Mr. Andrew Greensmith MBChB FRACS
About Microtia Surgery
In Microtia you need to remember both the external ear and the internal ear are infected to varying degrees. Frequently with the small external ear we see absence of the ear canal and the middle ear structures. But importantly the inner ear structures, the cochlea and the nerve of hearing are normal. So the problem is sound traveling through the canal cannot do that and we have a block, a conduction block, so the sound can still be received by vibrating the bone behind but it is very much compromised because it cannot pass through normal ear canal. And that explains one of the problems with hearing in children with Microtia.
Ear Re construction
The human ear is one of the most complicated structures on our bodies and is incredibly hard to replicate as it is in nature. But as Microtia surgeons we have to pay great attention to the detail of the structure with our artistic ability try to recreate this structure out of usually rib cartilage as the first preference. This involves a lengthy procedure where we use rib cartilage not the rib bone in multiple pieces to construct a three dimensional framework which we place in the pocket on the side of the head under the skin envelope and shrink wrap skin over it. This model used by myself to train other surgeons in Microtia surgery is a good way of seeing how this works. Once the framework is placed under the patient skin with the correct location, the skin of the patient is then shrink wrapped with a negative pressure drain over the framework and as you can the framework shows through the skin much like the real ear.