Simultaneous auricular reconstruction combined with bone bridge implantation-optimal surgical techniques in bilateral microtia with severe hearing impairment

Background: Congenital bilateral microtia with external ear canal (EAC)/middle ear malformation lead to severe appearance defects, hearing impairment and language barrier. Here we report an optimal integrated surgical technique for BoneBridge implantation and auricular reconstruction, which reduce time span of operation, total cost and patients' suffering as well. Method: Seven patients with bilateral external and middle ear malformation received 2-stage auricular reconstruction (age from 7 to 11 years old). In the 1st stage, 6th, 7th, and part of 8th autologous costal cartilage were used to make main body and C-shaped base part of the framework. In 2nd stage of the operation, dissect and lift the framework, isolate postauricular fascia and periosteum, put the BoneBridge subperiosteally and fixed with titanium screw. The C-shaped cartilage base was further attached to the framework and retroauricular fascial flaps and a full-thickness skin graft obtained from the donor site was used to cover posterior raw surface. Results: Patients were followed up for about 8 months post operation, all of them satisfied with the outcomes and symmetric shape on both sides about desirable 3D detail without adverse complications. Hearing test indicated the mean improvement of auditory threshold of 34.8 dB HL 3 weeks after BoneBridge implantation, with mean scores of speech recognition test ranging from 26% to 62%. Conclusion: The combined 2-stage surgical techniques of simultaneous auricular reconstruction and BoneBridge implantation is safe and efficient for bilateral microtia with significant advantages in decreasing operation difficulties, shortening treatment span and relieving suffering for patients.