Ear Reconstruction

Ear Reconstruction Surgery Preparation

The ears have great importance for facial feature definition. Although ears are not included in the traditional concept of beauty, ear deformities as the result of trauma, cancer or disease may cause alterations in facial appearance. Deformities in size, shape or position of the ears may cause significant patient anxiety and concern, and may affect the individual´s social interaction and self-perception.

What is ear reconstruction?

Ear reconstruction, as a part of otoplasty, is the reconstructive surgery procedure to correct serious ear deformities due to congenital, pathological malformation, and trauma. Ear reconstruction seeks to restore shape on a damaged ear, either with autologous tissue or implants. The reconstructive ear surgery is considered as one of the most challenging operations in reconstructive surgery.

Ears may need reconstruction due to the following reasons::

• Acquired deformities.
• Ear trauma.
• Burns.
• Tumors.

Microtic ear - What is microtia?

The term microtia refers to a congenital small external ear. It is a type of ear deformity due to the incomplete development of ear during the fetal stage. The defect can be either unilateral, affecting only one ear, or bilateral, affecting both. With bilateral microtia, there is a greater risk of hearing loss. In most severe cases, there is no development of the external part of the ear. This condition is known as anotia (“no ear”).

Children with anotia may have inner ear abnormalities. These children should see the otolaryngologist for early detection and management of hearing problems. In case of anotia, hearing aids might be needed. Also, self-esteem can be affected in children who are very concerned about these problems.

There are four basic degrees of microtia:

Grade I: A slightly small ear with identifiable structures. A small external canal may be present or not.


Grade II: Some features of a normal ear are missing.


Grade III: A very small portion of cartilage with nearly absence of external ear.


Grade IV: Absence of the total ear or anotia.

These deformities may be different in each patient and treatment can only be determined by a medical examination.

At what age can the microtia correction be performed?

Patients with microtia may suffer from psychological and emotional problems. That is why children with microtia should have surgery early to avoid possible emotional stress. Many patients often wear their hair in ways that it hides the affected area to deal with this problem. Although most patients with microtic ear are children, many adult patients with microtia consider ear reconstruction.

The ideal age for ear reconstruction is over the age of 4-7 when children have sufficient cartilage in the rib cage to allow reconstruction of an adult ear. However, the physician is who can determine the appropriate moment for reconstruction.

Consultation

What to expect during your consultation?

During consultation you may express your reasons to consider ear reconstruction and also your expectations. It is important that patients do a good research about ear reconstruction surgery.


This may help you to understand how the treatment will be developed, as you save time asking appropriate questions. Your doctor will address your questions and any specific concerns you may have. Also, your surgeon will show you photographs of comparable ear reconstruction procedures on other children to give you a realistic idea of what to expect from surgery.

Ear reconstruction is not an easy process for children. The patient and parents should understand that total ear reconstruction surgery takes place over the course of different stages at two to three month intervals. Also, microtia treatment may cause some postoperative discomfort with a prolonged recovery period and the patient may need to use protective dressings during treatment. Since a piece of cartilage is removed from the child´s rib cage, patient is usually most comfortable spending one or two nights in the hospital following the surgery.

It is important that you discuss the potential risks and complications of ear reconstruction surgery with your doctor. Although, the treatment of microtia involves a complex process, ear reconstruction may have significant psychological lifelong benefits for the affected child.

Preoperative evaluation

The preoperative evaluation is essential for the patient seeking ear reconstruction. The surgeon will thoroughly examine head and neck. Preoperative evaluation involves facial asymmetry, malocclusion and other characteristics of the hemifacial microsomia condition, in which the lower half of one side of the face is underdeveloped and does not grow normally. Also, surgeon estimates position and size of the opposite ear. The use of cartilage from the rib to reconstruct the external ear is also considered. Ear reconstruction surgery success depends on the preoperative evaluation, planning and appropriate treatment. Photos of the patient´s ears are taken to determine the appropriate shape and position.

Preoperative planning

The success of ear reconstruction basically depends on surgical planning. The following steps are required to ear reconstruction:

Mold: The surgeon creates a silicone mold as an exact copy of the opposite normal ear in case of unilateral microtia. When bilateral microtia exists, the surgeon may use the ear from another child or family parent of similar age, as a template.

Later, the area for graft insertion is delimitated.

Postoperative care

• To be sure of the success of the operation and wellbeing of the patient, appropriate postoperative care is required. To avoid potential complications, children must adhere to guidelines regarding postoperative care.


• The reconstructed ear will be closely observed by the surgeon to prevent development of wound infection and circulatory problems.


• Antibiotic medication is prescribed to prevent risk of infection.

What care should I take following ear reconstruction?

Part of the success of surgery depends on the postoperative care. It is very important to follow the surgeon´s recommendations to reach the desired outcome. Dr. Nieto closely observes her patient´s convalescence and healing. Please do not hesitate to contact her if you have questions or concerns. You will be given written instructions for your postoperative care to you and your family.

Postoperative recommendations – Ear reconstruction surgery

• You will be given precise instructions for postoperative care. Be sure that medical instructions are clearly understood by you and your family members.


• Children should avoid contact sports or very vigorous activity that may increase risk of hitting, for the following four weeks.


• A pressure dressing will be placed around the head to slightly compress the ears, hold everything in place, and promote healing.


• Call your surgeon immediately if you experience excessive and prolonged pain.


• ou may experience some itching and aching at the surgery site. Itching is typically a side effect of the sutures, which can become dry and irritated. Try not to scratch your scar as it may stretch. If sutures come apart, wound infection and other complications may occur.
• The ears may throb or ache a little for a few days, but this can be relieved by medication.


• Some patients refer a sensation of numbness after ear reconstruction surgery. This is a completely normal consequence of surgery. Sensation will return as healing progresses.
• Drainage tubes are removed 48-72 hours after surgery.


• Dr. Nieto will give you precise instructions for bathing and wound care.


• Also, you will be informed when your sutures need to be removed.


• Subsequent post-surgery visits will be scheduled to replace the head dressing and observe the healing process. Patient must return to the office for general check up as indicated by the physician.


• Remember, recovery process is different in each patient


• You may experience some sensation of tightness due to swelling. This condition is part of your healing and it will subside within days.


• It will be given prescriptions for use following surgery, including anti-inflammatory medicines to reduce swelling, oral antibiotics, and pain medications to minimize any discomfort.


• Inform immediately to your physician if you develop an unexpected reaction to the prescribed medication.


• You must make arrangements for a responsible adult friend or family member to take you home and take care of you during your convalescence.


• Avoid taking any medication that has not been prescribed by your doctor, especially aspirin (acetyl salicylic acid) or aspirin-like products (Ibuprofen, Advil, Motrin or Aleve). These medicines have anticoagulant adverse effects and may increase the risk of bleeding or scarring complications.


• You should expect some bruising as a natural part of reconstruction surgery. This condition will fade within days after surgery.


• Lifting heavy things, animals or children may affect the area of surgery. You must avoid any activity that increases risk of hitting for two weeks after surgery.


• You should avoid contact sports or very vigorous activity for three months.


• Please inform Dr. Nieto if you present heavy bleeding from the wound, severe pain or chest pressure, high fever (more than 38 degrees), significant redness or severe discomfort.

Ear Reconstruction Surgery Preparation

It is considered you are in surgery from the moment you arrive to the surgical area until you have sufficiently recovered from anesthesia. Before your surgery, your surgeon, anesthesiologist and the nursing staff will meet you in the pre-operative area to discuss your medical condition and answer your questions.

The anesthesia

What kind of anesthesia is used for ear reconstruction surgery?

Ear reconstruction surgery is performed under general anesthesia with intravenous induction and inhalation anesthesia. You will sleep through the entire operation, feeling no pain and remaining absolutely relaxed. The section about Anesthesia provides complete information on this medical practice along with recommendations and instructions.

Duration of the surgery - How long does ear reconstruction surgery take?

Surgery time for ear reconstruction may vary. Since in the first stage of the procedure, rib cartilage is taken from the chest, carved to resemble the shape of the ear, and placed in a pocket under the skin, time in the operating room may take 4-5 hours.

Hospitalization - Will I require hospitalization?

Ear reconstruction surgery involves a complex surgical procedure that demands medical observation. Since a piece of cartilage is removed from the child´s rib cage, patient is usually most comfortable spending one or two nights in the hospital following the surgery.

Therefore, your surgeon might recommend a stay at the surgical center to observe your recovery progress.

Preoperative preparation of patient

• It is recommended to wear comfortable clothing. Be sure your shirt has buttons or zipper in front. You will not want to try to pull something over your head.
• Wash your hair the day of the operation.
• Girls should tie hair into a ponytail.
• Boys should wear a short cut hair style.
• Patient preparation includes treating the surgical site before surgery, using appropriate antiseptic agents for skin preparation.
• In the operating room the intravenous therapy or IV will be initiated. The IV is the giving of liquid substances directly into a vein. Through a needle you will receive saline solution, anesthesia, and other medications you may need during surgery.