Combined reconstruction of congenital auricular atresia and severe microtia

Objectives: Due to their embryological development, auricular atresia and severe microtia are, in most cases, combined malformations. The aims of this study were firstly to develop a surgical technique for combined esthetic and functional reconstruction with a minimum of operations and secondly to evaluate its results.

Study design: Prospective clinical evaluation.

Patients and methods: Fifty-two patients with third-degree microtia and congenital aural atresia with a sound-conducting block of about 50 dB were treated. In the first operation, autogenous cartilage was harvested, and the auricular framework was fabricated and implanted. In addition, the tympanic membrane and the external ear canal were prefabricated, and stored in a subcutaneous pocket. In the second step, the elevation of the new framework was combined with the operation for atresia, utilizing the prefabricated tympanic membrane and external ear canal. In the third step, the cavum concha was deepened, and the external ear canal was opened and covered with a skin graft.

Results: In total, 76% of the patients had a final conductive hearing loss of 30 dB or less. No restenosis of the new external ear canal was observed. The esthetic results of the constructed auricles are shown in this report.

Conclusion: With this combination of plastic surgery for the auricle and functional surgery for the middle ear, no additional operations are necessary and the prefabrication of the external ear canal and the tympanic membrane gives stable and reliable results. This combined technique offers the best chance of optimal esthetic and functional rehabilitation for patients with these malformations.