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Two-staged Total Ear Reconstruction With Concomitant Atresiaplasty For Patients With Microtia
Christopher Runyan MD, PhD
Ann Schwentker MD
University of Cincinnati
2015-03-15
Presenter: Christopher Runyan
Affidavit:
The data for this project was collected by Dr. Runyan. Dr Schwentker provided the direction for the project.
Director Name: W John Kitzmiller
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
BACKGROUND/PURPOSE
Microtia patients often have hearing loss from aural atresia. Atresiaplasty to reconstruct the middle ear is usually performed subsequent to auricular reconstruction, to avoid leaving scars on the periauricular skin needed for ear reconstruction. We have developed a novel two-staged microtia reconstruction that includes a concomitant atresiaplasty during the second stage. For the first time we present this technique and our initial case series.
METHODS/RESULTS
Under IRB-approval a retrospective study was performed to examine the outcomes of five patients receiving this two-staged reconstruction since 2011. The average age at the beginning of reconstruction was 8.1±1.6 years. Duration of the second stage averaged 416±44 minutes, comparable to a combined traditional second stage and a separate atresiaplasty. One patient with a very large construct had partial exposure of the construct requiring coverage with a temporoparietal fascial flap and skin graft. One patient developed auditory canal stenosis due in part to temporomandibular joint proximity, requiring a surgical revision. This is comparable to our revision rates for auricular reconstruction or atresiaplasty performed separately. All patients have an excellent cosmetic outcome with improved hearing. The combined procedure facilitates exposure of the middle ear and allows better integration of the external meatus with the conchal bowl and tragus.
CONCLUSIONS
This study demonstrates a novel two-staged technique for combined microtia and middle ear reconstruction. The operative design appears to allow for complete mobilization of the construct with adequate vascularization except for in the largest construct in our series, and facilitates middle ear reconstruction.
