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Classification of the congenital anomalies of the ear

The congenital abnormalities of the ear present immense variety of clinical deformities. However the Greek term called MICROTIA (that means small ear) is the most popular to express the congenital anomalies with reduction of the size of the ear. In more than 90% of the patients with microtia present associated deformities in other segments of the body such as: abnormalities of the face, the heart, the chest, upper and lower extremities.

The congenital deformities may be unilateral or bilateral. To reconstruct an ear is a great challenge in Plastic surgery. In the bilateral operations they are even more complex because they may present other anatomical alterations on the structures of the face and skull, which became more difficult to achieve the well balance between the two sides and facial harmony.

 

DISTURBANCE OF HEARING

The anomalies of the auricles may present alterations in the structures of the internal and medial ear with repercussions directly in the auditory function. Such alterations are not constant and they exhibit diversified clinical forms. In 50% of the patients with microtia the external auditory canal is present, however the disturbance of the hearing happen in only 25% of the patients. The presence of the external auditory canal doesn't assure normal hearing, because there are million people with normal external canal but they are deft.

 

ACQUIRED DEFORMITIES OF THE EAR

Patients that presented their normal ears they can lose them partial or totally during the life caused by trauma. Thus, the trauma may produce structural alterations on one or on both ears producing partial or total amputation of the organ with unbalance on the facial harmony. Several causes can destroy the ears: burns, car accident, physical aggression (with knife, scissors and other sharp elements), animal bites caused by dog, horse, cow, pig, camel, even caused by human bite and other agents.

Besides the trauma, the tumors (cancer, hemangiomas, linfangiomas) and other illnesses as the leprosy, leishimaniose also may damage other segments of the body as well as the ears partially or totally. Sometimes to remove the ear is a mandatory treatment in order to save patients' life. After the cure of the illness and it complete healing the wounds the surgery it can promote the repair or reconstruction of one or both ears.

 

TECHNIQUES FOR RECONSTRUCTION OF THE EAR

For reconstruction of a new ear no matter if the deformity is congenital origin or acquired it is necessary to accomplish at least two surgical stages. In the first one it is necessary to create two fundamental structures:

A) The new cartilaginous skeleton
B) The cutaneous covering for the new ear

 

A) Creation of the new cartilaginous skeleton

To create the new skeleton of the ear there are scientific descriptions of the use of several synthetic materials (nylon, polyethylene, silicon), however the best element is the cartilage of the own patient's rib. The human rib is formed by bone on the posterior segment and cartilage on the anterior part of the chest. During the first stage it is necessary to remove a cartilage on the anterior aspect patient's chest followed by excavation in order to sculpt the new skeleton. The creation of the anatomical and aesthetic elements of the new organ depends basically of the sculptural work on the rib cartilage.

 

B) Creation of the cutaneous covering for the new ear

To create the cutaneous covering the surgeon may use the skin of the area by dissection with the purpose of creating a subcutaneous tunnel where the new skeleton of the ear will be introduced. It doesn't matter if the reconstruction of the ear is on congenital abnormalities or on traumatic amputation usually the patients present enough skin to cover the future ear.

The second operative stage should be performed 6 months after the first one. During that period of time the skin that covers the new cartilaginous skeleton will provide its necessary blood supply which assures to survive the cartilage placed previously embedded.

The operations must be performed in the hospital where the patients stay during 12 at 24 hours post-operative recovery.


You can see some photos of patients with deformities of the ear:

- Traumatic amputation of the upper pole caused car accident
- Traumatic total amputation caused by car accident
- Partial amputation of the ear due to surgical resection for treatment of cancer
- Total amputation caused by burn
- Amputation of the ear caused by human bite
- Traumatic deformity of the ear caused by using of piercing
- Congenital anomalies (absence of the ear)
- Bilateral Congenital anomaly (absence of the ears)

 

Modeling of the new auricular framework using costal cartilage

   

Costal cartilage removed from
the chest during surgery

 

 Sculptural handwork by excavation
to create anatomical and aesthetical
details of the new ear

 

The new skeleton of
the ear already sculptures
in costal cartilage

FIRST SURGICAL STAGE FOR RECONSTRUCTION OF THE EAR AFTER TRAUMATICA AMPUTATION

   

 

 

SECOND SURGICAL STAGE FOR RECONSTRUCTION OF THE EAR AFTER TRAUMATICA AMPUTATION

 

DRAWING OF THE AURICLES ALREADY RECONSTRUCTED IN MICROTIA

  

 

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