Case 20 Microtia



Kristopher M. Day and Raymond J. Harshbarger

Case 20 Microtia

Case 20 (a, b) A 32 year-old female enters to discuss interest in correcting the deformity of her right ear.



20.1 Description




  • Adult female with grade 3 “lobular type” microtia of the right ear



  • Absence of external auditory meatus suggesting right-sided hearing loss



  • Examination shows small, malformed, hypoplastic residual cartilage with abnormal lobule orientation and aural atresia



20.2 Work-Up



20.2.1 History




  • Hearing loss and previous hearing aid placement




    • Possible use of bone anchored hearing aid (BAHA)



  • Family history of ear abnormalities, facial clefts, congenital hand conditions, or other craniofacial syndromes




    • Visual impairment (e.g., oculoauricovertebral syndrome)



    • Renal disease (e.g., branchio-oto-renal syndrome)



    • Cardiac disease (e.g., CHARGE syndrome)



20.2.2 Physical Examination




  • Classify anomaly




    • Unilateral or bilateral



    • Severity by grade



    • Presence or absence of external ear canal and/or hearing loss



  • Grades of ear hypoplasia (see Fig. 20-1)




    1. Mild hypoplasia: Smaller ear, all elements present



    2. Moderate hypoplasia: Some missing elements; “concha-type,” possibly canal stenosis



    3. Microtia: Small peanut-shaped remnant; “lobule-type,” usually with aural atresia



    4. Anotia: Complete absence of external ear



  • Characteristic associated conditions




    • Hemifacial microsomia: Facial asymmetry




      • Goldenhar: Preauricular skin tags and epibulbar dermoids



    • Treacher Collins syndrome: Malar hypoplasia and micrognathia



    • Nager syndrome: High nasal bridge and thumb hypoplasia

      Fig. 20.1 Grades of ear hypoplasia. (Source: Reinisch J, Tahiri Y, eds. Modern Microtia Reconstruction. In: Derderian CA, Microtia. Switzerland: Springer; 2019:23–41.)



20.2.3 Pertinent Imaging and Diagnostic Studies




  • Audiometric testing



  • Temporal bone and craniomaxillofacial computerized tomography protocols



20.3 Consultations




  • Audiologist




    • Hearing evaluation



    • Commonly have conductive hearing loss > sensorineural hearing loss




      • Inner ear usually intact



      • Middle ear atresia common



  • Otolaryngologist




    • Evaluate for BAHA candidacy:




      • Initial temporary hearing aid worn with head strap prior to ear reconstruction



      • Critical to initiate early for speech development in bilateral microtia



      • Permanent BAHA placed postoperatively to avoid injury to skin envelope

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Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 20 Microtia
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