What is microtia?
Microtia is a condition where the outer ear is underdeveloped or absent. It is a congenital condition, which means it is present at birth. The term microtia simply means “small ear”. It affects about one in 10,000 people, is more common in male children and more common on the right side of the head. Microtia typically affects one ear but can also affect both ears.
Treatment
Microtia is usually treated by reconstructing the ear through surgery using cartilage from the ribs to create a new outer ear. The surgery can significantly improve the appearance of the ear and your child’s self-esteem, offering a more natural, balanced look and contributing to an enhanced quality of life.
Surgical ear reconstruction
The purpose of ear reconstruction is to create all the visible anatomical features of the outer ear. Ear reconstruction does not create an ear canal for your child. The goal of surgery is to create an ear that looks like the unaffected ear on the other side of your child’s head. The new ear will not feel like the other ear, and it will not hear like the other ear.
Conditions associated with surgery risks
Hemifacial microsomia
Microtia is sometimes associated with a condition known as hemifacial microsomia, where one side of the face is smaller than the other. In children with hemifacial microsomia, ear reconstruction surgery is more challenging and—in some severe cases—not recommended. This is because the hairline is often low, and the existing ear is too low and too forward to create a natural-looking ear. In mild to moderate cases of hemifacial microsomia, the surgery can be done; but it requires the use of a scalp incision and flap, as well as skin grafts, which never look as natural as the surrounding skin.
Surgery requirements
To have surgery, your child should be at least 10 years of age. By 10 years of age, your child’s unaffected ear should be developed, or nearly developed, to its adult size. Your child can, therefore, grow into both their unaffected and reconstructed ear as they age. By age 10, your child will also be old enough to be a part of the decision-making process on whether they wish to have surgery.
Your child’s chest circumference should also be greater than 60 centimetres to qualify for surgery. Once your child has grown to have a chest circumference of 60 centimetres or more, there will be enough cartilage for the surgeon to make an ear.
Preparing for the procedure
Most parents and children are more comfortable with their visit to the hospital if they know what will happen when they arrive. Please see Coming for surgery to find out how you can prepare your child for their ear reconstruction surgery.
During surgery
Your child will be brought down to the operating room and go to sleep under general anesthesia. Your child will not feel any pain during the operation.
To reconstruct the ear, rib cartilage will be borrowed from the right side of your child’s chest and sculpted into a framework that looks like an ear. In order to use the cartilage as a framework for the new ear, there needs to be enough of it to make a true three-dimensional construct of the missing ear structures. Skin flaps are then created using the surrounding skin to cover the cartilage framework. Any cartilage that is not used during the procedure will be placed back into the chest in areas where they will regenerate and reconstruct the ribs. After the procedure, there should be little, if any, change in the shape or function of your child’s chest.
The procedure will take between six and eight hours.
Alternate framework options
Cartilage is the preferred choice of framework for ear reconstruction, but t here are other framework options available. Two-piece plastic implants can be used in place of cartilage; however, they require creating a scalp flap during the procedure and the use of skin grafts. Plastic implants are also at risk of breaking and damaging the surrounding skin over time. This is why cartilage is the preferred choice.
After surgery
- Your child will need to stay in the hospital overnight for two to three days after the procedure for monitoring.
- Your child will be scheduled for a follow-up visit one week after the procedure.
- Your child’s stitches will be removed after two to three weeks.
- It will take three months for the swelling to go down after your child’s surgery, and longer if a skin graft was required. The ear will be considered to have its final appearance at this stage.
- Your child should not engage in contact sports or strenuous activity for three months after the procedure.
Note: If there are problems with wound healing within the first three to four weeks, your child may need to have another surgery to make adjustments to the ear.
Potential complications of the procedure
One disadvantage of using a cartilage framework is that—over time—it may degrade, causing the reconstructed ear’s shape to change. In some cases, the results of the surgery can be disappointing. Depending on the cause of the unsatisfactory outcome, reoperation may be an option for your child.
Alternatives to surgery: Osseointegrated implants
Some children and families choose not to undergo surgery and accept the ear as it is. While prosthetic ears are an option, they are typically not the first recommendation. A prosthetic ear may be recommended for a child who has sustained burns, due to the lack of normal, unscarred skin in the area, or for children with severe hemifacial macrosomia.
These prostheses are held in place with osseointegrated implants, which are titanium implants anchored directly to the surrounding bone of the skull. They require daily cleaning of the surrounding skin, and the implants also need to be replaced over time, which can be costly.
At SickKids
If your child is interested in ear reconstruction surgery and is over 10 years of age, please contact The Plastic Surgery Clinic at (416) 813-4982; plastics.nurses@sickkids.ca.
After surgery
Patients at SickKids who have ear reconstruction surgery will need to stay two to three nights at St. Joesph’s Health Centre after the procedure. Your child’s health-care team will arrange this for you.
Resources
U.S. Centers for Disease Control and Prevention - Anotia/Microtia
https://www.cdc.gov/birth-defects/about/anotia-microtia.html#:~:text=Anotia%20(an%2DNO%2Dshe,microtia%20in%20the%20United%20States
Boston Children’s Hospital - What is microtia?
https://www.childrenshospital.org/conditions/microtia