Irrespective of the nature of the condition and of the defect, the basic premise of this surgery is that we reconstruct the contours of a normal ear.
As the ear is complex in shape, a firm supporting framework has to be used in order for these contours to be properly reproduced.
Although various materials have been used in attempting to develop such a framework, it is rib cartilage, taken from the patient’s chest, which is currently the best-suited among them. A number of synthetic materials have also been marketed in order to avoid having to remove this cartilage but they are, by their very nature, foreign bodies and, once placed below thin, vulnerable skin, they will be prone to delayed complications, which will, in turn, be very difficult to resolve.
The harvesting of this rib cartilage leaves a scar of some 6-8 centimetres (2-3 inches) in length but it does not deform the patient’s chest, nor does it hamper the playing of sports.

When most or all of the ear has to be reconstructed, such a reconstruction is usually performed in two stages:
• First operation:
a framework consisting of rib cartilage for reconstituting the ear’s missing contours is fitted beneath the skin
• Second operation:
the space behind the ear is recreated. This space behind the ear is called the post-auricular sulcus

The interval to be observed between these two operations ranges from four to six months, depending on the particular patient’s situation.

During the first operation, the rib cartilage is harvested and the sculpted framework is implanted beneath the skin.
Once this first stage of surgery has been performed, all the contours of the ear will have been reproduced, but there will be no space behind the ear.
When viewed in profile, this ear appears to be normal but it does not stand out like the other one.
Creating the post-auricular sulcus during the second stage of surgery allows us make sure that the prominence of both ears matches when they are viewed face-on.

Before the first stage After the first stage After the second stage

» Age
When reconstruction is performed to correct the congenital deformity known as microtia - an operation that requires reconstruction of many of the ear’s contours - the reconstruction is usually performed after 9 or 10 years old, depending on the child’s height.
Why ? For two reasons:
1/ since our aim is to match the normal ear, we have to wait until this normal ear has grown to its full size, which is attained at 9 or 10 years of age
2/ because, in order to be able to harvest the necessary amount of rib cartilage, a certain degree of chest development is required beforehand
For these reasons, we have to reconstruct the ear after the patient has already started school, which can be difficult to bear, but it is necessary in order to guarantee a satisfactory final result.

» Two stages of surgery
It is not usually possible to cover both sides of the framework with the skin of the defective ear. A skin-graft is used during the second stage of surgery in order to reconstruct the post-auricular sulcus.
Why does one have to wait six months before performing the second stage of surgery?
Because it is the time it takes for the skin to adapt properly to the contours of the framework. This time-frame is a minimum, which can be extended if necessary.

» Auditory Function
In cases of microtia, the ear canal may be completely missing and, even though the nerve that enables hearing may be normal, sound conduction will be diminished, thus impairing hearing function.
If both ears are affected by microtia and both ear canals are missing, hearing must be assisted by means of a hearing aid.
When only one ear is affected in this way, hearing function may be close to normal but it is not stereophonic.
Surgical reconstruction of the ear canal and eardrum often gives disappointing results. It may be advisable in cases of poor auditory function to fit a Bone-Anchored Hearing Aid (or BAHA for short). New technologies that obviate the fitting of an external device can nowadays also be considered.