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Microtia Surgery with a Rib Graft cartilage framework in a single stage

Russell H. Griffiths, MD, performs ear reconstruction using a variety of methods, including rib cartilage surgery, at his practice in Boise, ID. This treatment method is recommended for patients with a variety of microtia types and other ear damage.  Dr. Griffiths can discuss the effectiveness of the treatment for your child's specific ear condition.

Microtia Reconstruction with Rib Cartilage as a Framework

Dr. Griffiths prefers to use a patient’s own cartilage for fabrication of an ear framework. He harvests a portion of the chest cartilage from the sixth, seventh and eighth ribs. The cartilage pieces are then artistically and meticulously sewn together then carved into a framework. Measurements are made so that the reconstructed ear framework has the same height, length, curvature, and projection of the contralateral (normal) ear.

Normal ear on left side with framework model for new ear on right sideThis photograph shows an ear and a rib graft framework from a patient with left sided grade III microtia. On the left is a photo of his normal ear. On the right is a mirror image of a photo of the framework that Dr. Griffiths made for him. The mirror image of the framework allows you to more easily study the architectural symmetry between the two. Notice how closely the details of his rib graft framework match his normal ear.

Chest scar after harvest of rib graft cartilage for microtia reconstructionCritics of using chest cartilage as an ear framework often cite the scar and chest discomfort following surgery as disadvantages of this technique. Dr. Griffiths uses an incision that is usually less than 6 cm to harvest the cartilage. He closes the incision with the finest plastic surgical technique to make the scar difficult to see in most patients.

How many stages does it take to cover the ear framework with vascularized tissue?

The ear framework needs to be covered with vascularized tissue. This can be accomplished with a three-stage procedure championed by Dr. Brent, a two-stage procedure championed by Dr. Nagata, or a novel one-stage procedure developed by Dr. Griffiths.

In a three-stage operation (no canalplasty), the ear framework is carved and inserted underneath a pocket of skin at the desired site under the microtia remnant. It needs to heal in this position for approximately six months so that it can obtain its own blood supply. The second stage involves rotation of the ear lobule and creation of a tragus and conchal bowl. The third stage involves lifting the ear away from the scalp and placing a skin graft to cover the back of the ear. It is during this third phase that an extra cartilage graft is often added behind the ear framework to enhance its projection.  If the patient is a candidate for a canalplasty then a fourth stage can be completed after the external ear has been made.  

In a two-stage procedure (no canalplasty), the ear framework is inserted and the ear lobe lobule rotated during the first operation. During the second operation, the framework is elevated and skin grafts are used to cover the back of the ear.  If the patient is a candidate for a canalplasty then a third stage can be completed after the external ear has been made.

Disadvantages of Multi-Stage techniques

The three-stage and two-stage techniques (no canalplasty) are wonderful options for reconstruction of microtia. Dr. Griffiths used these techniques over the first half of his career, carefully honing his technique in order to perform the most perfect reconstruction possible. He honors and respects the wonderful contributions made by Dr. Brent and Dr. Nagata. These two techniques however, have three main disadvantages: lack of ear projection, higher overall cost, and time. The multistage rib graft technique often cannot produce adequate long term ear projection, even if a wedge of cartilage is added below the framework during one of the later stages (Multistage rib graft surgeons rarely show long term follow up postoperative frontal view photos because of the lack of projection of the reconstructed ear is readily apparent when compared to the normal side).  As medical costs have risen in the past decade (particularly hospital fees), multiple operations create extra financial burden on the patient and families.  If the patient lives out of state not only are travel costs higher but multiple surgeries require greater time away from home which can impact school and parent work schedules.

One-Stage Microtia Reconstruction

Dr. Griffiths has developed a ONE-STAGE microtia reconstruction (with canalplasty) where he carves and places the framework, rotates the ear lobule, creates the tragus and the external portions of the external auditory canal, and on select patients our otologist can reconstruct the ear canal all at the same time.  His one-stage microtia technique produces wonderful results,  significantly lowers overall medical costs and is preferred by patients and families, particularly those who have to travel great distances for their operation.

Before and After: One-stage microtia ear reconstruction surgery with rib graft

Rib Graft One Stage Microtia reconstruction 

Before and After: One-stage microtia ear reconstruction surgery with rib graft and canalplasty

Rib Graft One Stage Microtia Reconstruction (with Canalplasty)

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How is Dr. Griffiths able to create an ear in one stage?

The one-stage procedure performed by Dr. Griffiths involves the use of a thin vascularized membrane underneath the scalp on the lateral forehead and temporal regions to cover the carved cartilage framework. This thin membrane is called the temporoparietal fascia (TP fascia flap).

Layered anatomical representation of the layers of skin beneath the ear

This diagram shows the superficial temporal artery and vein and the thin membrane that is fed by these arteries (Tempoparietal fascia).

Anatomical illustration of two important arteries in the human skull

Once this vascularized membrane is harvested it can be wrapped around the ear framework to provide a complete vascular covering. Dr. Griffiths utilizes a limited incision access to harvest this flap so that the scars are carefully concealed around the ear. The fascia flap is then covered with a skin graft. Skin grafts are carefully chosen to provide the best texture and color match to the skin of the contralateral ear.

Before and After: One-stage microtia ear reconstruction surgery with rib graft

Rib Graft one Stage Microtia Reconstruction

A key advantage Dr. Griffiths one stage technique is that the reconstructed ear has feeling (from the sensory nerves that come from the fascia under the skin grafts). This sensory input helps the patient avoid injuring their ear in the future.

Talk to Dr. Griffiths About Rib Cartilage Ear Surgery

There are many considerations to be made in the course of treating microtia and other ear damage. Contact Dr. Griffiths to schedule an appointment and see if this option is right for you and your child

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My son is experiencing a happiness and a confidence that I have never seen before. You have taken away a big, big hurt...Thank you for making my son happy. Michael, Father of a Former Patient

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Boise Office

100 East Idaho St
Ste 303
Boise, ID 83712

More Info Directions (208) 433-1736

Boise Office

100 East Idaho St
Ste 303
Boise, ID 83712

More Info Directions (208) 433-1736