Facial Plast Surg 2016; 32(02): 188-198
DOI: 10.1055/s-0036-1582229
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Autologous Costochondral Microtia Reconstruction

Sapna A. Patel
1   Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington
,
Amit D. Bhrany
1   Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington
,
Craig S. Murakami
2   Otolaryngology-Head and Neck Surgery, Virginia Mason Medical Center, Seattle, Washington
,
Kathleen C. Y. Sie
1   Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington
3   Otolaryngology, Seattle Children's Hospital, Seattle, Washington
› Author Affiliations
Further Information

Publication History

Publication Date:
20 April 2016 (online)

Abstract

Reconstruction with autologous costochondral cartilage is one of the mainstays of surgical management of congenital microtia. We review the literature, present our current technique for microtia reconstruction with autologous costochondral graft, and discuss the evolution of our technique over the past 20 years. We aim to minimize donor site morbidity and create the most durable and natural appearing ear possible using a stacked framework to augment the antihelical fold and antitragal–tragal complex. Assessment of outcomes is challenging due to the paucity of available objective measures with which to evaluate aesthetic outcomes. Various instruments are used to assess outcomes, but none is universally accepted as the standard. The challenges we continue to face are humbling, but ongoing work on tissue engineering, application of 3D models, and use of validated questionnaires can help us get closer to achieving a maximal aesthetic outcome.

 
  • References

  • 1 Tanzer RC. Total reconstruction of the external auricle. Arch Otolaryngol 1961; 73: 64-68
  • 2 Constantine KK, Gilmore J, Lee K, Leach Jr J. Comparison of microtia reconstruction outcomes using rib cartilage vs porous polyethylene implant. JAMA Facial Plast Surg 2014; 16 (4) 240-244
  • 3 Osorno G. Autogenous rib cartilage reconstruction of congenital ear defects: report of 110 cases with Brent's technique. Plast Reconstr Surg 1999; 104 (7) 1951-1962 , discussion 1963–1964
  • 4 Brent B. Technical advances in ear reconstruction with autogenous rib cartilage grafts: personal experience with 1200 cases. Plast Reconstr Surg 1999; 104 (2) 319-334 , discussion 335–338
  • 5 Nagata S. 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 1994; 93 (2) 221-230 , discussion 267–268
  • 6 Nagata S. 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 1994; 93 (2) 231-242 , discussion 267–268
  • 7 Nagata S. 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 1994; 93 (2) 243-253 , discussion 267–268
  • 8 Firmin F. Ear reconstruction in cases of typical microtia. Personal experience based on 352 microtic ear corrections. Scand J Plast Reconstr Surg Hand Surg 1998; 32 (1) 35-47
  • 9 Roberson Jr JB, Goldsztein H, Balaker A, Schendel SA, Reinisch JF. HEAR MAPS a classification for congenital microtia/atresia based on the evaluation of 742 patients. Int J Pediatr Otorhinolaryngol 2013; 77 (9) 1551-1554
  • 10 Long X, Yu N, Huang J, Wang X. Complication rate of autologous cartilage microtia reconstruction: a systematic review. Plast Reconstr Surg Glob Open 2013; 1 (7) e57
  • 11 Braun T, Gratza S, Becker S , et al. Auricular reconstruction with porous polyethylene frameworks: outcome and patient benefit in 65 children and adults. Plast Reconstr Surg 2010; 126 (4) 1201-1212
  • 12 Hempel JM, Braun T, Patscheider M, Berghaus A, Kisser U. Partial auricular reconstruction with porous polyethylene frameworks and superficial temporoparietal fascia flap. Eur Arch Otorhinolaryngol 2014; 271 (10) 2761-2766
  • 13 Soukup B, Mashhadi SA, Bulstrode NW. Health-related quality-of-life assessment and surgical outcomes for auricular reconstruction using autologous costal cartilage. Plast Reconstr Surg 2012; 129 (3) 632-640
  • 14 Park C. An algorithm and aesthetic outcomes for a coverage method for large- to medium-remnant microtia: I. Coverage in the one-stage erect position. Plast Reconstr Surg 2012; 129 (5) 803e-813e
  • 15 Kristiansen M, Öberg M, Wikström SO. Patients' satisfaction after ear reconstruction with autologous rib cartilage. J Plast Surg Hand Surg 2013; 47 (2) 113-117
  • 16 Sharma M, Dudipala RR, Mathew J , et al. Objective analysis of microtia reconstruction in Indian patients and modifications in management protocol. Indian J Plast Surg 2015; 48 (2) 144-152
  • 17 Kamil SH, Vacanti MP, Aminuddin BS, Jackson MJ, Vacanti CA, Eavey RD. Tissue engineering of a human sized and shaped auricle using a mold. Laryngoscope 2004; 114 (5) 867-870
  • 18 Berens AM, Newman S, Murakami CS, Sie KCY, Zopf DA. CAD and 3D Printing for Simulation of Auricular Reconstruction. Dallas, TX: American Academy of Otolaryngology- Head & Neck Surgery; 2015