Holger G. Gassner, M.D., Board Certified Facial Plastic Surgeon (USA)


  Phone: + 49 176 43 42 39 46 Deutsch English Русский

MICROTIA SURGERY

The auricle structure is one of the most difficult interventions of facial plastic surgery.  Prof. Gassner and Dr. Ralph Magritz cooperate here for the benefit of the patients.  They carry out these operations at the Nuremberg site together.  As a result, important parts of the operation can be performed simultaneously and, for example, the duration of anesthesia can be shortened.

Microtia repair (auricular reconstruction) entails the rebuilding of a missing or incompletely developed ear. Often, this procedure is performed for children who were born with one or both ears missing. Also, partial or complete tissue loss after accident, bite injury or cancer removal may be reconstructed. Reconstructive microtia surgery may require one or more surgical stages.

In principle, two methods of auricular reconstruction are described. One entails the placement of a synthetic implant to replace the cartilaginous skeleton of the ear. The other method entails replacement of the cartilaginous skeleton of the ear with a framework carved of the body´s own rib cartilage.

Both methods have advantages and disadvantatges. The use of synthetic material should allow for shorter operative time and may require fewer surgical stages. This method requires the use of an additional tissur flap of the temple are to better cover the implant. This may entail a visible scar of the hair bearing skin above the ear. In principle, sythetic material is more probe to infection and extrusion. That means that if the material gets infected or shows through the external skin, there is a real risk that the entire implant needs to be removed and the reconstructed ear may be difficult to salvage.

The placament of a framework of the body´s own rib cartilage requires an additional incision over the chest. This may be associated with postoperative discomfort and occasionally with visible contour irregularities of the chest wall. The harvest of rob cartilage requires additional operative time, which may be offset if a double team approach with two microtia surgeons is employed. Over the years, the risk of infection and complete loss of the ear is greatly reduced compared to the synthetic implant.

For these reasons, Dr. Gassner and Dr. Magritz prefer reconstruction with rib cartilage in the majority of cases. However, it must be emphasized that excellent surgeons can achieve excellent results with either method.

Frequently there is hearing loss associated with microtia.  Therefore it is recommended that patients with such complex deformities be seen by a number of specialists and preferably a team of specialists who have a lot of experience with such cases.  This includes experts in hearing testing in children as well as facial plastic surgeons.

Parents of new born children with missing or mal-developed ears typically have many important questions.

Therefore, within the first 6-8 weeks after birth, an appointment with a team of physicians that routinely treat patients with microtia or anotia should be sought.

As a rule, the evaluation of hearing and language acquisition in the first years of life is at the forefront for treatment.  Imagint (CT) is usually only necessary after a few years to plan reconstruction and, if necessary, to improve hearing.

The scientific analysis of the various surgical methods is still developing.

In recent years, it has been shown that an operation should be carried out at a somewhat later age of the child, i.e. beginning between the ages of 11 or 12 years as the coronary cartilages are often not fully developed during operations that have been carried out starting at the age of 6 years.

Currently Dr. Gassner follows the recommendation of other global experts in the field and prefers to reconstruct in year starting at about the age of 12 years.

The proceedings depend largely on the degree of the deformity, the individual anatomy of the patient and other important factors.

An ear that has been fashioned from rib cartilage or reconstructed with a synthetic implant feels firmer than a natural ear.
This is because both the rib cartilage and the synthetic plastic are more rigid than natural ear cartilage.

Das Aussehen eines natürlich gewachsenen Ohres kann nie zu 100% erreicht werden, es kann ihm aber nahe kommen. Der behandelnde plastische Gesichtschirurg wird Ihnen während eines Beratungsgespräches Bilder von typischen Ergebnissen zeigen, damit sich Patient und ggf. Eltern einen Eindruck des möglichen Ergebnisse verschaffen können.

If you have questions or would like to request a consultation, please Contact us.

Please advise the secretary that you would like a consultation on auricular reconstruction, not an ear implant.  This will ensure you will also become an appointment to discuss childhood hearing impairments.

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