Auricular Reconstruction of a Child’s Ear: Phase 1
Your child’s outer ear (auricle) is missing or not developed (called microtia). Surgery can be done to build your child an outer ear. It may be done over several phases. The exact details of each surgery and the number of surgeries needed depend on the surgeon, and on the structures present in your child’s ear. In general, phase 1 involves taking strong and flexible tissue (cartilage) from your child’s ribs. This is used to make a framework for the outer ear. Auricular reconstruction is the most common surgery used to repair a missing or underdeveloped ear. Two other options are also available. One uses an artificial mesh in place of cartilage to create the new ear. Another uses a prosthetic artificial ear. Having no treatment is also an option. Often, microtia happens with varying degrees of hearing loss. Your child's hearing loss may be corrected at a later time through different treatments.
A multistep process
Auricular reconstruction is done during 3 or more surgeries. Phase 1 may be done when a child is around 6 to 10 years old. This is the age that your child can safely give enough cartilage to build the new outer ear. And this is also the age that your child’s normal ear reaches adult size, so the new ear can be created to match it. After this procedure, another 2 to 3 procedures are needed to make the ear for your child. These surgeries are done about 3 to 6 months apart. This gives the skin time to heal. Additional surgery may be needed as your child ages. Your surgeon can tell you more.
Preparing for phase 1 surgery
In an age-appropriate manner, explain the surgery to your child. Prepare your child for the surgery as you have been told. Tell your healthcare provider about all medicines your child takes. This includes over-the-counter medicines. It also includes herbs and other supplements. Your child may need to stop taking some or all of them before surgery. Also, follow any instructions you’re given for preventing your child from eating or drinking before surgery.
The day of surgery
The phase 1 procedure lasts about 3 to 6 hours. Your child may need to stay in the hospital for 2 or more days afterward. Before surgery begins:
To keep your child from feeling pain during the procedure, he or she is given general anesthesia. This medicine puts your child in a state like deep sleep through the procedure.
When your child is asleep, an IV line is put into a vein in your child’s arm or hand. This line delivers fluids and medicines. A tube is then passed through your child’s mouth into the trachea (windpipe) to help with breathing during surgery. Special equipment monitors your child’s heart rate, blood pressure, and oxygen levels.
During the surgery
An outline is made of your child’s normal ear, if one is present. The healthcare provider then traces this outline onto the child’s skin where the new ear will be made. This helps to make sure the new ear is the correct size and position and is aligned with the other ear.
Cartilage is removed from the ribs. To do this, an incision is made on the belly near the bottom of the ribs. The healthcare provider removes cartilage from the end of the ribs using special tools. The incision is closed with stitches.
A cartilage framework for the new ear is made. The cartilage removed from the ribs is cleaned. It is then carved into a framework for the new ear. The healthcare provider does this using the template made earlier from the child’s normal ear.
The framework is placed on the side of the head. Following the outlines drawn from the child’s normal ear, incisions are made in the area where the ear will be created. Any cartilage from the malformed ear is removed. A skin pocket is made. If needed, the skin is stretched using a special tool. The cartilage framework is inserted into the skin pocket. Incisions are then stitched closed.
Extra cartilage is saved for future surgery phases. Any leftover cartilage is put underneath the skin on your child’s chest. When the healthcare provider needs this cartilage, he or she makes a small incision in the skin to collect it. Putting it under the skin keeps the cartilage healthy. It allows the healthcare provider to have cartilage to complete the ear without having to harvest it from the ribs each time. This helps limit the amount of pain your child will have.
One or more tubes (drains) may be placed into the surgery areas. This drains fluid that builds up after surgery as the area begins to heal.
Recovering in the hospital
When the surgery is complete, your child will be taken to a room to wake up from the anesthesia. You may be able to see your child at this time. Your child will be monitored as he or she rests. Pain medicine can be given if needed. It may be given through the IV or through a catheter that was placed in the chest. When ready, you and your child may be taken to a hospital room to stay for one or more nights. You will be told when you can take your child home.
Recovering at home
Once home, follow any instructions you are given for caring for your child. During your child’s recovery:
Give prescribed medicines as instructed. Even if your child doesn’t complain of pain, give the medicine on time. Do not wait for the pain to get bad. This makes the pain harder to control.
Do your best to prevent your child from touching the ear. Don’t allow siblings or other children to touch your child’s ear or play roughly around your child as he or she heals.
If your child is sent home with a tube (drain) in a wound, follow your healthcare provider’s instructions for how to care for it.
When to call the healthcare provider
Be sure you have a contact number for your child’s healthcare provider. After you get home, call if your child has any of the following:
Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider
Bleeding or a large amount of drainage from an incision
Symptoms of infection at an incision site such as increased redness or swelling, warmth, worsening pain, or foul-smelling drainage
Any injury to the ear
Take your child to scheduled follow-up visits. If appropriate for your child's age, encourage him or her to write down questions or concerns about the procedure. Make time during the visit for your child's questions or concerns to be discussed. During these visits, the healthcare provider will check on your child and make sure the ear is healing properly. You can also discuss and schedule any further surgeries needed to construct the ear.
Risks and complications
All procedures have risks. The risks of this procedure include:
Risks of anesthesia. You will discuss these with the anesthesiologist.
Dislike of how the ear looks after surgery
Cartilage wearing through the skin
Injury to the chest wall or lungs during cartilage harvest
November 13, 2017
Baluch, N., Auricular reconstruction for microtia: A review of methods, Plastic Surgery (2014); 22(1); pp. 39-43, Im, DD., Current Management of Microtia: A National Survey, Aesthetic Plastic Surgery (2013); 37; pp. 402-408, Wilkes, GH., Microtia Reconstruction, Plastic and Reconstructive Surgery (2014); 134; pp. 464e-479e
Fraser, Marianne, MSN, RN,Lickstein, David, MD