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Microtia (a smaller than normal, usually misshapen auricle) is one of the more common congenital anomalies of the external ear. It occurs with a frequency of one in every 7,000–8,000 births in the general population. Males and right ears are affected most often. Bilateral microtia occurs in one in every 12,000 births. The majority of cases are sporadic; less than 15% of individuals have a family history of ear anomalies.
Three grades according to severity are typically described in the Weerda classification:
- Grade I microtia represents a smaller than expected but generally well formed pinna with recognizable landmarks.
- Grade II microtic ears have rudimentary, misshapen pinnae. The cranial end is usually curved representing a crude helix.
- Grade III describes the worst manifestation of microtia: severe attenuation of the pinna, represented only by a small nodule of misshapen tissue that distinguishes it from the anotia, or a complete absence of the external ear.
Conventional surgical treatment is the Tanzer-Brent technique, a multistaged procedure that usually does not restore hearing and requires multiple autogenous rib grafts. The drawback of this approach is there are only a few physicians who can reliably obtain an acceptable and detailed auricular shape at the completion of the surgeries. The usual result is a thickened, poorly contoured mass on the side of the head. Additionally, the procedure requires a mutilating donor site at the six-year old child’s chest, with a 3 cm by 6 cm block of rib being harvested for the auricular body framework, and a 9 cm portion of rib taken for the helix. Absorption of the autogenous rib framework with loss of auricular detail has also been well documented in the medical literature.
Dr. Romo utilizes a prefabricated auricular prosthesis made of porous polyethylene and covered with an ipsilateral temporoparietal fascia (TPF) flap with a contralateral postauricular full thickness skin graft. This approach is used in primary Grade II and Grade III microtia patients as well as in failed microtia reconstructions that had employed local skin and autogenous rib grafts. This microtia reconstruction technique eliminates the chest donor site morbidity and allows surgeons with less exacting carving skills to produce an elegant and detailed auricular reconstruction.
Children with bilateral microtia receive bone conduction hearing aids at birth and auricular reconstruction at four years of age; unilateral cases usually start reconstruction at five years of age. Before reconstruction, all children receive a full evaluation by an experienced audiogram and temporal bone CT scan if warranted. Hearing restoration is attempted after reconstruction whenever possible in appropriate patients.
Please visit our website www.earreconstruction.com for information on reconstruction of ear deformities.
• Click here to see before & after photos