State of the Art (Blog)
Prosthetic Ear Over Microtia – A Treatment Option
Many of our patients were born with microtia and atresia, which means that the external ear is missing or malformed (microtia) and the external ear canal is absent (atresia). This birth difference affects one or both ears, but most commonly presents just on one side. The little ear is often located a little more forward and slightly lower than a normal ear. In the following photos, you can see that the shape, size, and placement of the microtia vary from one person to another:
Prosthetic Ear Over Microtia
We see many children and adults with microtia and atresia in our office who are interested in prosthetic restoration of the external ear. When moving forward with an ear prosthesis, some patients choose not to remove the little ear, and keep it as-is. Preserving the little ear means saving skin and cartilage that might be useful for future surgical reconstruction with Medpor or rib graft, or whatever new techniques emerge as technology advances. A prosthesis that fits over the little ear provides an opportunity to see what it’s like to have a more normal big ear without surgical intervention. For some families, the prosthesis acts as a temporary treatment solution until the child is old enough to decide for himself how he’d like to proceed with treatment of the microtia, if at all.
When the microtia is preserved, the prosthesis is designed to fit over the little ear like a glove. During the sculpting appointment, we determine appropriate placement of the prosthesis by observing anatomical landmarks, taking facial measurements, and finding a symmetrical position in relation to the other ear when possible.
There will almost always be a compromise to the form of the prosthetic ear as it wraps over the underlying microtia – typically a raised area or bulge that doesn’t exist in a normal ear. The degree of compromise depends on the size and position of the little ear, and will vary from one patient to the next. Below are photos of two different patients that demonstrate the type of compromise that may occur when working over the underdeveloped ear (please click on the thumbnails to see larger images).
In some cases, it may not be possible to work around the existing microtia and achieve an acceptable result. We are happy to meet with you and your family to discuss the prosthetic ear over microtia option for your particular situation.
Attachment Option 1) Skin Adhesive
When the microtia is kept in place, the prosthesis can be designed to attach in two ways. One option is to use skin adhesive to secure the prosthesis in place over the little ear. This involves daily application of a gentle liquid adhesive onto the back surface of the prosthesis and pressing it into place. The prosthesis is then removed at the end of the day and the adhesive is cleaned from the prosthesis. No surgery is needed for an adhesive-retained prosthesis, and it can usually be completed in just three office visits. Below is an example of an adhesive-retained auricular (ear) prosthesis in place over the underdeveloped ear.
Attachment Option 2) Craniofacial Bone-Anchored Implants
The second attachment option requires one or two relatively minor surgical procedures to have two or three craniofacial bone-anchored implants placed just behind the microtia for attachment of the prosthesis. Small titanium implants are placed into the bone just behind the little ear and allowed to heal for a period of 3-6 months. External components called abutments are then attached to the titanium fixtures and protrude through the skin for magnetic attachment of the prosthesis. Like an adhesive-retained prosthesis, an implant-retained prosthetic ear should also be removed at night for cleaning and to clean the underlying skin.
The patient below has two bone-anchored implants for magnetic attachment. On the back surface of the prosthesis, you can see the two magnets and the hollowed out area that fits snuggly over the little ear.
The patient in the next photos has a little ear that is especially far forward and low. The microtia remains outside of the margins of the prosthesis when it is positioned symmetrically to the other ear, so there is no compromise to the form of the ear.
Even when attachment is very secure, it is possible to dislodge an ear prosthesis during certain activities. An adhesive-retained ear may also loosen due to facial movement, perspiration or humidity. An implant-retained prosthesis provides the most reliable and secure retention, especially for young patients.
Making a Decision
There are many treatment options for microtia, as well as doing nothing at all and going natural. There is no “right” or “wrong” approach, as it’s a very individual decision. It can be overwhelming to choose which option is the best for you or your child, and we are very happy to provide as much information and support as possible to aid in the decision-making process. Please explore our website to learn more about prosthetic restoration of the ear, and feel free to leave a comment or call us with questions or to schedule a complimentary initial consultation. We look forward to hearing from you.