improve the shape, position or proportion of the ear. A defect or misshapen ear can be congenital and present at birth or can be post-traumatic due to an injury. A defect in the ear structure that is present at birth or that becomes apparent with development can be corrected by otoplasty. This procedure can also treat misshapen ears caused by injury. Otoplasty creates a more natural shape while bringing balance and proportion to the ears and face. Otoplasty can be performed on a patient age five and older or once the cartilage is stable enough for correction.

4.  Soft Tissue repair –  is achievable when the ear is mostly developed, but did not form completely to a mild degree (such as stage 1 of Microtia) or has a cleft. This surgical technique can also be helpful when pinning the ears back.

There is one option for helping to extend the existing outer ear with an ear mold:
1.  Preformed Ear Molds – can be used during the infant years after a child has been born to help extend or expand the existing ear tissue in hopes of molding a larger outer ear. A patient must be a candidate for this option and the patient will typically will have grade I Microtia where the ear is fully formed, just smaller in size. Patients may also be a candidate if the outer ear is slightly malformed or the pinna needs to be elongated. Again, this is an option that can only be considered during the very early months following the birth of a child.

There is one option for surgically reconstructing an ear canal and restoring hearing loss, together:
1.  Canalplasty or Aural Atresia Repair is the surgical technique offered to create an ear canal and restore hearing loss. This surgical procedure involves drilling a channel into the skull, creating an opening for the new ear canal. The ear canal is then lined using grafted tissue. The newly created ear canal alone will allow for better sound. Hearing loss can still be present due to the middle ear bones of the ear being damaged, malformed, or fused together, which is common in patients who have Microtia and Atresia. Atresia repair can help restore hearing loss by manipulating the middle ear bones and restoring hearing loss to within normal hearing range. A patient must be a candidate for this procedure. A CT scan is required before having canalplasty/atresia repair.

There is one combined surgical option for reconstructing an outer ear, creating an ear canal, and restoring hearing, together:
1.  CAM (Canalplast/Atresia Medpor) combined surgery provides the option to have hearing restored and an outer ear reconstructed in one single stage of surgery using the Medpor polyethelene surgical technique.

*   It is important that the location of the facial nerve be known before considering having rib graft surgery, Medpor, or canalplasty/atresia repair surgery. Damage to the facial nerve during surgery can cause facial paralyses. A CT scan can show the location of the facial nerve prior to having surgery.

Hearing Devices and Prosthetic ears:
There are also less invasive surgical options available for restoring hearing loss and for creating an outer ear:
1.  Hearing Devices known as bone anchored hearing systems or bone anchored implants (BAIs) can also help improve hearing loss by amplifying sound. These type of hearing devices can be implanted using a screw and fixture (similar to a dental implant) or with a magnetically coupled implant. A bone anchored hearing device can also be worn on a soft band head band without having surgery.

2.  Prosthetic Ears  can be another option for having a bigger sized ear, but without having reconstructive surgery. Prosthetic ears can be attached by having bone anchored implants (magnetic posts) surgically implanted into the skull that help hold the ear in place via magnets or snaps.

To make an appointment, e-mail us at:   MicrotiaAtresiaClinic@VUMC.org or call ph:  615-343-6166.