Ear reconstruction

Ear reconstruction is surgery to repair or rebuild the external part of the ear, called the auricle or pinna. This surgery may be done to correct an irregularity of the outer ear that is present at birth (congenital defect). Or it may be used to restore an ear affected by cancer surgery or damaged by trauma, such as a burn.

Several surgical approaches are available for ear reconstruction. Cartilage taken from the ribs can be used to make a framework for the ear, or a medical implant may be used instead. In some cases, an artificial (prosthetic) outer ear anchored in bone may be an option.

For children who need ear reconstruction for a condition present at birth, the surgery often is done between the ages of 6 and 10, although it may be possible at earlier ages in some cases.

Ear reconstruction typically is done to treat the following conditions that affect the outer part of the ear:

• Underdeveloped ear (microtia)
• Missing ear (anotia)
• Part of an ear is buried under the skin on the side of the head (cryptotia)
• An ear is pointed and has extra folds of skin (Stahl's ear)
• An ear is folded over itself (constricted ear)
• Part of an ear was removed or damaged as a result of cancer treatment
• A burn or other traumatic damage to an ear

Ear reconstruction only involves the outer part of the ear. It does not change the ability to hear. Surgery to correct hearing problems may be planned along with this surgery in some cases.

Ear reconstruction, as with any type of major surgery, has risks, including the risk of bleeding, infection and a reaction to anesthesia.

Other risks associated with ear reconstruction include:

• Scarring. While scars from the surgery are permanent, they're often hidden behind the ear or within ear creases.
• Scar contraction. Surgical scars can tighten (contract) as they heal. This might cause the ear to change shape, or it may damage the skin around the ear.
• Skin breakdown. Skin used to cover the ear framework may break down after surgery, exposing the implant or cartilage underneath. As a result, another surgery may be needed.
• Damage at the skin graft site. If skin is taken from another part of the body to form a flap to cover the ear framework — this is called a skin graft — scars may form where the skin was taken. If skin is taken from the scalp, hair may not grow back in that area.

Ear reconstruction is a complex process that requires a team of specialists. You'll likely meet with a plastic surgeon and a physician who specializes in ear care (otolaryngologist). If hearing loss is a concern, a hearing specialist may be involved in the surgical planning, as well.

To see if you're a good candidate for ear reconstruction, your team will likely:

• Review your medical history. Be prepared to answer questions about current and past medical conditions. Your health care provider may ask about medications you take now or those you have taken recently, as well as any surgeries you've had.
• Do a physical exam. Your health care provider will examine your ear. A member of your team might also take pictures or create impressions of both ears to help with surgery planning.
• Order imaging exams. X-rays or other imaging exams can help your team assess the bone surrounding your ear and decide on the surgical approach that's right for you.
• Discuss your expectations. Your health care provider will likely talk with you about the results you're expecting after the procedure and review the risks of ear reconstruction.

Before ear reconstruction you might also need to:

• Stop smoking. Smoking decreases blood flow in the skin and can slow the healing process. If you smoke, your health care provider will advise you to stop smoking before surgery and during recovery.
• Avoid certain medications. You'll likely need to avoid taking aspirin, anti-inflammatory drugs and herbal supplements, which can increase bleeding.
• Arrange for help during recovery. Make plans for someone to drive you home after you leave the hospital and stay with you for at least the first night of your recovery at home.

Ear reconstruction can be done in a hospital or in an outpatient surgical clinic. Ear reconstruction usually is done using general anesthesia, so you'll be in a sleep-like state and won't feel pain during surgery.

During the procedure

Several approaches to ear reconstruction surgery are available.

• Reconstruction with rib cartilage. This approach, called autologous reconstruction, often is used for children with ear conditions that are present at birth. In those cases, the surgery is usually done between ages 6 and 10. By that time, the ear has almost reached its adult size, and there's enough rib cartilage available for the procedure.

  This approach involves 2 to 4 surgeries, depending on the technique a surgeon prefers to use. The surgeries include:

  • Removing cartilage from the ribs. The cartilage is used to make a framework that looks like an ear.
  • Positioning the framework under the skin at the ear site.
  • Elevating the ear away from away from the head.
  • Molding skin from another part of the body — typically the scalp, other ear, groin or collarbone — over the ear framework to create a natural appearance.
• Reconstruction with an implant. Instead of using cartilage from the ribs, this surgical approach uses a medical implant for the ear framework. The surgeon anchors the implant at the ear site and covers it with a flap of skin on the side of the head. Skin from another part of the body also is used to cover the new ear. Typically, reconstruction using an implant only requires one surgery. Children as young as 3 may be able to have this surgery.
• Placement of an artificial ear. With this type of ear reconstruction, the remaining part of the ear is removed. An artificial ear (prosthesis) is then surgically anchored into the bone at the ear site. This approach may be used when ear tissue is severely damaged, as with a burn; when a large part of the ear is missing due to cancer surgery; or when another ear reconstruction approach failed. It is typically used in adults rather than children.

After the procedure

Recovery after ear reconstruction depends on the type of surgery you have. Some ear reconstruction requires a hospital stay, or you may be able to go home the same day.

After surgery, you may have:

• Pain
• Swelling
• Bleeding
• Itching

Take pain medicine as directed by your health care provider. If you take pain medicine and the pain increases, contact your health care provider right away.

Talk to a member of your health care team about what you need to do to take care of your ear after surgery. You may need to wear a covering over your ear for several days.

Do not sleep on your side where the ear was reconstructed. Try not to rub or place pressure on your ear. Consider wearing button-down shirts or shirts with loose-fitting collars.

Ask your health care provider when you can go back to your daily activities, such as bathing and physical activity. Young children who have ear reconstruction need close supervision. Rough play or other strenuous activity could cause damage to the ear.

Ear reconstruction requires follow-up care. Talk to your health care provider about the appointments you need after surgery.

It can take up to three months for the ear to fully heal after ear reconstruction. If you're not satisfied with the results, talk with your surgeon about the possibility of another surgery to improve the appearance of your ear.