Auricular Reconstruction for Anotia (Absent Ear Surgery)

 643. <Auricular Reconstruction for Anotia (Absent Ear Surgery)>

Anotia, the complete congenital absence of the external ear, requires complex reconstructive surgery that addresses both function and aesthetics.

In early infancy (around 6 months), most patients with microtia-related hearing loss begin auditory rehabilitation with a soft-band BAHA (Bone-Anchored Hearing Aid). This device transmits sound vibrations through the skull directly to the cochlea, bypassing the malformed ear canal. At around age 6, a titanium BAHA implant is surgically fixed once the skull bone reaches a minimum thickness of 3mm.

By age 10, when rib cartilage has matured, autologous rib cartilage grafting is typically performed to sculpt a natural-looking ear. Using 6th–8th costal cartilage segments, a 3D framework is hand-carved and inserted into a skin pocket at the appropriate anatomical site. Six months later, the ear is elevated and supported with additional cartilage. Fine skin flaps from the temporal region are used to define the postauricular fold.

Alternatively, Medpor (a porous polyethylene implant) allows for a shorter surgical process but carries an ongoing risk of infection. Tissue expansion is usually needed beforehand, and a vascularized fascia flap (e.g., temporalis) is used to enhance implant integration.

Auricular reconstruction is more than cosmetic—it's a journey to restore identity, symmetry, and sound. Each case requires a careful balance between surgical technique, timing, and patient-specific goals.

[Absent ear surgery is not just about creating an ear—it's about restoring the ability to hear and belong.]

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