Microtia refers to an under-developed or absent ear. This can occur as part of hemifacial microsomia (HFM—see separate section), and in some cases may be the only manifestation of HFM. Microtia occurs more commonly on the right side, and occurs on both sides in 10% of cases. Boys are more commonly affected than girls.
Is this condition painful?
No, microtia does not cause any pain or discomfort.
Are there different types of microtia?
Yes, microtia can occur on a spectrum from mild deformity to complete absence of the cartilaginous framework of the ear. Usually, some remnant of the earlobe is present, although in an abnormal position and orientation.
What causes microtia?
Please see the discussion of causes of hemifacial microsomia.
What are the main issues related to microtia?
The appearance of the ear and hearing in the affected ear are the primary issues for microtia patients. Almost all patients with significant microtia have abnormalities of the ear canal and/or middle ear, and have abnormal hearing in the affected ear. Children with microtia are evaluated by an otolaryngologist who works with the craniofacial treatment team to decide whether any surgery should be done specifically to improve hearing or whether a hearing aid would be beneficial.
Are there other problems that occur with microtia?
Since microtia is part of the spectrum of hemifacial microsomia, patients with microtia may have any of the associated anomalies that occur with hemifacial microsomia. Please see the separate discussion of hemifacial microsomia for details.
What is the treatment for children with microtia?
The craniofacial surgeon (plastic surgeon) and the otolaryngologist (“ENT”) will decide together on the timing of any surgery on the ear canal or middle ear for hearing. Reconstruction of the external ear is a staged process; that is, a series of procedures is required. The child must be at least six years of age before beginning this process, so that enough growth has taken place to allow an adequate reconstruction. The reconstruction is done using the child’s own tissues: cartilage taken from the ribs is used to build an ear, and then implanted beneath the soft tissues on the side of the head. Usually, either three or four operations are required to complete the reconstruction. The whole process takes about a year. The most extensive procedure is the first procedure, in which the rib cartilages are used to construct the ear framework. The remaining procedures are relatively minor in comparison, and can be done on an outpatient basis.
What sorts of specialists will be involved in my child’s care?
The optimal treatment of children with microtia is achieved in a multidisciplinary setting. As noted above, these children may have a number of issues that must be addressed. Usually, the specialists involved include:
- the geneticist, who helps assign a diagnosis and counsels the family regarding the possibility for recurrence in future children
- the craniofacial surgeon (a plastic surgeon who has done additional specialized training), who does most of the operations
- an otolaryngologist (ENT), who can address hearing problems or perform middle ear surgery if necessary
- a developmental pediatrician, who can follow the child’s physical and mental development and the pediatric plastic surgery nurse, who is instrumental in coordinating care and counseling and educating families
Will we get to know our surgeon?
Because children with microtia usually require a series of procedures, the patients and their families often develop very close relationships with their surgeon and other members of the treatment team. It is important for patients and their families to feel comfortable with their surgeon, since they will need to work together for at least a year.