1. 上海市第六人民医院 Shanghai Sixth People’s Hospital Microtia Shankai Yin Prof Dept of Otolaryngology, the sixth hospital affiliated to Shanghai jiaotong university Otolaryngology institute at Shanghai jiaotong university

2. 上海市第六人民医院 Shanghai Sixth People’s Hospital 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

3. 上海市第六人民医院 Shanghai Sixth People’s Hospital  Known causes  Thalidomide( 啶酮 )  Isotretinoin()  Genetic  Risk factor  Diabetes Etiology 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

4. 上海市第六人民医院 Shanghai Sixth People’s Hospital Embryology of Auricle From The Ear comprehensive otology:

5. 上海市第六人民医院 Shanghai Sixth People’s Hospital Anatomy of auricle  From The Ear comprehensive otology:

6. 上海市第六人民医院 Shanghai Sixth People’s Hospital Classification of Microtia  Many classification systems  Grade I, II, III Grade I: all anatomic subunits present but misshapen Grade II: anatomic subunits either deficient or absent Grade III: classic “ peanut ear ” and anotia

7. 上海市第六人民医院 Shanghai Sixth People’s Hospital  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 lossstenotic  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

8. 上海市第六人民医院 Shanghai Sixth People’s Hospital

9. 上海市第六人民医院 Shanghai Sixth People’s Hospital Microtia reconstruction  Dr. Tanzer 1959 1 st 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 History

10. 上海市第六人民医院 Shanghai Sixth People’s Hospital Principles  Hearing 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.

11. 上海市第六人民医院 Shanghai Sixth People’s Hospital Surgery options  canal 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

12. 上海市第六人民医院 Shanghai Sixth People’s Hospital Rib Cartilage Graft

13. 上海市第六人民医院 Shanghai Sixth People’s Hospital

14. 上海市第六人民医院 Shanghai Sixth People’s Hospital The ear frame before it is assembled 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. a polyethylene plastic Ear frame assembly

15. 上海市第六人民医院 Shanghai Sixth People’s Hospital Long term result

16. 上海市第六人民医院 Shanghai Sixth People’s Hospital

17. 上海市第六人民医院 Shanghai Sixth People’s Hospital

18. 上海市第六人民医院 Shanghai Sixth People’s Hospital

19. 上海市第六人民医院 Shanghai Sixth People’s Hospital Tissue engineering