Microtia- diagnosis and management

1. Microtia

2. • Microtia varies from the complete absence of
auricular tissues (anotia) to a somewhat
normal but small ear with an atretic canal

4. Weerda classification

8. Associated deformities

9. Timing
• body image concept usually begins forming
around age of 4 or 5 years
• Enough rib cartilage to serve as the sculpting
medium by age 6
• At age 6, the normal ear has grown to within 6
or 7 mm of its full vertical height

10. Treatment options
1. Autologous Costal Cartilage Graft
2. Tissue expansion and Autologous Costal
Cartilage Graft park technique)
3. Implant reconstruction (Reinisch and Lewin)
4. Prosthetic reconstruction (Wilkes technique)

11. Autologous cartilage graft
1. Tanzer
2. Brent
3. Nagata

12. Tanzer
• Stage 1:
– Lobule transposed
• Stage 2:
– costal cartilage, harvested sub-perichondrially
from sixth, seventh, and eighth contralateral ribs,
implanted beneath mastoid skin, using a V-shaped
postlobule incision

13. • Stage 3:
– construct was elevated from head
• Stage 4:
– concha and tragus created with composite
contralateral ear and skin/cartilage grafts

14. Brent technique
Stage 1: harvesting costal cartilage

18. • Stage 2. lobule reconstruction

20. • Stage 3: elevation of the construct

21. • Stage 4: tragus, antitragus construction,
conchal excavation, and symmetry adjustment

23. • Disadvantages:
1. 4 stages.
2. lack of definition of the conchal bowl,
intertragic notch, and contour of antitragus
3. Effacement of postauricular sulcus, result in
decreased projection of reconstructed ear.
due to contraction of the skin grafts.
4. composite skin/cartilage grafts may contract,
diminishing the retrotragal hollow everting
tragus itself

24. Nagata
• two stages.
• first introduced in 1993
• Several possible technical refinements,
depending on the type of microtia present
(i.e., lobular, small concha, conchal, anotia,
low hairline)

25. • First Stage:
– base frame – seventh and sixth ipsilateral costal
cartilages
– helix and crus helicis - ninth costal cartilage
– superior crus, inferior crus, and antihelix- eigth
costal cartilage

30. • Second Stage:
– Six months
– Skin incised 5mm posterior to the construct
– Elevated
– crescent-shaped piece of cartilage harvested from
the fifth rib
– Temporoparietal fascia flap
– ultra-delicate splitthickness skin graft

32. • Advantages:
1. Excellent blood supply and minimal risk of
resorption of grafted cartilage.
2. high-definition framework of auricle.
3. Symmetrical projection of ear.
4. The possibility of ear reconstruction in anotia,
low hairline and secondary cases.

33. • Disadvantages:
1. Long learning curve.
2. Surgeon must have great artistic talent
3. high (8 percent) extrusion rate of wire sutures
4. risks of scalp scarring, temporal hair thinning,
and the sullying of a potential reconstructive
lifeboat.
5. significant chest wall deformity
6. not specifically addressed the issue of frontal
symmetry

34. Complications
• Chest Wall Donor-Site Complications
– pneumothorax and atelectasis
– chest wall deformity and scarring
• Complications at the Ear Reconstruction Site
– Exposure of the cartilage
– Skin necrosis
– Infection (0.5%)
– Hematoma (0.3%)
– extrusion of suture material
– resorption of cartilage framework