Reconstruction - Craniofacial

Ear Reconstruction / Microtia

In total construction of the auricle (external ear) the plastic surgeon must sculpt a delicate convoluted framework from rib cartilage and cover it with a fine skin envelope.

Alloplastic (or artificial) frameworks are not well-tolerated. At UCLA, it is believed that a patient's rib (or costal) cartilage is the most reliable framework.

The goal of the surgeon is to create an acceptable representation of an external ear with proper size, position and orientation to other facial structure. The procedure is usually undertaken at 6 to 9 years of age.

Generally, the reconstruction may be done is 4 stages (Brent technique) or 2 stages (Nagata technique) depending on the patient's ear deformity (microtia type) and surgeon preference for each case.

The 4 staged technique consists of:

1. Framework fabrication from rib cartilage;
2. Elevation of framework with skin graft and banked cartilage;
3. Lobule (ear lobe) rotation;
4. Creation of tragus (front of ear, covering the ear canal).

The 2 stage technique consists of:

1. Framework fabrication from rib cartilage, including the tragus;
2. Elevation of framework with temporal parietal flap and skin graft.

The first stage of the reconstruction requires an overnight stay in the hospital. Other stages are outpatient procedures. The entire process may take 6 months to one year to complete.

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