Microtia-Anotia
Overview
Microtia is a condition in which the external portion of the ear (the auricle) is malformed. In the strictest definition, there is also narrowing or absence of the external auditory canal (external auditory meatus). This is different from a “small ear” in which the ear is normally shaped, but smaller than normal as in Down syndrome. Microtia varies in severity from barely discernable to an external ear with major structural changes. Anotia is the total absence of the auricle most often with narrowing or absence of the external auditory meatus. Anotia/microtia can occur unilaterally or bilaterally.
Symptoms
* Aural atresia * Difficulty wearing headphones or glasses * Balance Problems * Kidney Problems
Treatment
Reconstruction of microtia is deferred until five to seven years of age, at which time the opposite normal ear can be used as an adult-sized pattern for reconstruction of the abnormal side. At this age also, the rib cartilages have attained enough dimension to serve as a graft source and template for reconstruction of the ear framework. Reconstruction typically involves three stages. While surgical preferences influence the exact steps within this sequence, my preference is for an initial stage involving the reconstruction and transplant of the ear cartilage framework to its desired location on the affected side. The second stage involves transposition and positioning of the earlobe and reconstruction of the tragus with deepening of the conchal hollow. A final stage involves elevation of the ear from the scalp. A child's particular deformity may impose variation on these routines. Since microtia occurs in approximately one in eight thousand births and is associated with some failure of development in the first and second branchial arch (see Craniofacial Microsomia), the treatment of these children is generally best carried out under the guidance of Team Centers, where a large volume of children similarly affected are seen. Reconstruction follows the same course and guidelines as described for microtia but necessitates additional cartilage to shape the likeness of the ear lobule. In addition, grafts and flaps are frequently required over the anterior surface of the reconstructed ear to add the missing skin cover and eliminate the presence of hair-bearing scalp over the framework.