Pinna surgery and creating the ear canal

Auricular reconstructive surgery and creating the ear canal

The reconstruction pinna surgery from rib cartilage is carried out in two to three stages and is based on the techniques described by Brent, Nagata, and others.

The aesthetical and the functional aspects of the surgeries for reconstructing the pinna and creating the ear canal are often interwoven, and most of the time they are performed simultaneously.

First stage

The surgery is performed starting from the age of 9-10 years old, so that the required amount of cartilage can be harvested from the ribs to create a pinna that will have an aesthetic shape and will be stable for many years. The rib cartilage is harvested from the chest, while conserving the interior part of the rib cartilage envelop (Perichondrium) and performing a surgery for reconstructing the rib cage shape in order to avoid an aesthetic defect in the chest area.

Thereafter, the twisted cartilage of the pinna is excised from the location of the future ear, and a pocket is prepared for the new pinna transplant that was sculptured from the above rib cartilage. In cases where the external ear canal and the middle ear cannot be reconstructed, a new eardrum is prepared and a new external ear canal is created from the rib cartilage.

The new eardrum, the new external ear canal and an additional rib cartilage are grafted under the skin of the chest in preparation for the second phase of the restoration. At the end of the first phase a pinna with a normal appearance is obtained, but still it is attached to the head with no fold behind the ear.

Second stage

This phase is performed at least 6 months after the first phase. In this phase a socket between the pinna and the head is created. Whenever the CT imaging indicates that it is possible, a new ear canal is created and the eardrum is inserted into place. A skin graft is taken from the location of the previous scar in the chest, and in this way a new scar is not created. In addition, the piece of cartilage that was preserved under the skin of the chest in the first operation is taken out. From the skin graft and the preserved piece of cartilage the retroauricular sulcus socket is created behind the new pinna. In most cases where the middle ear cannot be restored this phase is the last step.

In cases of combined reconstruction, the middle ear, the ear canal and the eardrum that were prepared during the first phase are also taken out.

A new ear canal is created in the skull, the stapes is located, a prostheses which connects the stapes to the new eardrum is inserted, and the new auditory canal is inserted into place.

Third stage

This phase is performed about 6 months after the second phase. The external ear canal is opened by taking an additional skin graft from the chest scar area in order to prepare the skin cover for the external ear canal. 

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