Ear reconstruction is a two-stage procedure where the contours of the normal ear are shaped with costal cartilage and placed in a skin pocket to create the ear.
What can be achieved?
At Artiste Plastic Surgery Ear Reconstruction is performed for the following reasons:
- Craniofacial/hemifacial microsomia (CFM)
- Treacher Collins Syndrome (TCS)
- Goldenhar Syndrome
- Complex craniofacial conditions
- Other congenital anomalies
- After traumatic amputation
- After surgical excision
- After complications from Otoplasty surgery
Ear Reconstruction TECHNIQUES
Dr Jack Zoumaras uses the Francoise Firmin technique of ear reconstruction. This involves two stages. The first stage consists of harvesting rib cartilage and carving all the 3-D contours of the ear and the second stage involves creation of the post-auricular sulcus and elevation of the construct. Dr Jack Zoumaras spent 6 months in Paris with Francoise Firmin learning about ear reconstruction from the worlds best. In this time Dr Jack Zoumaras was trained in this technique and has already started a database of ear reconstructions performed in Sydney to date.
Microtia is the congenital absence of the external ear/pinna. It affects 1 in 8000 live births and may be associated with other congenital syndromes such as CFM, TCS, and Goldenhar’s. It commonly affects the right side greater than the left and in some circumstances bilateral. It affects children of Asian descent slightly more than others. The cause of isolated Microtia is unknown and likely multi-factorial; there is a small genetic component with the risk of an affected parent transmitting to a child around 5%.
Depending upon the severity of the Microtia, the inner ear may or may not be developed. If not developed the child will not be able to hear from the ear. If the middle and inner ear is developed then conductive hearing through a bone anchored hearing device (BAHA) is possible. Patients with Microtia will be assessed before the age of 1 at a Microtia clinic with an audiologist, ENT and Plastic Surgeon and nurse co-ordinator.
The second stage is after 6 months to allow the new ear to heal into the pocket and be stable.
The second stage is overnight surgery and pain is minimal compared to the first stage. Again a head bandage is worn for a few days.
The second stage involves elevating the flat 3D construct of the ear from the ear pocket to create elevation and a post-auricular sulcus. A skin graft and/or temporoparietal fascia flap is sometimes needed to project the ear. This stage can be combined with surgery on the other ear to create symmetry.
You will remain in hospital for 4 days with a head bandage and suction drains that will be changed regularly. After discharge the drains will be removed and a lighter dressing applied. Most of the pain initially comes from the chest wall that is managed with intravenous and oral medications.
Rib cartilage is harvested from the same side as the ear to be reconstructed. After preparing the ear pocket the rib cartilage is sculpted to form a new ear. This sculpting is modelled after a template of the normal ear. The entire 3-D contour of the ear is reconstructed during this stage. The new ear is placed into the pocket with suction tubing. Due to a lack of skin the new ear is flat against the head.