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Treatment Complications

Every surgical procedure includes specific complications which should be taken into consideration when decisions regarding treatment are being made.  Complications associated with atresia surgery are listed below.  Fortunately, extreme attention to detail can reduce the incidence of these complications to low levels.  Surgical team experience correlates strongly with how often certain complications occur.

The following table and descriptions summarize the incidence of complications from the world’s literature associated with atresia surgery:

Complication Frequency
Infection 2%
Eardrum Lateralization 3-18%
Canal Stenosis 7-18%
Hearing Nerve Injury 2%
Facial Nerve Injury 2%

Infection – any surgery that causes a break in the skin can lead to a post operative infection at the surgical site when microorganisms, most commonly bacteria or fungus,  invade the tissues surrounding the surgery site in the immediate post operative period or within 30 days of surgery.

Eardrum Lateralization – the newly reconstructed eardrum pulls away from its attachment with the middle ear bones causing a drop in hearing as the vibrations captured by the reconstructed eardrum are no longer transmitted to the middle ear bones.

Canal Stenosis – the surgically created skin-graft-lined ear canal narrows or closes as a result of overzealous healing forces at the site of surgery.

Hearing Nerve Injury – hearing nerve cells in the inner ear are injured producing an irreversible partial or total hearing loss.

Facial Nerve Injury – the facial nerve, responsible for movement of the muscles of the face, is located in close proximity to the surgical site.  It has the potential of being injured, leading to a weakness or even paralysis of facial movement that can be partial or total.  In some cases, function improves or normalizes over time and in other cases the deficit may be permanent.

The following table summarizes the incidence of complications in our experience as detailed in a peer reviewed medical publication:

Atresia Repair Before Microtia Reconstruction: Comparison of Early With Standard Surgical Timing (PDF)

Complication Frequency
Infection 0%
Eardrum Lateralization 6%
Canal Stenosis 6%
Hearing Nerve Injury <1%
Facial Nerve Injury 0%

Other problems are at risk of developing in the the longer term following atresia repair surgery.  For example, skin grafting with tissue moved from other parts of the body requires routine cleaning once or twice a year for life because this tissue acts differently than that of a regular ear canal.  If regular cleanings are not performed, build up of skin debris increases risk of an infection developing that may injure the eardrum or canal skin requiring repeat surgery.  Likewise, middle ear infections may break through the new drum, exactly in the same way they can in a normal eardrum, and cause a hole or perforation.  Most of these heal on their own but in 10% a procedure is required to close the perforation.

New protocols initiated at CEIMG International Center for Atresia & Microtia Reconstruction have addressed the most common complications of canal stenosis and eardrum lateralization seen world wide in atresia repair surgery.  In the initial years since these protocols have been introduced, it is clear that these stated complication rates have continued to decrease even further. Future research and statistical reporting, as well as publication of our new protocols, will follow in the near future.

While not technically a complication, malformations in the middle ear bones may cause the need for middle ear bone reconstruction.  As the first to describe the malformation, Dr. Roberson and colleagues have detailed an abnormality in the connection between the 2nd and 3rd middle ear bones (the incus and stapes respectively) that may lead to reduced surgical outcomes in hearing.  In 13% of patients, instead of the two middle ear bones being connected by a bony joint, a scar exists between these two bones, preventing the transmission of sound to the inner ear.  If severe enough, middle ear bone reconstruction needs to be performed.  Roughly half the time, this is performed at the time of the first surgery.  In the other half, a second surgery is required to reconstruct the abnormal connection.  Dr. Roberson has designed titanium middle ear bone prostheses used for this purpose.  Our findings are described here: Fibrous IS Joint Abstract (PDF)

 

 

Constant improvement and refinement has been a part of our historical culture at CEI.  With experience and extreme attention to detail, our patients and their families benefit from reduced complications and problems following surgery.


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