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Ear Reconstruction – Microtia
The procedure
What is the ear reconstruction in microtia treatment like?
Ear reconstruction surgery involves four different stages at two to three month intervals. However, stages depend on the quality and quantity of skin available in the auricular region. Depending upon the treatment, the surgeon may determine the stages to be developed.
The following are the three options for ear reconstruction of microtia:
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Prosthetic reconstruction. |
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Reconstruction using an alloplastic ear framework. |
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Autogenous reconstruction (most commonly performed). |
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Autogenous reconstruction
1.First stage
Rib cartilage graft
According to the child´s ear shape, costal cartilages from the contralateral side of the ear being constructed are taken. The cartilaginous portions of the 6th and 7th ribs are removed. These ribs provide enough cartilage for the body of the framework. Also, smaller pieces are taken from the 8th rib and used to create the helix.
Construction of the auricular cartilage
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The cartilaginous portion of the rib is harvested according to the previously measured template. |
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The cartilage is carefully carved into the desired shape. |
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The cartilage framework is thicker than the normal ear to project a natural shape. |
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The cartilage framework is immersed in a sterilizing solution. |
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Cartilage pieces are fixed in place with nylon suture. |
Dissection of the remnant skin in the auricular region
This procedure may vary from patient to patient. Sometimes the amorphous skin is completely removed, and a skin pocket covering is created in the auricular region. Drainage tubes are inserted in the pocket. The drain stays on about 5 days. When earlobe and exists and there is skin available, incisions are modified to make use of this tissue.
2.Second stage
After the first stage, the following procedures are less complicated. This second stage is performed on an outpatient basis and may take approximately one hour. Sutures are removed one week following surgery.
3.Third stage
This stage combines the procedures of ear lobe transposition and lifting the ear with a skin graft. This procedure is performed on an outpatient basis and may take 2 hours. Sutures are removed one week following surgery.
4.Fourth stage
The fourth stage consists of excavation of the concha and achieving symmetry of the ears. This procedure is performed on an outpatient basis and may take 2 hours. Sutures are removed one week following surgery.
Ear reconstruction in acquired deformities
Acquired ear deformities are usually the result of trauma, disease or burns. Unfortunately, these defects are also the hardest to reconstruct. Lack of soft tissue covering following a traumatic injury can limit the options available for ear reconstruction. Usually, skin grafts or skin flaps may be needed to permanently replace compromised tissues. Other methods for ear reconstruction are:
Auricular (ear) prosthesis
Ear prostheses are particularly suitable for patients when ear reconstruction is not possible, inadvisable or because of patients´ preferences. Although ear prosthesis artificially restores the ear and also serves as a great psychological benefit in rehabilitation of the patient (cancer), in most of cases, an auricular prosthesis is not recommended for children. Children prefer not to wear prostheses, and they frequently lose them.
Disadvantages
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Sensation of being wearing “something artificial”. |
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Fear of sudden movement of the ear prosthesis in social situations. |
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Skin irritation. |
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When prosthesis does not match patient´s skin color. |
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Social concern. |
Ear reconstruction patients may temporarily have an auricular prosthesis until the surgery is performed. Whichever decision the patient makes, dissection of the remnant microtic ear for prosthesis placement must be avoided.
Remnant tissue
Successful reconstruction of the ear in acquired deformities, requires meticulous and promptly attention to all the aspects of the available auricular soft tissue environment surrounding the planned reconstruction.
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