Craniofacial Center | Dallas, Texas

Treacher Collins Sydrome: Treatment

The Ears
For children born with absent ears (microtia), there are two options to rebuild ears, one is to get artificial ears, and the other is to rebuild the ears 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 technique 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, this series of operations typically begins sometime after the child has turned eight-years old. The best time to rebuild the ears is determined by the child's size and how the child is coping socially. Children with TCS are typically smaller than their classmates, and it is necessary for children to be a certain size before ears can be made. Ears are reconstructed over a series of three operations. Some doctors believe that both ears should not be built at the same time. However, in Dallas we have had good success with building both ears at the same time, and believe that this is the best way because it reduces the total number of operations a child must undergo.

The first stage ear reconstruction 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 create the ear. It is then inserted under the skin. Two additional stages are required to complete the reconstruction; both performed as outpatient procedures. Children with TCS are more likely to require hair removal, as can be seen below, in a child who has just finished the second stage procedure. The third stage will involve making a hole that looks like an ear canal.

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. It is also possible for children to undergo reconstruction of the absent eardrum (by a specialized ENT), in order to try to improve hearing. The decision as to whether or not to proceed with inner ear reconstruction should be made with a specialist in this area. Our office would be happy to make some recommendations as to who to see. Typically, this procedure is not possible for most patients with TCS, because the inner ear may not be formed well enough to give a good result. It is best to wait until the child is about 9-years old before undergoing the specialized CT scan that will determine whether, or not, it is possible to create an eardrum.