Making a new ear out of a person’s rib (bone, cartilage and skin) is called autologous ear reconstruction. This service has recently been set up in the Birmingham Children’s Hospital (BCH) in order to treat a condition called Microtia. Children suffering from this condition are born with either one or both ears missing, and sometimes this can be associated with other conditions.
I have experience in the cosmetic surgery of the ears, and because of this I have been asked to help Mr Mark Lloyd, a newly appointed consultant plastic surgeon at BCH, who has expertise in this area.
It has been a great privilege for me to help him harvest the rib grafts and to assist him as he sculpts a new ear out of this cartilage. It is truly an art form and much judgement is needed because the new cartilage skeleton of the ear has to be made as perfectly as possible. Templates made as a mirror image from the ear that is present are used to help design the framework.
The framework then has to be placed within a pocket of skin, and again, careful dissection has to be carried out to make sure this flap of skin is thin enough to conform to the framework, and also robust enough to be viable as permanent skin cover.
At the second stage, about 6 months later, more cartilage is harvested from the ribs to elevate, or protrude, the ear making it look more natural. These complex operations can only be carried out after the child is at least 10 years of age, when the ribs have grown big enough for use. And only on patients who do not want, or cannot tolerate, artificial or prosthetic ears.
These prosthetic ears are a true art form, and are made in Birmingham bespoke for each patient.
These two alternatives are discussed in special microclinics at Birmingham Children’s Hospital, which means consultants from multiple disciplines get together to discuss the specifics of each case.
This experience has helped me appreciate cosmetic problems patients have better, such as over-protruding ears (over protrusion) low deformities, asymmetry – which are the common reasons why people ask for cosmetic advice about ears.
**Image credit Stanford Medicine, Stanford Ear Institute