Microtia

Abstract

Congenital anomalies of the ear present with a wide variety of clinical forms, which require specific technique for each one. Therefore, it is useful to classify them in order to perform adequate evaluation preoperatively. The term severe microtia must be restricted to patients with auricular malformation, who always present with a vertical fold on the anterior border of the future auricle. It is a congenital anomaly caused by undevelopment of the ectoderm with minor or median associated on neighboring region without complex abnormalities on other segments along the body. Ear reconstruction is performed in one or two surgical stages. Those cutaneous folds present two segments in all patients: 1. The superior one covers the congenital remnant cartilaginous tissue. 2. The lower segment is similar to the ear lobule but it is rotated upward. Reconstruction of the ear is performed on patients at the age after 6 or 7 years old. It is mandatory to replace the auricular framework that is excavated on costal cartilage with all anatomical and aesthetical details, which I personally prefer. The new auricular skeleton, after being meticulous curvedly shaped, is embedded through a subcutaneous tunnel carefully dissected on the region of the future ear. The main pedicle of the new auricle is created on the anterior border of the mastoid bone supplied by a vascular network coming from deep tissue. When a second surgical stage is required, it is done 6 months later. Cervical cutaneous flaps are created in order to cover the raw area on the mastoid region.