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Rib Cartilage Ear Surgery is a surgical technique to treat Microtia that uses a child’s rib cartilages to make a structural framework of an ear, which is then placed in a pocket under the scalp skin.
Rib graft was first used for ear reconstruction in 1920, when Dr. Harold Gillies removed rib from one person and used it to create an ear in a Microtia patient. Although this technique ultimately failed, it was the basis for Dr. Radford Tanzer’s work in 1959, when he used a patient’s own ribs for ear reconstruction. Dr. Tanzer’s pioneering work formed the foundation of today’s techniques in Rib Cartilage Ear Surgery.
One of the biggest advantages of Rib Cartilage Ear Surgery is that the surgery uses the body’s own tissue for the structural framework. Although ears and ribs are both made from cartilage, if you feel your ear and then your ribcage, you’ll notice that they do not bear much resemblance to each other. Ear cartilage is delicate and bendable, and specially designed to funnel sound waves into the ear canal. Rib cartilage is thick and firm, as it is designed to protect the lungs from injury. Thus, they are not equivalent materials but, when successful, a Rib Cartilage Ear should last a lifetime.
Three to four rib cartilages are removed from the chest wall and used to carve an ear framework. The ear is built up in layers to make it 3-dimensional. The framework is then placed under the scalp in the first of several surgeries. Unlike Medpor, no foreign material is used. However, since cartilage is not as strong as Medpor, there are limits to how thin the framework can be made and still remain strong. For this reason, cartilage ears may appear thicker than Medpor ears.
View a presentation of how the Rib Cartilage Ear Reconstruction surgery is done.
(WARNING: graphic surgical photographs are shown.)
Three to 4 surgeries are performed to create an ear (depending on surgical technique) when the child is old enough to have the procedure (6 or 7 years old). In the Nagata technique, 2 surgeries are performed, but in order to gain improved projection, the child must be at least 10 years old. If a patient has bilateral Microtia, 4 to 6 surgeries are required. In all cartilage techniques, the first surgery requires inpatient hospitalization due to the pain caused by removing the ribs.
Each child is unique in terms of pain perception but, generally speaking, there is significantly more pain at the chest wall incision than at the new ear. In all cartilage techniques, the first surgery requires a 1-3 day inpatient hospitalization due to the pain caused by removing the ribs. Patients receive IV pain medications (Morphine) until the pain is controlled on medicines you can take by mouth (Tylenol with Codeine). The ribcage is also treated for several days with a pain pump placed within the incision. This pump slowly drips numbing medicine into the area.
To our knowledge, Rib Cartilage ear surgery has never been performed on a 3-year-old because children do not have enough cartilage for ear reconstruction until they are at least 6 years old. If the child is small or the normal ear is large, the surgery may have to be delayed 1 or more years.
Early after surgery, the cartilage ear is swollen. The ear is protected with a cup for 3 weeks. The ear is well healed by 3 months after surgery, when the 2nd stage is performed.
If successful, Rib Cartilage Ear Surgery should last a lifetime.
Having an ear reconstruction should not limit your child from pursuing the activities she or he enjoys. Your child may go back to normal activities 6 weeks after surgery. This includes all sports. Children should always wear appropriate protective equipment for their particular sport (helmets for baseball, football and hockey). Many patients with Cartilage Ear Reconstruction have gone on to play competitive sports.
Patients have sensation in the new ear from the skin that overlies the rib framework. The sensation will never be quite the same as a normal ear, however.
The skin covering the cartilage framework works like normal skin, allowing the typical bumps, cuts and bruises we all get to heal. However, if a strong direct force hits a cartilage ear, there certainly could be injury to the reconstruction.
Yes, if there is a complication with the surgery and the skin overlying the cartilage does not survive, or if there is a significant infection, the cartilage framework can “melt away.” If there are no such complications, the cartilage ear framework should remain stable over time.
Yes. If this occurs, a Medpor ear surgery may be performed to salvage a failed Rib Cartilage ear surgery. Many patients have had successful outcomes with a “redo” Medpor ear reconstruction.
Any surgical ear reconstruction cannot look as natural as a “normal” ear. The most notable difference is that both Medpor and Cartilage ear reconstructions cannot bend the way a natural ear does, since the framework needs to be strong to resist the forces of scar formation.