EAR RECONSTRUCTION OPTIONS

Ear reconstruction is a very specialised area. Not every plastic surgeon can reconstruct ears and it is a very challenging area for reconstructive surgeons. To obtain consistently good results, the surgeon you choose to do ear reconstruction needs to be very experienced and specialise in this procedure. There are a few options available for ear reconstruction:

1. A Prosthetic Ear
A false ready-made ear usually made from silicone is attached to fixtures that are embedded into the bone at the side of the head. It may also be attached using a special adhesive. It usually involves 2 surgeries, 3 months apart when the child is 7/8 years old. The prosthetic ear must be renewed approximately every 2 years. It should be removed every night and cleaned daily. Patients in Ireland who wish to pursue this method are usually sent to the UK for this procedure, although the fixtures for the prosthetic ear can be implanted by ENT's in Ireland.

2. Ear Reconstruction using Rib Graft
An ear is reconstructed by removing some of the patient's own rib cartilage and shaping an ear framework from this. The number of surgeries involved varies between 3 to 5 operations over 18-24 months before the ear is finished. Most surgeons using this method of reconstruction prefer to wait until a child is about 10 years of age before starting surgery to ensure the ear has stopped growing and that the rib cage is large enough to provide the donor material necessary. If atresia repair is done with rib graft, then the atresia repair should be done AFTER the rib graft.

Results using this technique are variable and heavily dependent on the experience and skill of the surgeon. The surgeons best known for reconstructing ears using ribgraft include Dr Burt Brent in California, USA, Dr Nagata in Japan and Dr Francoise Firmin in Paris, France.

3. The Medpor Implant
An ear framework is made using a synthetic material called porous polyethylene. This material has been successfully used in plastic surgery for over 30 years. For 15 years, it has been used for ear reconstruction. This readymade ear is placed under the patient's scalp and covered in the patient's own skin taken from the tummy and back of the other ear, if present. The procedure can be done on children from the age of 3. It involves two outpatient surgeries, 3 months apart. The implant is porous and so blood vessels grow through the implant. The surgeon best known for this method of ear reconstruction is Dr John Reinisch at The Children's Hospital in Los Angeles, USA, who developed this technique and has reconstructed 500+ ears using the medpor implant. Dr Reinisch has also successfully reconstructed ears on patients who lost ears due to burns or who had failed surgery using other methods of reconstruction. If atresia repair is done with the medpor implant then the atresia repair should be done BEFORE the medpor implant.

This method of reconstruction is currently not available in Ireland or The European Union but patients from Ireland have travelled to the USA for this procedure.

4.Soft Tissue Reconstruction
This may be possible when there is sufficient existing tissue in milder forms of microtia. The surgeon best known for this is Dr Roland Eavey in Massachusetts, USA.

5.Opt Not To Reconstruct The Outer Ear
Some patients may opt to not pursue surgery. It's an individual decision and often depends on the degree of the microtia and many other factors.