Microtia Surgery Kansas City

Microtia

Microtia is an incompletely formed ear. Two to three surgeries performed by a well- trained and experienced plastic surgeon are required to create a new ear. For patients with internal ear structures identified on a CT Scan, a final stage to create an ear canal may be performed by an Ear, Nose Throat surgeon. Surgeries may start as early 8 years of age or when the diameter of the rib cage is approximately 60cm. Fortunately, for your child, Dr. Singhal at Singhal Plastic Surgery, P.A. has over 15 years of experience recreating ears for children born with microtia and has produced many beautiful new ears.

Stages of Surgical Reconstruction:

1st Stage:

Rib Harvest
Creation of Skin Pocket
Placement of New Ear Framework

Length of Hospital Stay 24 hours

The 1st stage consists of two separate procedures:

1) Harvesting the rib cartilage

2) Inserting the carved, sculpted cartilage into a skin pocket at the site of ear to be reconstructed. The length of surgery is approximately 4 hours.

HARVESTING THE RIB CARTILAGE

A slightly oblique chest incision is made over the 6th, 7th and 8th ribs close to the sternum (on the opposite side of the Microtia). On a thin child, the incision is about 3 b 4 1/2 inches. The 6th and 7th ribs are usually fused together and will form the base framework of the new ear. The 8th rib is used to form the rim of the ear called the “helix”. Once the three pieces of rib are carved, sculpted and sutured together, the framework for the ear is created. A small piece of extra rib is saved underneath the chest wall for the next stage.

INSERTION OF NEW EAR FRAMEWORK INTO SKIN POCKET

This newly reconstructed cartilage ear framework is now inserted into a skin pocket at the site of microtic ear.

Post-operative Instructions:

The patients are discharged after overnight stayB after surgery. An ear dressing is applied during surgery as well as an outer protective dressing called an oto-shield. The protective oto-shield will be worn for approximately 3 weeks. Drains will stay in place for about 7 days to provide negative suction so that the skin can adapt to the newly inserted framework. These will be removed at your follow-up appointment. Contact sports are restricted for about 4 to 6 weeks. The hair may be washed a few weeks after surgery. The next stage may proceed approximately 3 months later.


2nd Stage:

Creation of the Earlobe
Temporo-Parietal fascial flap and Split-thickness Skin Graft
Elevation of the ear
Harvesting cartilage (possible)

FORMATION OF THE EARLOBE

Length of Surgery: Approx 4.5 hrs
Length of Hospital Stay: 24 hours

The 2nd stage consists of forming the earlobe, otherwise known as “transposition of the lobule”, elevating the newly formed ear from the side of the head, covering the elevated cartilage with temporo-parietal fascial flap and placing a skin graft on the fascia. Additional cartilage that was placed inside the chest wall may be place behind the ear to assist with elevation. Drains are used similar to first stage.

Post-operative Instructions:

The patients go home with pain medication. Drains may be in place for 7 days. An ear dressing and otoshield are in place. Contact sports are restricted for about 3 to 4 weeks. The hair may be washed a few weeks after surgery. The next stage may proceed approximately 3 months later.


3rd Stage:

Revision/touch-up, possible excision of scalp scar
Formation of the Tragus

ELEVATION OF THE EAR & SKIN GRAFT PLACEMENT

Length of Surgery: Approx 2 hrs
Length of Hospital Stay: Overnight stay

Approximately 3 months after the 2nd stage is completed, the 3rd stage is begun.
An incision is made behind the newly constructed ear and the undersurface is undermined. This raw tissue is now lined with a skin graft. Once the graft is secured, a bolster dressing is placed behind the ear. In addition, a special bandage is placed over the graft site. The 3rd stage also consists of the formation of the tragus (the cartilaginous bump in front of the external auditory canal),

Post-operative Instructions:

The patients go home with pain medication as well as antibiotics. The ear dressing and the sutures are removed around the seventh post-operative day. Contact sports are avoided for about 4 weeks. The hair may be washed a few weeks after surgery. The final stage may proceed approximately 3 months later.


4th Stage: (done by ENT)

 

You may reach Dr. Singhal’s office by calling (800) 518-9314