Anotia

Abstract

The term anotia specifically refers to patients with congenital anomaly of the external, middle, and inner ear in which there is no remnant auricular cartilage. For this reason I do not call it anotia in patients with total amputation of the ear, because there is always some segment of auditory canal after avulsion. According to my classification, patients with anotia always present with imbalanced facial asymmetry caused by undevelopment of the bones of the face and skull as well as of the soft tissues. Also, patients present complex anomalies of other organs and segments of the body, such as the heart, chest wall, and column, and lower and upper extremities. The associated anomalies are a combination of undevelopment of the ectoderm and mesoderm. Reconstruction of the auricle on patients with anotia is the most difficult procedure, because the disharmony of the face is a challenge to project the new ear. The surgical planning is an important step before surgery and the references points of the normal side should not be transferred to the affected one because of facial asymmetry. The auricular framework must be excavated on a rib cartilage and it is mandatory to create the auricular lobule in the same block. Therefore, the operation is performed in two surgical stages. Covering the posterior aspect of the ear may be performed by cervical cutaneous flaps in order to achieve better projection of the reconstructed ear as well as to avoid postoperative scar retraction and contraction.