Complex Ear Reconstruction Cases explained by Dr. Parag Telang

Ear reconstruction surgery is one of the most difficult surgeries in the spectrum of plastic surgery. It is important to be able to replicate the three-dimensional structure of the ear. That is why using one’s own rib cartilage gives us much more flexibility to be able to give the patient the kind of shape that is required. In the previous technique of ear reconstruction, the surgery was completed in four stages, which meant that the person had to come back four times for different stages of the surgery. Now, in the technique that we use, the entire ear reconstruction is completed in two stages. So the recovery is much smoother for the patient. Ear reconstruction using the patient’s own rib cartilage can be done to correct ear deformities in newborns, and children who are born with microtia, prominent ear, lop ear, or cup ear deformity. It is also ideal for those who have lost their ear due to trauma and need either complete or partial ear reconstruction.

In this article, Dr. Parag, a top ear surgeon, explains a few complex cases of different types of ear reconstruction that have been performed by him.

Case 1

Problem: Lobular Microtia

Age: 9 years

Complexities: Complete missing ear and missing ear canal

A child with a deformity called lobular microtia visited me. Along with a completely absent ear, his ear canal was missing too. So in this case, we also tried to recreate the appearance of an ear canal. First, we harvested the rib cartilage from the child's chest. They were then crafted and given the shape of a normal ear, which looked complete in all aspects. This ear framework is designed on the basis of his opposite ear. So there is a lot of flexibility in achieving a good shape and symmetry with the opposite ear. The entire ear is reconstructed at the end of the first stage but it is still attached to the scalp. After six months, in the second stage, ear elevation is performed where a small piece of cartilage is introduced behind the ear. So, after the second stage, the ear looks completely projected, just like a normal ear.

After the completion and healing of the second stage, the child got good symmetry with the opposite ear. Also, he got a complete gap behind the ear where the child can wear a spectacle or glasses.

Case 2

Problem: Lost complete ear in a car accident

Age: 38 years

Complexities: Match the existing opposite ear, Local skin has been damaged

It is not that ear reconstruction can be performed only for children who are born with microtia or congenital absence of the ear. Ear reconstruction using a rib cartilage technique is also applicable to those who have lost their ear due to injury. Like a gentleman who had lost his complete ear in a car accident visited me. So, in this scenario, again, rib cartilage was harvested from his chest. They were then given the shape of a normal ear, exactly symmetrical to the existing opposite ear. A rib cartilage technique gives us the flexibility to achieve symmetry with the existing normal ear.

Now, because the local skin was also damaged, the ear framework was first inserted in the correct location and then we covered it with a fascia from the scalp, which is called a temporal fascia. That is what provides cover to the framework. The fascia was then covered with a skin graft, which was extracted from the patient's thigh. We reconstructed the entire ear in one single stage. The patient might want any finer adjustments or modifications in the ear which can be performed at a later stage. This patient wanted a little more elevation on the lobule. So this was performed in a different surgery later on. But apart from that, the entire ear reconstruction can be completed in one single stage.

Case 3

Problem: Microtia and have had 13 surgeries already

Age: 13 years

Complexities: Already went under 13 ear reconstruction surgeries, Rib cartilage was already removed from sides of the chest, Artificial implants suffer from high infection risk

Microtia or absence of an external ear is seen in one child out of 8000 births. There are plenty of challenging cases which come to me. Recently, I operated on a girl who was 13 years old and was from Odisha. She had undergone 13 ear reconstruction surgeries in Odisha. In her previous surgeries, the rib cartilage from both her chest had been removed. However, rib cartilage still remains the most preferred modality of reconstructing the ear, there are a lot of artificial implants which are available, but they suffer from a very high infection and rejection rate. Hence, in this surgery again, we had to take rib cartilages from higher up third, fourth, and fifth rib cartilages, which we were able to harvest, giving it the shape of a normal ear. This ear framework was then covered by fascia and now the child is having satisfactory results. She had a satisfactory recovery and she's now able to wear normal earrings in her ear.

Why Dr. Telang?

It is important that the ear reconstruction surgery is performed by a board-certified plastic surgeon having proper training in this surgery because the ear is an extremely unforgiving surgery and the first surgery is the best chance that one has to get a result that will match the opposite ear. Dr. Parag Telang is a world-renowned surgeon for microtia and ear deformities and is considered to be the best ear surgeon in India. He is an expert in ear reconstruction surgery for children who are born with missing or partial ears or have had a traumatic loss of an ear. He is the founder of “The Microtia Trust”, the best ear reconstruction surgery clinic which provides a wide range of treatments for ear deformities to patients. The patients come from all around the world to avail benefits of his innovative approach to treatment, compassionate care, and surgical skills that help one to achieve the best-desired results.