1. OUTER EAR DISEASE

2. Microtia

3. Anatomy of auricle
*From The Ear comprehensive otology

4. Microtia

5. Classification of Microtia
Grade I: A slightly small ear with identifiable structures and a small but present external ear canal
Grade II: A partial or hemi-ear with a closed off or stenotic external ear canal producing a conductive hearing loss
Grade III: Absence of the external ear with a small peanut vestige structure and an absence of the external ear canal and ear drum
Grade IV: Absence of the total ear or anotia

6. Microtia IV I II
III

7. Etiology Known causes Risk factor Thalidomide(啶酮) Isotretinoin(异维甲酸)
Genetic
Risk factor
Diabetes
The occurrence of microtia is usually a random, sporadic event, and it is important for the parents to understand that the deformity was not caused by anything the mother did before or during the pregnancy

8. Epidemiology Occurs 1 in 7,000 to 8,000 infants
Occurs more often in right ears
Occurs more often in males
Higher incidence in Hispanics and Asians than in blacks and whites
Fewer than 15% with positive family history
Associated with other congenital malformations
Cause is multifactorial.
Facial cleft/ cardiac defect > anophthalmia/ microphthalmia > limb reduction defects/ severe renal malformation > holoprosencephaly 8

9. Surgery options canal reconstruction auricular reconstruction
Ear canal reconstruction is unnecessary and overcomplicated
Very good hearing is possible with modern hearing aids
auricular reconstruction
Rib Cartilage Graft Reconstruction
a polyethylene plastic implant

10. Microtia reconstruction
History
Dr. Tanzer 1959
1st article on auricular reconstruction with autogenous rib cartilage, 6 stages procedure
Dr. Brent 1974
4 stages procedure, foremost authority on auricular reconstruction
Dr. Nagata 1985
2 stages procedure

11. Rib Cartilage Graft

12. The ear frame before it is assembled
A polyethylene plastic
The ear frame before it is assembled
A Nylon Carving Block is available for purchase from Porex for use in contouring MEDPOR Biomaterial. Avoid placing the porous implant material on surgical drapes or other fibrous material that may shed particles on the implant.
Photo of implant components on a surgical drape. Caution: The porous implant material should not be placed on surgical drapes or other fibrous material that may shed particles on the implant. 12

13. Tissue engineering

14. Long term result

15. Long term result

16. Principles Hearing External canal Age
testing is first done to determine if the inner ear is intact and hearing is normal
External canal
to determine if a canal exists, by CT scan. (if a canal is not visible externally)
Age
The earliest age surgery can be attempted is age 3 for Medpor and 6 for Rib Cartilage Grafts. However a later age recommend, 8-10 when the ear is full adult size

17. Thanks！