Surgical results of two-stage reconstruction of the auricle in congenital microtia using an autogenous costal cartilage alone or combined with canaloplasty

Background: The authors performed two-stage ear reconstruction using autogenous costal cartilage alone or combined with canaloplasty of the acoustic meatus to improve the functional results with minimal operative stages. Methods: In the first stage, lobule transposition, fabrication of the cartilage framework, and implantation of the framework were performed. In the second stage, elevation of the auricle, coverage with the mastoid fascia flap and skin graft, and concha excavation were performed. Canaloplasty was combined simultaneously in 27 patients with radiologic and audiometric evidence of cochlear function. Results: A total of 37 cases in 36 consecutive patients with microtia were treated. Results of external ear reconstruction were evaluated by ear contour, quality of detail, and projection of the ear. Thirty-three cases presented acceptable ear contour after ear reconstruction. Unfavorable results were lack of detail of the reconstructed auricle in two patients and deformation of the constructed helix in one patient. Six patients exhibited improved hearing over 30 dB pure-tone average and three patients exhibited improved hearing below 30 dB after canaloplasLy in the concha type. In the lobule type, seven patients demonstrated a greater than 30-dB gain in pure-tone average, six patients demonstrated a gain below 30 dB, and there was no improvement in five patients. Complications related to canaloplasty were chronic drainage of the auditory meatus in three cases and meatal stenosis in six cases. Conclusions: The results of the contour of the reconstructed auricle with reduced operative stages combined with canaloplasty were acceptable to the patients. However, in lobule-type deformities, meticulous manipulation is necessary to reduce complications after canaloplasty.