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What to Expect with Reconstruction Surgery
When using rib cartilage as the main source of tissue, ear reconstruction may be completed in one or two surgeries, approximately three to six months apart. The first surgery is longer and requires hospitalization. The ENT and general surgeon work side-by-side in the operating room to:
- Harvest rib cartilage through a small chest incision
- Sculpt the cartilage into similar shape and size as the opposite ear
- Remove the existing ear cartilage and replace it with the new, sculpted cartilage
Patients will usually stay in the hospital for one to two days following surgery and will go home with a large, bulky dressing that will stay on until the follow up visit – typically one week later. Children usually return to school a week after surgery, and physical activities and water exposure may resume after four to six weeks.
After the first surgery, the ear will have a good shape, but it may appear too close to the head. After the swelling goes down, a second surgery is planned to make the ear “stick out” and look more natural. A very thin slice of skin from the scalp area behind the ear is then grafted on the back part of the ear. Surgery and recovery time are much shorter compared to the first stage.
Reconstructing the ear with an implant can be done at an earlier age because the need for rib graft is not required. This reconstruction can be done as early as 3 years and requires one operation. The surgery takes between 4-5 hours, but may be longer if combined with an atresia repair or placement of a bone anchored hearing aid. Patients do not require hospitalization after an alloplastic reconstruction, but can stay if they feel more comfortable.
The prosthetic material that is used for ear reconstruction is called Medpor. It is a common material used for other types of facial procedures, like cheek, chin and nose augmentation. It is well tolerated by the body and becomes incorporated into the native tissue within weeks of reconstruction.
After surgery, patients will wear a series of ear molds over their newly reconstructed ear for protection and to ensure that projection is maintained. This molding process lasts for 3 months. Patients can remove the molds for bathing and when they are in public, but it is encouraged at night-time and when they are at home.
If bilateral ear reconstruction is required, we will wait a minimum of 3 months in between each surgery. Alloplastic ear reconstruction is possible as a secondary or salvaging operation for previous, unsuccessful microtia repair attempts.