1 in 6000 children are born with a very small deformed external ear (microtia) or completely absent external ear (anotia). The external ear canal is also often absent and usually the middle ear (ear drum etc) is also absent or severely under developed. However patients still have hearing in that ear through bone conduction to the inner ear. About 75% of the time the microtia occurs just on one side and is not associated with any other abnormalities. It can sometimes run in families.

Plastic Surgeons are often involved with these patients to restore the external form of their ear. There are several methods available but the two main choices are whether to have a prosthetic reconstruction with a clip on plastic ear or an ear reconstructed out of the patients own tissues, usually a combination of skin, cartilage and/or some synthetics.

The first reconstructive method of using a prosthetic ear is performed by inserting titanium studs into the side of the skull where the ear would be. A prosthetist then makes out of a soft silicone rubber a very life like ear that clips onto these titanium metal studs. The advantages of this type of operation are that the prosthetic external ear looks very realistic and the surgery is relatively straightforward. However, the titanium studs in the skull need regular cleaning and hygiene and the silicone external prosthesis needs replacing every year (it tends to fade).

Performing the reconstruction with the patient's own tissues is more complex and usually takes two to three stages. The skeleton of the ear can be made from spare cartilage found in the inner part of the ribs. The skin is then placed over this cartilage to give the shape of the ear which in subsequent operations is then brought out from the side of the head to give the appearance of the external ear. It is impossible to get these ears looking exactly like a normal ear since the skin and cartilage from which it is made are generally too thick. However, in most cases it is very satisfactory. The advantages are that although the operations are bigger initially once done the ear will usually be very trouble free. If injured it heals itself and in fact it will grow slightly with the patient.

A further type of tissue reconstruction involves using some synthetic plastic (polypropylene) covered in a flap of tissue from the temple area which is then covered by a skin graft. This operation is somewhat simpler than using the patient's own cartilages but has a similar appearance in terms of the aesthetic outcome. It still has some small disadvantages in that the foreign material within the ear reconstruction can sometimes over the years cause trouble such as exposure or infection.

The exact methods chosen for ear reconstruction is a complex decision dependent on a number of variables from both the patients side, the skills and preferences of the surgeons involved and the facilities available at that institution. Plastic surgeons are key in performing this type of surgery.

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