Microtia Reconstruction

Abstract

Ear reconstruction dates back to ancient India, where a cheek flap repair of the earlobe was first described in the Sushruta Samhita. However, it wasn’t until the end of the nineteenth century that surgeons systematically began to address congenital ear defects. In 1920, Sir Harold Gillies constructed an ear by carving costal cartilage and burying it under mastoid skin. This technique was later modified by Pierce who used a skin graft to line the postauricular sulcus and a tubed flap to construct the helix. Gillies later utilized maternal cartilage for ear reconstruction and, like many others who followed him, was frustrated by progressive resorption of the cartilage.

A major breakthrough came in 1959, when Tanzer utilized autologous rib grafts carved in a solid block, and thus ushered in the age of modern ear reconstruction. Subsequent excitement with the use of foreign materials for ear reconstruction, such as silicone and MEDPOR frameworks, has been tempered by the associated problems with infections and framework extrusion. Tissue engineering offers the next frontier in total ear reconstruction; this could obviate the need for a donor site and potentially shorten the postoperative course by combining stages of reconstruction; however, the utility of engineered ears has not been demonstrated clinically.

At present, sculpted autologous rib cartilage for ear reconstruction, as popularized by Brent and refined by Nagata and Firmin, is the preferred and most reliable method for total ear reconstruction. Both the Brent and Nagata techniques will be described in this chapter. Key differences in these techniques include the capacity for greater ear detail in the Nagata technique with fewer operative stages.