Study on Esthetic Appearance of Reconstructed Pinna in Microtia

INTRODUCTION: Microtia is a cogenital malformation characterized by total or partial absence of the whole auricle or any of its components, varying from a small auricle to total absence (Anotia). Microtia is the most common congenital anomaly of auricle. Reconstruction of the microtia ear represents one of the most demanding challenges in reconstructive surgery. Total auricular reconstruction with autogenous costal cartilage is one of the greatest technical feats that a reconstructive surgeon may encounter. An inherent understanding of sculpture and design influence the success of surgery. In this study we had followed Dr. Brent four stage pinna reconstruction techniques and we had analysised ethestic appearance pinna reconstruction in fifteen cases. AIM AND OBJECTIVE OF THE STUDY: To study on esthetic component of reconstructed of pinna in our microtia cases. To create an acceptable facsimile of an ear of the proper size, position and orientation to other facial features. MATERIAL AND METHODS: The present the study on esthetic appearance of reconstructed pinna in microtia was done in the Department of Plastic, Reconstructive and Facio- Maxillary surgery, Madras Medical College and Hospital, Chennai during July 2003 to June 2005 and all the cases were regularly followed up in the outpatient department of plastic surgery at 2 months intervals upto August 2005. Inclusion criteria are 1. Microtia type II A and Type II – B (Tanzer classification), 2. Either Sex, 3. Age group 6 years to 30 years. Exclusion Criteria are 1. Microtia associated with syndrome (Treacher Collin Syndrome, Hemifacial Microsomia), 2. Age below 6 years and above 30 years. RESULTS: The present study consisted of fifteen cases of microtia II A (complete hypoplasia auricle with absence external auditory canal). All patients had undergone four stage pinna reconstruction in the department of plastic surgery July 2003 to August 2005. SUMMARY AND CONCLUSION: Management of microtia can be one of the most rewarding yet humbling challenges faced by the reconstructive surgreon. For 15 case microtia type – A we had followed total auricular reconstruction is with autologous cartilage and on modification of the methods of Brent. Our goals in auricular reconstruction of microtia are i) A satisfied patient, ii) proper positioning, iii) a pleasing size and contour. In ear reconstruction should be an ear that is sufficiently natural in appearance it will pass unnoticed by others. Current methods fall short of this goal, however, because of the transplanted autologous tissue, which are different from those in the normal ear. Even if perfect framework could be carved from costal cartilage, the ideal ear would still elude use because the thicker temporal mastoid skin would obscure the delicacy of the convolution what we have achieved as highly pointed out by the BRENT “An acceptable facsimile of ear” which is happily accepted by our patients and parents. As pointed out in our study, we have found out the caveats in the reconstruction of ear in our microtia patients. They are (1) The skin in the auriculomastoid area thicker on par with neck skin. (2) The amount fibrosis in the bed is also more in spite of adequate hemostasis and sharp and gentle dissection. (3) Cartilage volume available for framework is also relatively less. Because of the above reasons the delicate carving of the fabricated costal cartilage framework is obscured and therefore the interhelicine groove and fossa on the external aspect are less pronounced. To conclude that the highly complex nature of ear reconstruction places it in the higher echelons of reconstructive surgical procedures. The multidisciplinary issue surrounding congenital ear deformities. Combined with the technical expertise and experience necessary to satisfactorily conduct the surgery, suggest that these types of reconstruction should not he performed by surgeons unfamiliar with the technique optimal results can be only achieved through dedicated study and experience