Other Techniques for Microtia Management

  • Sabrina CugnoEmail author
  • Neil Bulstrode


There are many patients with microtia who never seek consultation for reconstruction, either having accepted the deformity or having resorted to camouflage of the malformed vestigial remnant with hair. Although osseointegrated prosthetic reconstruction is more readily considered in adults, its use in primary reconstruction in the pediatric population remains an area of contention, particularly in cases of microtia. In children, a prosthesis is more commonly regarded as a salvage option following failed secondary reconstruction where costal cartilage or soft tissue coverage remains insufficient for consideration of additional autogenous or alloplastic reconstructive efforts. Pre-lamination of a composite auricular flap with subsequent microsurgical transfer has been used for auricular reconstruction when regional options for secondary reconstruction have been expended, and transfer of a free fascial flap is considered a lesser option. In recent years, there has been considerable interest in generating a prefabricated cartilaginous ear framework from autogenous chondrocytes; however, these initiatives have not been fully realized.


Camouflage Prosthesis Pre-lamination Prefabrication 


  1. 1.
    Wilkes GH, Wolfaardt JF. Osseointegrated alloplastic versus autogenous ear reconstruction: criteria for treatment selection. Plast Reconstr Surg. 1994;93(5):967–79.CrossRefGoogle Scholar
  2. 2.
    Thorne CH, Brecht LE, Bradley JP, Levine JP, Hammerschlag P, Longaker MT. Auricular reconstruction: indications for autogenous and prosthetic techniques. Plast Reconstr Surg. 2001;107(5):1241–52.CrossRefGoogle Scholar
  3. 3.
    Branemark R, Branemark PI, Rydevik B, Myers RR. Osseointegration in skeletal reconstruction and rehabilitation: a review. J Rehabil Res Dev. 2001;38(2):175–81.PubMedGoogle Scholar
  4. 4.
    Tjellstrom A. Osseointegrated implants for replacement of absent or defective ears. Clin Plast Surg. 1990;17(2):355–66.PubMedGoogle Scholar
  5. 5.
    Gion GG. Surgical versus prosthetic reconstruction of microtia: the case for prosthetic reconstruction. J Oral Maxillofac Surg. 2006;64(11):1639–54.CrossRefGoogle Scholar
  6. 6.
    Holgers KM, Tjellstrom A, Bjursten LM, Erlandsson BE. Soft tissue reactions around percutaneous implants: a clinical study of soft tissue conditions around skin-penetrating titanium implants for bone-anchored hearing aids. Am J Otol. 1988;9(1):56–9.PubMedGoogle Scholar
  7. 7.
    Granstrom G, Bergstrom K, Odersjo M, Tjellstrom A. Osseointegrated implants in children: experience from our first 100 patients. Otolaryngol Head Neck Surg. 2001;125(1):85–92.CrossRefGoogle Scholar
  8. 8.
    Korus LJ, Wong JN, Wilkes GH. Long-term follow-up of osseointegrated auricular reconstruction. Plast Reconstr Surg. 2011;127(2):630–6.CrossRefGoogle Scholar
  9. 9.
    Hamming KK, Lund TW, Lander TA, Sidman JD. Complications and satisfaction with pediatric osseointegrated external ear prostheses. Laryngoscope. 2009;119(7):1270–3.CrossRefGoogle Scholar
  10. 10.
    Westin T, Tjellstrom A, Hammerlid E, Bergstrom K, Rangert B. Long-term study of quality and safety of osseointegration for the retention of auricular prostheses. Otolaryngol Head Neck Surg. 1999;121(1):133–43.CrossRefGoogle Scholar
  11. 11.
    Han K, Son D. Osseointegrated alloplastic ear reconstruction with the implant-carrying plate system in children. Plast Reconstr Surg. 2002;109(2):496–503; discussion 4–5.CrossRefGoogle Scholar
  12. 12.
    Wright RF, Zemnick C, Wazen JJ, Asher E. Osseointegrated implants and auricular defects: a case series study. J Prosthodont. 2008;17(6):468–75.CrossRefGoogle Scholar
  13. 13.
    Sucur D, Ninkovic M, Markovic S, Babovic S. Reconstruction of an avulsed ear by constructing a composite free flap. Br J Plast Surg. 1991;44(2):153–4.CrossRefGoogle Scholar
  14. 14.
    Akin S. Burned ear reconstruction using a prefabricated free radial forearm flap. J Reconstr Microsurg. 2001;17(4):233–6.CrossRefGoogle Scholar
  15. 15.
    Zhou G, Teng L, Chang HM, Jing WM, Xu J, Li SK, et al. Free prepared composite forearm flap transfer for ear reconstruction: three case reports. Microsurgery. 1994;15(9):660–2.CrossRefGoogle Scholar
  16. 16.
    Chiang YC. Combined tissue expansion and prelamination of forearm flap in major ear reconstruction. Plast Reconstr Surg. 2006;117(4):1292–5.CrossRefGoogle Scholar
  17. 17.
    Young F. Cast and precast cartilage grafts: their use in the restoration of facial contour. Surgery. 1944;15:735.Google Scholar
  18. 18.
    Peer LA. Reconstruction of the auricle with diced cartilage grafts in a Vitallium ear mold. Plast Reconstr Surg. 1948;3:653.CrossRefGoogle Scholar
  19. 19.
    Brent B. Technical advances in ear reconstruction with autogenous rib cartilage grafts: personal experience with 1200 cases. Plast Reconstr Surg. 1999;104(2):319–34; discussion 35–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Plastic and Reconstructive SurgeryMontreal Children’s Hospital, Shriners Hospital for Children, CHU Sainte-JustineMontrealCanada
  2. 2.Department of Plastic and Reconstructive SurgeryGreat Ormond Street HospitalLondonUK

Personalised recommendations