Microtia is a well known congenital ear deformity that has a broad spectrum of presentations. From a small residual bump to a crumpled shortened ear, no two cases of microtia are exactly alike. But they all similar in that they are an incompletely formed ear that is much smaller than a normal one. The underlying cartilage framework and ear canal are malformed and it is easy to see why such a complex structure can go developmentally awry.
One of the marvels of modern plastic surgery is the reconstruction of the microtia ear deformity, the most complex form of an otoplasty. While it is not a life-threatening or life-changing deformity, its reconstruction is a complex array of operative steps that call upon a variety of basic plastic surgery techniques and an artistic ability. While it is not as technically precise as the vascular anastomosis of a free flap, it is similarly unforgiving in its execution. You have one good opportunity to work with the skin over the deformed cartilage remnant. Your first effort is your best chance for the best result. Salvages of failed ear reconstructions are extremely difficult and almost always far from satisfying.
While there are different methods for putting the initial cartilage framework together, and it is a learned skill to masterfully assemble one, the more critical step is in how the overlying skin is handled. What is the correct location and angulation of the framework, is the skin adequate or does it need tissue expanded, how much of the deformed cartilage should be removed, and what about the typical low lying hairline? All of these issues can compromise an otherwise well-crafted cartilage framework by obscuring its exquisitely carved detail.
Beyond the most critical step of first-stage cartilage framework fabrication and insertion is the creation of smaller but aesthetically important ear details. The lobule, ear to head separation, and the concha-tragus unit all make important contributions to what we see as a more normal ear. While different microtia surgeons may stage these subsequent creations at different times or in differing combinations, all will attest to their value in the pursuit of what nature failed to create.
Even with all the current and future innovations of plastic surgery, microtia reconstruction remains a marvel and is a collage of plastic surgery techniques focused one relatively small area. The sheer rarity of microtia makes its reconstructive mastery limited to just a handful of plastic surgeons.
Dr. Barry Eppley
Indianapolis, Indiana