Ear reconstruction is considered as one of the most challenging operations in plastic surgery. It is usually undertaken in specialist centres, where, with the appropriate training and case availability it is possible to attain excellent results. The majority of plastic surgeons see one or two cases per year. Ear reconstruction is requested by two main groups of patients: those who have an underdeveloped ear at birth (a condition known as microtia) and those who have lost a normal ear through trauma, disease or previous surgery.
Ear reconstruction photo gallery
The reconstruction process is in two stages, about 6-12 months apart. The first stage involves creating a skin pocket at the site of the ear by re-orientating the available tissue and thinning the skin to mimic the ear skin. Rib cartilage is then harvested in three pieces. These are carved and wired together with fine stainless steel wire to produce a very detailed ear framework. The framework is then inserted in the pocket and gentle suction is applied to enable the skin to adhere to framework. This operation takes 4-6 hours and the expected length of stay in hospital is 5-7 days.
Rib harvested for ear reconstruction
The second stage involves releasing the ear from the head and inserting a piece of cartilage behind it to maintain projection. A flap of vascularised tissue is then utilised to cover the exposed cartilage. This is either transposed from behind the ear or rotated from under the scalp. This is then covered by a skin graft (taken from the scalp, thigh or groin). The second stage takes 3-4 hours and the expected hospital stay is 2-3 days.
For congenital ear abnormalities (microtia), surgery is usually deferred until the age of nine or above; before this age there is generally insufficient volume of rib cartilage that needs to be harvested for the reconstruction. This operation can be performed at any age in adulthood although it can be more difficult in older age people because of cartilage calcification. The psychological benefit of ear reconstruction to the patient is immense. Prior to reconstruction most of the children are withdrawn, lack confidence and suffer from teasing at school. Adults are also affected in a similar manner following ear loss.
The operation has a high success rate with over 90% of the reconstructed ears being graded good or excellent by our patients.
Carved framework
from harvested rib
The alternative to autologous ear reconstruction is a prosthetic ear (Branemark). This is clipped on to two titanium pins inserted into the skull. There are pros and cons to each method. The disadvantages of prosthetic ear are that it needs to be removed daily for cleaning, it can be accidentally unclipped from minor trauma, frequently complicated by problems around the pins throughout life and suffers from poor colour match.
