Skip to main content
SpringerLink
Log in

Current Management of Microtia: A National Survey

  • Original Article
  • General Reconstruction
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Microtia reconstruction remains one of the most challenging procedures encountered by the reconstructive surgeon. A national report on the current management of microtia has never been presented before. The purpose of this project was to survey members of the American Society of Plastic Surgeons (ASPS) to identify their preferences and practices and report their opinions regarding issues related to microtia reconstruction.

Methods

An anonymous web-based survey consisting of 19 questions was distributed to the members of the ASPS. Questions focused on the management of microtia. The study design was descriptive, using categorical data analysis.

Results

Thirty-eight percent of all respondents perform microtia reconstruction; 91 % learned the autogenous cartilage-based reconstruction technique, while only 16 % were exposed to alloplastic reconstruction. Seventy percent of all respondents learned autogenous cartilage-based ear reconstruction exclusively. Fifty percent of respondents who perform microtia reconstruction reported a steep learning curve. In the pediatric patient population, 49 % of microtia surgeons prefer performing the surgery when the patient is between 7 and 10 years of age, while 40 % of microtia surgeons prefer the patient to be 4–6 years of age. Fifty-nine percent of all respondents believe that in 15 years tissue engineering will represent the gold standard of microtia reconstruction.

Conclusion

Staged microtia repair using autogenous cartilage remains the heavily favored method of microtia reconstruction among plastic surgeons. Moreover, there is a deficiency in training the newer surgical techniques, such as alloplastic and osseointegrated options. This study also highlights the continuing need to elucidate the optimal timing for microtia repair in the pediatric patient to mitigate the potential psychosocial morbidity well described in the literature.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Marx H (1926) Die Missbildungen des Ohres. In: Henke F, Lubarsh O (eds) Handbuch der Spez Path Anatomie Histologie. Springer, Berlin, pp 620–625

    Google Scholar 

  2. Castilla EE, Orioli IM (1986) Prevalence rates of microtia in South America. Int J Epidemiol 15:364–368

    Article  PubMed  CAS  Google Scholar 

  3. Harris J, Kallen B, Robert E (1996) The epidemiology of anotia and microtia. J Med Genet 33:809–813

    Article  PubMed  CAS  Google Scholar 

  4. Tanzer RC (1971) Total reconstruction of the auricle: The evolution of a plan of treatment. Plast Reconstr Surg 47:523–533

    Article  PubMed  CAS  Google Scholar 

  5. Tanzer RC (1978) Microtia: A long term follow-up of 44 reconstructed auricles. Plast Reconstr Surg 61:161–166

    Article  PubMed  CAS  Google Scholar 

  6. Rueckert F, Brown FE, Tanzer RC (1990) Overview of experience of Tanzer’s group with microtia. Clin Plast Surg 17:223–240

    PubMed  CAS  Google Scholar 

  7. Brent B (1980) The correction of microtia with autogenous cartilage grafts: I. The classic deformity. Plast Reconstr Surg 66:1–12

    Article  CAS  Google Scholar 

  8. Brent B (1980) The correction of microtia with autogenous cartilage grafts: II. Atypical and complex deformities. Plast Reconstr Surg 66:13–21

    Article  PubMed  CAS  Google Scholar 

  9. Nagata S (1993) A new method of total reconstruction of the auricle for microtia. Plast Reconstr Surg 92:187–201

    Article  PubMed  CAS  Google Scholar 

  10. Nagata S (1994) Modification of the stages in total reconstruction of the auricle: Part I. Grafting the three dimensional costal cartilage framework for lobule type microtia. Plast Reconstr Surg 93:221–230 discussion 267–268

    Article  PubMed  CAS  Google Scholar 

  11. Nagata S (1994) Modification of the stages in total reconstruction of the auricle: Part II. Grafting the three dimensional costal cartilage framework for concha-type microtia. Plast Reconstr Surg 93:231–242 discussion 267–268

    Article  PubMed  CAS  Google Scholar 

  12. Nagata S (1994) Modification of the stages in total reconstruction of the auricle: Part III. Grafting the three dimensional costal cartilage framework for small concha-type microtia. Plast Reconstr Surg 93:243–253 discussion 267–268

    Article  PubMed  CAS  Google Scholar 

  13. Nagata S (1994) Modification of the stages in total reconstruction of the auricle: Part IV. Ear elevation. Plast Reconstr Surg 93:254–266 discussion 267–268

    Article  CAS  Google Scholar 

  14. Firmin F (1998) Ear reconstruction in cases of typical microtia: Personal experience based on 352 microtic ear corrections. Scand J Plast Reconstr Surg Hand Surg 32:35–47

    Article  PubMed  CAS  Google Scholar 

  15. Firmin F (2001) Auricular reconstruction in cases of microtia. Principles, methods and classification. Ann Clin Plast Esthet 46:447–466

    Article  CAS  Google Scholar 

  16. Park C, Lee TJ, Shin KS, Kim YW (1991) A single-stage two-flap method of total ear reconstruction. Plast Reconstr Surg 88:404–412

    Article  PubMed  CAS  Google Scholar 

  17. Park C (2000) Subfascial expansion and expanded two-flap method for microtia reconstruction. Plast Reconstr Surg 106:1473–1487

    Article  PubMed  CAS  Google Scholar 

  18. Zim SA (2003) Microtia reconstruction: an update. Curr Opin Otol Head Neck Surg 11:275–281

    Article  Google Scholar 

  19. Suutarla S, Rautio J, Klockars T (2009) The learning curve in microtia surgery. Facial Plast Surg 25:164–168

    Article  PubMed  CAS  Google Scholar 

  20. Beahm EK, Walton RL (2002) Auricular reconstruction for microtia: Part I. Anatomy, embryology, and clinical evaluation. Plast Reconstr Surg 107:2473–2482

    Google Scholar 

  21. Zhang L (2010) It is time to reconstruct human auricle more precisely and microinvasively. Plast Reconstr Surg 125:155e–156e

    Article  PubMed  CAS  Google Scholar 

  22. Botma M, Aymat A, Gault D, Albert DM (2001) Rib graft reconstruction versus osseointegrated prosthesis for microtia: a significant change in patient preference. Clin Otolaryngol 26:274–277

    Article  PubMed  CAS  Google Scholar 

  23. Tagliacozzi G (1597) De Curtorum Chirurgia per Institionem. Venice: Gaspare Bindonus

  24. Dieffenbach JF (1845) Die Operative Chirurgie. P. A. Brockhaus, Leipzig

    Google Scholar 

  25. Thorne CH, Brecht LE, Bradley JP et al (2001) Auricular reconstruction: indications for autogenous and prosthetic techniques. Plast Reconstr Surg 107:1241–1252

    Article  PubMed  CAS  Google Scholar 

  26. Cronin TD, Ascough BM (1978) Silastic ear construction. Clin Plast Surg 5:367–378

    PubMed  CAS  Google Scholar 

  27. Ohmori S, Sekiguchi H (1984) Follow-up study of the reconstruction of microtia using Silastic frame. Aesth Plast Surg 8:1–6

    Article  CAS  Google Scholar 

  28. Reinisch J (1999) Microtia reconstruction using a polyethylene implant: An eight year surgical experience. Abstract and presentation at the 78th Annual Meeting of the American Association of Plastic Surgeons, Colorado Springs, CO, May 5, 1999

  29. Brent B (2002) Microtia repair with rib cartilage grafts: a review of personal experience with 1000 cases. Clin Plast Surg 29:257–271

    Article  PubMed  Google Scholar 

  30. Habiballah JA, Bamousa A (2000) Allograftic and alloplastic auricular reconstruction. Saudi Med J 21:1173–1177

    PubMed  CAS  Google Scholar 

  31. Romo T 3rd, Fozo MS, Sclafani AP (2000) Microtia reconstruction using a porous polyethylene framework. Facial Plast Surg 16:15–22

    Article  PubMed  Google Scholar 

  32. Jiamei D, Jiake C, Hongxing Z, Wanhou G, Yan W, Gaifen L (2008) An investigation of psychological profiles and risk factors in congenital microtia patients. J Plast Reconstr Aesthet Surg 61:S37–S43

    Article  PubMed  Google Scholar 

  33. Sabbagh W (2011) Early experience in microtia reconstruction: The first 100 cases. J Plast, Reconstr, Aesthet Surg 64(4):452–458

    Article  Google Scholar 

  34. Adamson JE, Horton CE, Crawford HH (1965) The growth patterns of the external ear. Plast Reconstr Surg 36:466

    Article  PubMed  CAS  Google Scholar 

  35. Farkas LG (1978) Anthropometry of normal and anomalous ears. Clin Plast Surg 5:401

    PubMed  CAS  Google Scholar 

  36. Pierce GW, Klabunde EH, Bergeron V et al (1947) Useful procedures in plastic surgery. Plast Reconstr Surg 2:358

    Article  CAS  Google Scholar 

  37. Brent B (1992) Auricular repair with autogenous rib cartilage grafts: two decades of experience with 600 cases. Plast Reconstr Surg 90:355–374

    Article  PubMed  CAS  Google Scholar 

  38. Brent B (1999) The pediatrician’s role in caring for patients with congenital microtia and atresia. Pediatr Ann 28:374–383

    PubMed  CAS  Google Scholar 

  39. Cao Y, Vacanti JP, Paige KT et al (1997) Transplantation of chondrocytes utilizing a polymer-cell construct to produce tissue-engineered cartilage in the shape of a human ear. Plast Reconstr Surg 100:297–302

    Article  PubMed  CAS  Google Scholar 

  40. Kamil SH, Vacanti MP, Aminuddin BS, Jackson MJ, Vacanti CA, Eavey RD (2004) Tissue engineering of a human sized and shaped auricle using a mold. Laryngoscope 114:867–870

    Article  PubMed  CAS  Google Scholar 

  41. Neumeister MW, Wu T, Chambers C (2006) Vascularized tissue-engineered ears. Plast Reconstr Surg 117:116–122

    Article  PubMed  CAS  Google Scholar 

  42. Pruzinsky T, Sarwer DB, Cash TF, Goldwyn RM, Persing JA, Whitaker LA (2006) In: Sarwer D, Pruzinsky T, Cash TF, Goldwyn RM, Persing JA, Whitaker LA (eds) Psychological Aspects of Reconstructive and Cosmetic Plastic Surgery: Clinical, Empirical and Ethical Perspectives. Lippincott Williams & Wilkins, Philadelphia, pp 3–4

    Google Scholar 

Download references

Conflict of interest

The authors have no conflict of interest to disclose.

Author information

Authors and Affiliations

  1. University of Southern California (USC) Medical Center, Keck School of Medicine, 401 S. Detroit St. #209, Los Angeles, CA, 90036, USA

    Daniel D. Im

  2. Yale-New Haven Hospital, Yale School of Medicine, New Haven, CT, USA

    Boris Paskhover

  3. Department of Plastic and Reconstructive Surgery, NYU Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, NY, USA

    David A. Staffenberg

  4. Division of Plastic and Reconstructive Surgery, UCLA, Los Angeles, CA, USA

    Reza Jarrahy

Authors
  1. Daniel D. Im
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Boris Paskhover
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David A. Staffenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Reza Jarrahy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel D. Im.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Im, D.D., Paskhover, B., Staffenberg, D.A. et al. Current Management of Microtia: A National Survey. Aesth Plast Surg 37, 402–408 (2013). https://doi.org/10.1007/s00266-012-0008-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-012-0008-x

Keywords

Search

Navigation