Girl born with deformed right external ear
The patient is a now 24-year-old girl from Ranchi in Jharkhand, India who was born with near total absence of her external right ear. She had just a peanut like wedge instead. There was also absence of an external ear canal and eardrum.
Her marriage had been fixed three years ago and they had approached a local plastic surgeon. Upon examining the patient, he had realized that she needed to get it addressed at a specialty center. He had then referred them to our hospital for treatment.
Our hospital is a premier surgical center for microtia surgery in India. Many patients have been rehabilitated here and are leading completely normal lives today. Our hospital is a premier center for facial plastic surgery in India.
Initial presentation and consultation at our hospital
Dr SM Balaji, ear reconstruction surgeon, examined the patient and conducted a detailed evaluation. He explained to the patient the processes involved in ear reconstruction surgery.
Microtia surgery is performed in three stages. The first stage involves reconstruction of the ear using rib cartilage. A skin pocket is first created at the site of the missing external ear. The cartilage is then banked in the skin pocket created at this location.
The patient has already undergone this stage of the surgery two years ago at our hospital. Lobule shifting had also been completed. She now presents for the second stage microtia surgery.
Presentation and classification of microtia ear deformity
Microtia is a congenital deformity where the external ear is underdeveloped. Complete absence of the external ear is referred to as anotia. Microtia can be unilateral or bilateral and occurs in around 1 out of about 8,000–10,000 births. The right ear is more commonly affected than the left ear.
Unilateral microtia is more common than bilateral microtia. Microtia is graded according to its severity. In grade I microtia, there is a less than complete development of the external ear with identifiable structures and a small but present external ear canal. Grade II microtia manifests a partially developed ear with an underdeveloped upper half. The external ear canal is closed leading to conductive hearing loss.
Grade III microtia is more severe with near complete absence of the external ear with just a small peanut-like structure along with the absence of the external ear canal and ear drum. This is also the most common form of microtia. Grade IV microtia denotes the complete absence of the external ear.
Second stage microtia surgery for ear reconstruction
After a clinical evaluation, the second stage surgery for ear elevation was scheduled for the patient. Under general anesthesia, the banked cartilage was first removed. This was followed by excision of the scar in the inframammary region where the graft for the first stage had been harvested. A full thickness skin graft was then obtained from the hip region and right ear elevation was done using the banked graft and the full thickness skin graft.
Successful completion of the second stage microtia repair
The ear was successfully elevated, but constant monitoring was needed to ensure that the site of the graft did not develop an infection. Routine check-up was performed for a period of about one month. The patient and his parents were very happy with the results of the surgery.