44. Surgical Technique – Microtia – Standard Case Report
A photo essay of a single case of unilateral microtia is presented with some details not covered in the earlier chapters (contributed by Parag Telang of Mumbai). A fifteen year old girl presented with right unilateral microtia with a low hair line (Fig. 1). After two sittings of depilation with a laser an adequate area became available for reconstruction and that area was marked at an angle of approximately 25° to a line parallel to the line of the nasal profile. In this area the lower most part of the helix anteriorly would lie at a point determined by the lateral canthal ligament of the eye on the same side and the lower border of the lobule to be reconstructed was marked corresponding to the lobule on the opposite side (Fig. 2).
The cartilaginous framework was marked on a stiff piece of cardboard by drawing lines by taking the help of the opposite normal ear. When the cartilages on the fifth, sixth and the seventh rib were exposed, it was found that the breadth of the synchondrosis of the fifth, sixth and the seventh rib was narrower than the total requirement (Fig. 3) and therefore only the base plate was carved from this area (Fig. 4). The additional material for the helix, anti-helix, the tragus and the anti-tragus were carved separately from the surrounding cartilage (Fig. 5) and was then mounted on the base plate and fixed with a stainless steel wire (Fig. 6).
A small vertical piece of cartilage was also carved and separated but stored in the area for future use to create the post-auricular sulcus. An incision was marked posterior to the future lobule (Fig. 2) and a pocket was created in the marked area like a bi-pedicled flap where the posterior part near the new hairline and the anterior part parallel to the superficial temporal artery were not cut. After the cartilaginous framework was placed in the pocket, the wound was closed with two suction drains (Fig. 7). Six months later the cartilage had settled down (Fig. 8).
The stored cartilage was then removed from the chest. The auricular framework was lifted. The cartilage was placed in the defect and a local temporal fascia flap was turned over to cove the cartilage which in turn was covered with a split skin graft from the scalp. Part of the graft was used to line a dimple at an appropriate place to mimic the external auditory meatus by wrapping the graft around a hollow tube. At the same time the lobule was transposed to create a full ear. Later the lobule was pierced to enable the girl to wear an ear ring (Fig. 9 and 10).