Auricular Reconstruction with Autogenous Rib Cartilage Graft using Tissue Expander after Canaloplasty in Microtia

ABSTRACT

Along with aural atresia, abnormalities of the middle ear and external ear canal can impede the audition of the developing infant. In cases of bilateral atresia when bone-conduction aids fail to adequately restore impaired hearing, unilateral canal reconstruction may be required at a very early age to enable proper speech and language development. We are often confronted by cases in which canaloplasty has previously been performed by ENT surgeons, leaving auricular canals of various locations and sizes in addition to scars. In such cases, it can be difficult to prepare a skin flap sufficient in size to cover the cartilagenous framework for auricular reconstruction. Scar tissues with relatively poor vascularity induced by a prior incision and elevation of the soft tissue may compromise the ultimate result of auricular reconstruction. To obtain the sufficient, thin, pliable and well vascularized skin, we used tissue expansion at the first stage of the auricle reconstruction in microtia patients who previously received canaloplaty. From December, 1988 to February, 1999, we attempted tissue expansion using volume 35cc, cresent- type inflatable silicone expanders(SebbinR) in 12 patients who previously received canaloplasty. Ear frameworks were prepared using autologous rib cartilage. The expanded skin provided sufficient, thin, pliable, and well vascularized skin for easy draping and better contouring. The reconstructed auricle was satisfactory in both color and texture and had nearly normal sensation. No resorption of the inserted rib cartilage has been observed from 7 months to 9 years and 9 months after the operation.