Hemifacial Microsomia: Treatment

Ear Reconstruction:
For children with an absent ear (microtia), there are two options to rebuild the ear, one is to get an artificial ear, and the other is to rebuild the ear using the child's own rib (also called an autogenous reconstruction). I believe that it is important that the child participate in the decision as to which to ear would be best. The pro and cons of each method of reconstruction are discussed in an office visit. For those families choosing an autogenous reconstruction the outer ear is typically reconstructed around age eight, but on occasion may be done as early as six. The best time to rebuild the ear is determined by the child's size (more importantly, how big the child's ribs are) and how the child is coping socially. Ears are reconstructed over a series of three operations.


The first stage ear reconstruction, in a child with hemifacial microsomia is shown above. Cartilage is taken from the child's rib (parents cannot donate their rib cartilage) and this cartilage is carved and assembled to match the opposite ear. It is then inserted under the skin. Two additional stages are required to complete the reconstruction; both performed as outpatient procedures. Before undergoing ear reconstruction, it is wise to ask your doctor to see examples of his or her work. It is very difficult to rebuild an ear that did not turn out well the first time. For more detailed information on ear reconstruction, see the Microtia section.

It is also possible for children to undergo reconstruction (by a specialized ENT) of the absent eardrum in order to try to improve hearing on the affected side, and achieve some stereo hearing that improves the localization of sound. The decision as to whether or not to proceed with inner ear reconstruction should be made with a specialist in this area.