Reasons for Surgery
Surgery of the external ear is commonly performed by plastic surgeons for a variety of reasons. Trauma can result in lacerations, “cauliflower ears,” deformities, or even complete loss of the ear itself. Other reasons for surgery include prominent ears, deformed ears, or absent ears (from birth).
The ear can be subdivided into two main components: external and internal. The internal ear consists of the auditory canal and the internal structures required for hearing. The external component is everything else outside of the canal. This visible portion of the ear is the area that plastic surgeons focus upon.
The ear is a very specialized and unique structure of the body. The cartilage is the internal spongy material that provides shape and support to the external ear. The overlying skin is very thin and pliable. It tightly adheres to the underlying cartilage, which makes the hills and valleys of the ear very apparent. The external ear is very challenging to duplicate or manipulate surgically. Therefore, ear surgery usually requires the expertise of even the most specialized of all plastic surgeons.
Ear Conditions and Surgical Procedures to correct
Probably the most common types of ear procedures involve trauma – usually a cut to the ear. Surgery involves the careful attention to detail in repairing the skin and/or cartilage involved. Healing of the cartilage depends on the presence of healthy skin and soft tissue overlying it. Without this, the cartilage becomes necrotic and will wither away. “Cauliflower ears” are a type of post-traumatic ear deformity that is often seen with wrestlers. This is caused by bleeding of ear between the cartilage and the skin. This blood collection clots and is transformed into dense scar tissue that causes the appearance of a “cauliflower.” These difficult surgeries involve the tedious removal of scar tissue and re-sculpturing of the ear cartilage and skin.
Congenital ear deformities (present at birth) present in many different ways. Some ears are small or “constricted.” Some have unusual shapes (i.e. “Spock” ears) or are asymmetric. In other cases, there may be an absence of one or both ears and/or the auditory canal. In all of these patients, surgery should be delayed until age 5 to 7; this is when the ear is approximately 85% of the adult size. Any procedures done sooner may result in recurrent deformity or asymmetry as a result of unpredictable growth.
Microtia is the term used for children born with an absent ear(s). There is usually a small cartilage remnant and small skin tag, but no external ear or auditory canal. These children will require a multi-stage ear reconstruction. The first procedure performed (age 5-7) involves the harvest of rib cartilage graft and carving and splicing together a new ear framework. This is placed under the skin where the ear should be located. Subsequent surgeries (usually 2 additional) are involved to recreate the earlobe and elevate the ear away from the head.