Ear Reconstruction Surgery

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There are three main approaches to reconstruction of the external ear for treatment of microtia, each is discussed in detail on their respective sections. The two most popular methods involve burying a framework under the skin to create a new ear which will be a permanent part of the patient. 

The first, which is the oldest type of reconstruction, uses rib cartilage harvested from the chest that is carved and assembled into a framework with a shape similar to a normal appearing ear. Autologous rib cartilage transplantation is the current gold-stand treatment for microtia, but harvesting rib cartilage inevitably results in donor site injury. 

The second method uses an implant made from Porous Polyethylene (Medpor) to create a normal appearing ear however it lacks bioactivity and may cause extrusion and infection.  

The third method which is not part of the patient, is to use a removable or fix prosthetic ear that is attached to implants in the bone or applied to the skin with an adhesive.

Before the surgery, the surgeon will conduct a thorough history and examination, as well as hearing tests. The surgeon will also assess whether to use the person’s own (autologous) tissue, such as skin or cartilage or Medpor implants to reconstruct the ear or if a or prosthetic is more likely to yield a better result.

Ear reconstruction surgery is considered one of the most challenging facial reconstructive surgery procedures. The ear reconstruction process happens is in two stages, about 6-12 months apart. The first stage of ear surgery takes 4-6 hours and the expected length of stay in hospital is 5 days. The second stage takes 3-4 hours and the expected hospital stay is 2-3 days.

Ear prosthetics, artificial ears attached by adhesives or bone implants, are another way to reconstruct ears. However, ear prosthetics are rarely suitable for children. The prostheses are delicate and expensive, and patient compliance and upkeep are very important to their use and success. They tend to be better suited for adults with acquired ear loss, as they lead a less active lifestyle than children, and are less likely to damage the prostheses.

Auricular prostheses are made for traumatic, surgical, and congenital defects. Surgical versus prosthetic reconstruction remains controversial for microtia patients. The ideal age for prosthetic treatment is between 6-9 years and is consistent with the optimal age for surgical reconstruction. The child should be mature enough to want and help care for the prosthesis. In cases of unsuccessful surgical outcome, the prosthetic ear is one of the option.  Prosthetic ear is a suitable option for the ear defects caused by trauma and disease in adult populations.

Tissue adhesives are used conventionally for ear prosthesis retention because of their low cost and quick results. Tissue adhesive is an old method and causes skin reaction. It is difficult to wear and take off adhesive while bathing and swimming. 

Osseointegrated implant is superior option for retention and because of nature sense of prosthesis, ease of use, long life time and retention during daily activities is accepted by patients. An implant-retained prosthesis may also be advantageous when the defect has hair on the surface of where the prosthesis needs to be placed or when the patient has excessively oily and perspiring skin. A bar/clip mechanism or magnets are used as the interface of attaching the prosthesis to the implant screws. One contraindication to osseointegrated implants is radiation therapy treatment. After radiation therapy, the bone suffers from demineralization, hard tissue vasculitis, fibrosis, long-lasting infections, poor blood supply, and oxygen deficiency. Hyperbaric oxygen treatment allows irradiated patients to obtain osseointegration.

Firstly, Titanium implants are drilled in to the skull. Abutments are provided and on top of that prosthetic ears are fixed.

• Only reserved for failed ear reconstructions with no other option remaining
• Older people who are not fit for surgery

• The ear has to be removed daily at the sleeping time, therefore, the patients are never able to incorporate the implant in there body image and a sense of deformity remains in the psyche
• Implant sites need care by cleaning around regularly
• Prosthetic ears lack sensations and the colour and temperature does not change with the body and patients are always able to perceive the difference
• Needs to be changed every five years
• The long term cost is higher than the autogenous cartilage reconstruction·  The ear has to be removed daily at the sleeping time, therefore, the patients are never able to incorporate the implant in there body image and a sense of deformity remains in the psyche
• Implant sites need care by cleaning around regularly
• Prosthetic ears lack sensations and the colour and temperature does not change with the body and patients are always able to perceive the difference
• Needs to be changed every five years
• The long term cost is higher than the autogenous cartilage reconstruction

Microtia occurs in about 1 in 8000 to 10000 live births and is more common in males.

We recommend that 9-15 years of age as the ideal age to commence reconstruction. By this time the young patient’s cartilage is mature enough to withstand the shearing stress it is subjected to in a newly created skin pocket.

The number of stages would depend on the technique chosen for reconstruction after examining the patient. Generally a two-stage reconstruction protocol works well for most of the patients.

On account of the our unique cartilage harvesting technique , there would be no chest wall deformity.

The entire reconstructive regime would require about 9-12 months to conclude.

First and second stage surgery both require about 3-5 days of hospital stay.

After first stage - Normal activities could be resumed as soon as the chest and ear drains are removed, usually it takes around 3-5 days.

After the second stage – It takes around a week for the skin graft to settle after the ear framework elevation, there after the patient could resume normal activities.

Yes, this technique of ear reconstruction which is used for microtia could also be used for reconstructing ears after loss due to any other reason.

Yes, piercing of the ear is possible after autogenous reconstruction of the ear.

Ear lobe repair or auroplasty is a commonly performed out-patient procedure at Nuface Clinic. The hole in the delicate ear lobe tissue often gets stretched or may even tear through the ear lobule due to heavy ear rings or due to accidental traction injury. 

Heavy ear rings with Thin stalk or hook tend to cut through more easily. Thus an ear ring with a thicker hook or stud is preferable if your ear holes have a tendency to enlarge.

During the natural process of ageing, the skin gradually loses collagen and elastin fibres which give strength, elasticity, and tightness to the skin.

Sometimes earlobes may get cut because of trauma. Ear loops may be pulled by getting entangled in stuff, or maybe a small child pulls at it too hard.

The procedure is performed under local anaesthesia. The skin edges of the enlarged hole or tear are shaved off to create raw edges. These edges are then meticulously sutured with fine threads to recreate an intact ear lobe. In some cases, additional manoeuvrers are done to recreate the round lower margin of the ear lobe. Closed the hole or tear along with leaving behind a small hole at the same time for wearing ear rings is not recommended as it leaves a weak spot in the resultant scar which is more likely to give way. A small dressing is applied.

The dressing may be removed after 5 to 7 days. The sutures are removed after 7 to 10 days. The area heals very well and the scar is barely noticeable after a few weeks. 

You must wait till the scar becomes strong enough before you pierce the ear lobe again. This duration may be as long as 3 to 6 months after surgery. Further, it is preferable that the new piercing is done away from the scar and not along the scar line.

When correctly performed both types of repair can produce fantastic results. Though there are some caveats to either procedure.

The suture-less glue repair may leave a scar that is not flush with the surface of the earlobe. The inwards dipping suture-line catches the light at the wrong angles and creates a shadow along the ridge making the scar very prominent. The incision scar may also widen with time.

On the other hand, sutured repair causes the inconvenience of returning to the clinic for suture removal after seven days but produces a much better and thin scar which is generally flush with the surface of the earlobe.

The reason is that sutures grab the skin as well as the soft tissue inside and hold them together while the tissues heal. Glue approximates the skin surfaces only, and the healing soft tissue beneath the skin shrinks away from each other causing valley like a deep final incision scar.

There is nothing you can do to change your skin type or eliminate gravity.

Use lighter earrings for routine wear. Danglers (ornaments that hang) tend to pull on the ear lobe as they sway, so studs are a better choice as they stay snug to the ear lobe.

Earrings with a thin central staff cut through the skin quicker than with thick stalk.

You need to be more careful if you have thin skin and thin earlobes. Your earholes will probably enlarge early. But do remember that given enough weight all ear holes will expand eventually.

Ear lobe repair surgery cost much lesser than western countries. Since it is out-patient procedure, cost for surgery is very much on the lesser side. Ear lobe repair surgery cost 5000/- to 10000/- per ear at Nuface Clinic.

Prominent ear also known as otapostasis or bat ear is an abnormally protruding human ear. In this condition, the concha (the depression in the external ear leading to its central opening) is large with poorly developed antihelix (a curved prominence of cartilage parallel with and in front of the helix on the pinna) and scapha (the curved depression separating the helix and antihelix of the ear). This results in the ear sitting further out from the head and is the most common problem causing prominent ears.

Approximately 1-2 % of the total population is affected by prominent ears problem. It is an inherited problem and may be unilateral or bilateral and could be a result of lack or malformation of cartilage during primitive ear development. 

Having prominent ears may negatively affect a child’s self-image because he looks different and may be teased by peers. This can lead to poor development of interpersonal relationships, social withdrawal, and even depression.

The ear cartilage in adults does not keep growing; it is fully mature and unfortunately, cannot be manipulated through any process other than surgery. The surgical correction however is a relatively easy procedure, low risk, quick recovery and very high reward.

When planning surgery in children it is important not to interfere with growth so timing is important. Prominent ears should not be corrected surgically before this age, but can be successfully treated from 5 years onwards. By this stage the ear has achieved approximately 80% of adult size and the surgery will have little impact on future growth. 

Surgery is required to treat prominent ears. This is usually performed under general anaesthetic, in hospital, as day surgery. It can be done as out-patient procedure under local anaesthesia for adults. Otoplasty involves exposing the cartilage structure of the ear and reshaping it to create the missing fold. Sutures are used to help hold the new shape.

There are different types of surgical techniques to correct this defect, one used at our Centre is the Mustardè technique which is to perform a small incision behind the ear flap, a part of skin is removed so that you can access the cartilage which will be modified by weakening and if necessary removing the excess parts. The new shape is stabilized with the interior points and finally, the incision will be closed with stitches in absorbable material. Then the ear is immobilized in its new form with a bandage using an elastic band that will be kept for approximately 15 days. The surgery lasts for a total duration of about 60 minutes with a night of hospitalization and about two days of recovery.

The cost of Prominent/Bat ear surgery varies from doctor to doctor and from one geographic area to another. Cost depends on surgeon fees, fees for the surgical facility, anesthesia, medical tests, prescriptions, surgical garments, or other miscellaneous costs related to ear surgery. Because otoplasty is elective surgery, insurance does not cover these costs. Approximate cost for Prominent/Bat Ear correction remains between 30000-100000/-.

Choose your surgeon based on quality, training, and experience—not cost.

Constricted/lop/cup ears refer to a variety of ear deformities where the top rim of the ear (helical rim) is either folded over, wrinkled, or tight. This condition can range from mild to severe. In the mild form, the rim of the upper ear (helix) alone may be folded — this form is sometimes called lop ear. In the severe form, the cartilage of the helix and scapha (the curved depression below the rim of the upper ear) may be constricted, forming a tight roll.

It is unknown what causes constricted ears. There may be a shortage of skin or cartilage, or both.

Newborns with constricted/lop/cup ear deformities may respond to non-operative molding while their ear cartilage is still soft. Ear molding uses a combination of a commercially available ear molding systems and orthodontic molding materials to reshape the ear.

If ear molding is started early enough (ideally in the first few weeks of life), surgery can often be avoided. 

Once the ear cartilage has stiffened, surgery is necessary to correct the constricted ear deformity. Depending upon the severity of the condition, it may be possible to work with the ear cartilage already present to achieve a better shape of the ear. Constricted ear deformity, before and after surgery.

In more severe cases of constricted/lop/cup ears, a rib cartilage graft may be necessary to replace wrinkled helical cartilage from the ear. If there is a tight band of skin that pulls the helix down, your child’s surgeon may add additional skin and cartilage from the normal ear to match the other side.

Some children have bilateral constricted ears, in which both ears are affected. Your child’s surgical team will discuss options with you to determine whether to repair both ears at the same time, or in stages.

The cost of constricted/lop/cup ear correction surgery varies from doctor to doctor and from one geographic area to another. Cost depends on surgeon fees, fees for the surgical facility, anesthesia, medical tests, prescriptions, surgical garments, or other miscellaneous costs related to ear surgery. Because otoplasty is elective surgery, insurance does not cover these costs. Approximate cost for Prominent/Bat Ear correction remains between 30000-100000/-.

Choose your surgeon based on quality, training, and experience—not cost.

Cryptotia refers to an ear cartilage framework that is partially buried beneath the skin on the side of the head. The upper portion of the ear is hidden, and there may be some malformations of the cartilage of the upper ear (the scapha and the superior and inferior folds of cartilage, or crura). This can make it difficult to wear glasses or masks.

It is unknown what causes cryptotia. It is more commonly seen among Asians. In Japan, it has been reported in as many as 1 in 500 births.

One treatment option for cryptotia is ear molding, a non-surgical treatment option that may help avoid the need for surgery. This treatment utilizes an external device that shapes and stretches the upper portion of the ear.

Unlike many other congenital ear deformities, which are most effectively treated in the first few weeks of life when the ears are soft and mouldable, cryptotia may be effectively treated with ear molding well beyond the neonatal period. In some cases, successful non-operative correction of cryptotia has been reported even up to 5 years of age. This success may be possible because these ears already have a normal cartilage framework and primarily require skin expansion to cover the embedded cartilage.

Cryptotia can also be treated surgically. Surgical correction of cryptotia may require the use of local skin flaps or skin grafts to lift the ear framework from the side of the head. Severe cases may require a cartilage graft.

The goals of surgery are to:

• Restore the auriculocephalic sulcus (the groove between the upper ear and the side of the head)
• Replace the deficient skin using local skin flaps or skin grafts to cover embedded cartilage
• Reinforce any collapsed cartilage
• Release abnormal tethering ear muscles

Although a general anesthetic is needed, the operation is done on an outpatient basis and your child will be able to return home the same day.

The cost of Cryptotia surgery varies from doctor to doctor and from one geographic area to another. Cost depends on surgeon fees, fees for the surgical facility, anesthesia, medical tests, prescriptions, surgical garments, or other miscellaneous costs related to ear surgery. Because otoplasty is elective surgery, insurance does not cover these costs. Approximate cost for Prominent/Bat Ear correction remains between 30000-100000/-.

Choose your surgeon based on quality, training, and experience—not cost.