Combined reconstruction of congenital auricular atresia and severe microtia

Objectives: Due to their embryologic developments, auricular atresia and severe microtia are in most cases combined malformations. The aims of this study were to develop a surgical technique for combined esthetic and functional reconstruction with a minimum of operations and to evaluate the results. Study Design: Prospective clinical evaluation. Patients and Methods: Fifty-two patients with third-degree microtia and congenital aural atresia with a sound-conducting block of about 50 dB were treated as described here. In the first operation, autogenous cartilage is harvested and the auricular framework fabricated and implanted. In addition, the tympanic membrane and the external ear canal are prefabricated and stored in a subcutaneous pocket. In the second step, the elevation of the new framework is combined with the operation for atresia utilizing the prefabricated tympanic membrane and external ear canal. In the third step, the cavum conchae is deepened and the external ear canal opened and covered with a skin graft. Results: Seventy-six percent of the patients had a final conducting hearing loss of 30 dB or less. No restenosis of the new external ear canal was observed. The esthetic results of the constructed auricles are shown. Conclusion: With this combination of plastic surgery for the auricle and functional surgery for the middle ear, no additional operations are necessary, and the prefabrication of the external ear canal and the tympanic membrane gives stable and reliable results. Therefore, we think that this combined technique offers the best chance for an optimal esthetic and functional rehabilitation of patients with these malformations.