Retroposition of the Vestigial Cartilage in Patients With Microtia: A Novel Technique to Enhance Projection of the Reconstructed Ear

Background: The projection of the reconstructed auricle is an important step in ear reconstruction. The novel use of the vestigial cartilage can successfully replace the projection piece harvested from the costal cartilage, improve the three-dimensional contour of the reconstructed auricle, and help deepening of the concha, compensate for mastoid atrophy in patients with hemifacial microsomia. Methods: A total of 34 patients with microtia were included and classified according to the Nagata classification. Anotia and atypical cases with deficient cartilage are excluded. Two-stage auricle reconstruction was performed. The first stage included retroposition of the vestigial cartilage, framework implantation and lobule transposition. After 3 to 6 months, the second stage was performed and included elevation of the reconstructed auricle and coverage by split-thickness skin graft. Results: The results were satisfactory regarding the shape, symmetry, maintenance of the auriculocephalic angle, and stability of the reconstructed ear. The vestigial cartilage was classified into 3 different types according to its shape. Type 1(V1) cartilage is a sausage-shaped cartilage that can be directly used as a projection piece. Type 2(V2) cartilage is a flat-shaped cartilage that should be folded upon itself. Type 3(V3) cartilage is an atypical type where the cartilage does not have a specific shape. This type can be used as it is or reconfigured with sutures according to the amount of projection needed. Moreover, 87% of patients were satisfied with the appearance of their new ears, 90% of patients can wear their glasses or sunglasses, and 94% of patients can easily clean their new ear. Conclusions: According to the shape and amount of the available vestigial cartilage, it can be used as a projection piece either alone or with an augmentation piece from the costal cartilage.

Automated summary

This study demonstrates the successful use of vestigial cartilage in ear reconstruction, improving the three-dimensional contour and addressing mastoid atrophy. The shape and amount of the vestigial cartilage can determine the method of reconstruction, with satisfactory outcomes and ease of use and maintenance.