Microtia Treatment Options
Porous Polyethylene (PPE) Microtia Repair: Three Options
With this technique, the outer ear is reconstructed by implanting a medical-grade synthetic implant (several companies make these implants: Medpor, etc.) covered with a tissue flap and skin. Several companies make PPE implants (Omnipore, Medpor, etc.). The outer ear can be completed in a single surgery and can occur earlier in life than rib graft repair. No donor cartilage is required.
Unlike rib graft reconstruction, which must be fully complete before canalplasty can occur, PPE reconstruction can be achieved early in life, either concurrent with canalplasty (in a single surgery) or in one surgery following prior canalplasty after a period of healing. Earlier options of outer ear reconstruction with this technique allows hearing to be supplied earlier in life, maximizing development. Three options for timing of the PPE outer ear reconstruction exist with relation to ear canal surgery:
Ear Canal Surgery First: Canalplasty surgery can occur when the patient is a minimum of 3 years of age and 15 kg in weight. A healing period of at least 4+ months must pass prior to proceeding with second-stage PPE surgery for outer ear reconstruction.
Combined Atresia Microtia (CAM) Surgery: With this option, the canalplasty and outer ear (PPE) reconstruction are completed in a single surgery. This procedure was pioneered at the California Ear Institute in 2008 and has become the most popular option for treatment, especially for those traveling from a distance. Surgery is performed on an outpatient basis, with patients able to be discharged home the same day after surgery.
PPE Reconstruction First: In rare cases, patients who have had prior outer ear surgery and later choose to pursue canalplasty surgery may be candidates for canal surgery after PPE reconstruction. However, this is strongly discouraged, as the complication rate for the PPE implant with ear canal surgery has been shown to be higher than other options. In addition, the plastic surgeon who performs the repair is not able to predict where the ear should be located, so the ear canal ‘lines up’ with the reconstructed outer ear, which can lead to increased complication rates and inferior aesthetic outcomes.
Rib Graft Microtia Repair:
Rib graft microtia repair is the most common strategy worldwide for the reconstruction of malformed outer ears associated with microtia. Cartilage is taken from the patient’s rib on the chest and carved to create an implant that is placed under the skin to simulate a normal ear. Since a significant amount of cartilage is required, rib graft surgery is usually initiated at 5-6 years of age and requires 3-4 stages. Ear canal surgery must be performed only after all stages of rib graft repair are completed and healed for several months. As a result, in patients with rib graft, canalplasty must be delayed until an average of 11-12 years old in our practice. In order to allow normal development, hearing must be provided through alternate means during the time required for rib graft repair to be completed with surface bone conduction devices before hearing can be secured with a canalplasty.