This document discusses reconstructive techniques for ear defects. It begins with the anatomy and importance of the auricle. Methods of reconstruction include stick-on prosthetics, osseointegrated implants, synthetic frames, and total autologous reconstruction using costal cartilage grafts. Techniques like Brent and Nagata are described for microtia repair in children. Reconstructive options depend on the location of the defect in the upper, middle, or lower third of the ear. Local flaps are often used for smaller defects while bespoke cartilage frames are increasingly used for partial ear reconstruction. Total autologous reconstruction using the patient's own costal cartilage provides the best framework but remains technically challenging.

1. DEFECT BASED RECONSTRUCTION : EAR
Dr.Ajay Manickam
Junior Resident ENT & Head neck surgery
R.G. Kar MedicalCollege

2. The Auricle
 The complex 3 dimensional shapes of any
human appendages – skin & cartilage
 Emotional & psychological distress

3. The auricle
 Cosmetically important structure

4. History
 Susruta reconstructed ear lobules using local
flaps 600BC
 Autogenous costal cartilages – modern era –
HaroldGillies 1920
 RanfordTanzer 1950 laid foundation for
current ear technique.

5. Anatomy
 Blood supply (1) posterior branch of
superficial temporal artery & (2) posterior
auricular artery
 Anatomy of periauricular area – most
important

6. Anatomic axis of the ear

7. Ear anomalies
 Congenital
 Acquired

8. Congenital ear anomalies
Tanzer’s classification
 Anotia
 Complete hypoplasia
 Hypoplasia of middle third
of auricle
 Hypoplasia of superior
third of auricle
 Prominent ears
Cosman’s classification
 Lidding
 Smaller ear
 Low ear position

9. Reconstruction of ear
 Stick on ear prosthesis
 Osseo integerated ear prosthesis
 Use of synthetic auricular frames
 Total autologous reconstruction

10. Stick on ear prosthesis
 Prosthetic pieces
attached using skin
adhesives
 Limitations – may not
attach strongly in mean
time, skin reaction

11. Osseontegerated ear
prosthesis
 Pliable silicone – shaped &
colour matched with
opposite ear
 Anchorage by bone
anchored osseointegerated
titanium plates
 Limitations – daily cleaning,
risk of local tissue
unflamation

12. Synthetic auricular frames
 Synthetic frame used to recreate shape of ear
 Frames burried in subcutaneous pocket or
covered with superficial temporal fascia
 Silicone or PTFE
 Better success with temporalis fascia flap
 Significant risk of infection

13. Total autologous
reconstruction
 Ear frames from autologous costal cartilage
 Burried in subcutaneous pocket or temporalis
fascial flap
 Popular methods are BRENT and NAGATA

14. Microtia
 Nagata’s
classification
 Lobule type
 Concha type
 Small concha
type
 Anotia
 Atypical
microtia

15. Microtia repair
Brent technique
 5 years of age
 Four stages
 6th, 7th, 8th, costal cartilages
harvested
 Nylon sutures
 Auricular projection
involves only skin graft
Nagata technique
 10 – 12 years of age
 Two stages
 6th, 7th, 8th, costal cartilages
harvested
 Stainless steel sutures
 Auricular projection
involves cartilage wedge
sup temporal artery flap

16. Acquired ear defects
 Partial defects – direct closure, local tissues,
autologous reconstruction
 Total defects – congenital total defect
 Skin only defects – full thickness skin flap,
local flaps

17. Reconstructive options
 Upper third – local flaps –VY technique . Post
auricular flap defects involving helical rims
 Middle third – Antia Buch reconstruction &
dieffenbach flap
 Lower third – lobule. Local flaps are used
Defects of the concha – trapdoor flaps
Defects upto 1.5cm wide can be excised as a
wedge and closed directly

18. Upper third local flaps
VY flaps – helical rims or marginal
reconstruction defect
Pedicled flap based on post auricular
artery

19. Middle third
We can use post auricular artery
based flaps
Dieffenbach flap – staged
reconstruction of pinna
Antia buch advancement flap –
incorporates chondrocutaneous
segment – but smaller ear

20. Lower third
Local flaps are used one or two stage
procedure
Often Non anatomical cartilage graft can
give support for reconstructed ear lobule

21. Defects of concha
 Trapdoor flaps are used for this purpose
 Flap is inset after tunnelling through post part
of the auricular defect

22. Partial ear defects
 Local flaps , skin only flaps may not deliver
best results
 Bespoke cartilage frames are increasingly
used in reconstruction.

23. Cartilage framework for
pinna reconstruction upper
1/3

24. Middle third recontruction

25. Conclusion
 There is yet no ideal alloplastic implant
 Scalp skin grafts provide best texture and
colour match
 Costal cartilage provide best framework
reconstruction

26. Thank you