Introduction:
The human ear is an important organ because it performs hearing functions. It is a 3-dimensional structure, usually oval-shaped. Sometimes damaged, less developed, or completely absent ear is seen in people or children as a result of trauma, injury, cancer, or since birth due to some condition or defect. It causes impaired hearing or a complete absence of hearing function in the patient.
With medical advancements, nowadays, it is possible to repair and or completely restore a damaged ear. Various types of ear reconstruction surgeries available use skin grafts, human cartilage from the rib, or artificial material such as polyethylene material to reconstruct the ear.
What Is Ear Reconstruction and Why Is It Done?
Ear reconstruction is a type of plastic surgery done to rebuild the damaged ear and restore its function and appearance. The ear reconstruction surgery is medically called auricular reconstruction. Ear reconstruction is usually done
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To achieve reconstructive results.
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To regain the shape of the ear.
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To restore functionality.
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To enhance external ear aesthetics.
When Is Ear Reconstruction Needed?
Ear Reconstruction is needed if there are:
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Damage to the ear due to trauma or injury.
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Cancer surgery.
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Missing or absent ear since birth - congenital disorder.
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Underdeveloped ear since birth - microtia.
What Are the Materials Used in Ear Reconstruction?
Different types of materials are used, such as:
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Autogenous Grafts - These are skin grafts taken/harvested from the patient’s healthy skin.
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Autogenous Cartilage - These are bone grafts taken/harvested from the patient’s healthy bone. The autogenous cartilage framework is the gold standard for external ear reconstruction.
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Alloplast - These are synthetic materials made from natural materials.
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Osseointegrated Materials - These are synthetic materials used for the fusion of bone with the implant or external device such as an artificial ear prosthesis.
What Are the Methods and Surgeries Used for Ear Reconstruction?
There are a few methods for ear reconstruction.
Autologous Ear Reconstruction:
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In this method, the patient’s rib cartilage is used as a graft for ear reconstruction. It is a commonly performed technique for patients of age 6-10 years.
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Cartilage is taken from the rib of the patient, and a three-dimensional model of a normal ear is constructed - a cartilage framework.
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This framework is placed under the skin of the new ear to match the opposite ear.
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Suction catheters are placed for 2-3 weeks to provide well-defined borders to the framework.
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After complete healing, generally six months, the next step of reconstruction takes place. The inserted framework is raised to match the natural position and level of the normal ear. This requires skin grafts or flaps to elevate the ear.
There are two methods for autologous ear reconstruction:
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Brent’s Method: It includes harvesting rib cartilage, constructing the cartilage framework, inserting the framework at the ear site, lobule transposition, placing a skin graft to elevate the ear, and constructing the tragus.
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Nagata Method: It includes placing the cartilage framework, constructing the tragus, and lobule transposition. In the second stage, a fascial flap and a graft is placed to elevate the ear.
Ear Reconstruction Using Alloplast Graft or an Implant:
- It is made of polyethylene material. A prefabricated framework is used to construct the shape of the normal ear. It is then covered with tissues (fascia) and placed on the reconstruction site. It is then covered with a dressing. This procedure can be done in small children of age above three years.
Ear Prosthesis
An artificial ear is attached to the reconstruction surgery site. These are rarely used in children because they are delicate and expensive.
Otoplasty
It is a cosmetic procedure done to change the appearance, shape, or size of the ear. It can be done in patients of age five years and above till adulthood. For example, cauliflower ear reconstruction.
Defect Repair
Any defect in the ear caused by trauma, injury, cancer, etc., is repaired. It includes the reconstruction of the missing part of the ear.
What Are the Complications of Ear Reconstruction Surgery?
The commonly reported complications are:
Pneumothorax - Collapsed lung causing air leakage in the space present between the lung and chest.
Infection - Surgical site infections are common that lead to delayed healing or failed healing process. It may occur because of the entry of harmful microorganisms from the surgery site.
Exposed Cartilage Framework - If the framework is exposed, it should be kept clean with 10 % Sulfamylon cream. The exposed area can be covered with an extra local flap.
Graft Necrosis - It occurs when the blood supply in the tissue is compromised or disrupted.
Scar Formation - A scar may vary in size and shape; it occurs when a normal healing process takes place at the surgery site. Generally, scar tissues are formed over the repaired tissues. Sometimes, the scar tissues become hard, and overgrowth is seen, resulting in keloid formation that can be larger than the original defect size.
What Are the Benefits and Drawbacks of Autologous Ear Reconstruction?
Autologous ear reconstruction is the gold standard for all techniques. A few benefits and drawbacks are,
1. Brent’s Method:
Benefits - Low complication rate; a detailed construction of the auricle is done.
Drawbacks - The procedure is performed in multiple stages; is time-consuming; requires cooperative patient behavior and compliance.
2. Nagata Method:
Benefits - The projection of the ear is almost perfect; the sound reproduction is similar to the normal ear; the chest wall is minimally deformed.
Drawbacks - Cartilage is constructed twice; it may cause hair thinning at the donor site; limited repair options in the future; necrosis may occur in the lobule.
How Long Does Ear Reconstruction Surgery Take to Heal?
After the surgery, the patient may feel pain and discomfort for a few weeks. After 14 days, the doctor removes the sutures, and the patient can resume physical activity after three weeks. Other signs of healing, such as swelling, may go away within a month; it may sometimes take a year to subside completely.
Conclusion:
Human ear reconstruction is complicated and challenging. With the latest medical advancements, there are various surgical options to recreate and replace a missing or underdeveloped ear. The autologous ear reconstruction method is the most commonly used method that gives excellent results with a success rate of 90 % and above. Sometimes, along with the surgery, hearing rehabilitation is required with an expert to help the patient relearn hearing-related skills and activities.
