MEDPOR Microtia Ear Reconstruction

Understanding Microtia & MEDPOR Reconstruction

What is Microtia?

Microtia is a congenital condition present at birth where the external ear (auricle) is underdeveloped. It ranges in severity from mild structural abnormalities to complete absence of the ear (anotia). Microtia occurs in approximately 1 in 6,000 to 12,000 births and can affect one or both ears, though unilateral (one-sided) cases are more common.

In addition to the visible ear deformity, many children with microtia also have associated conditions such as aural atresia (underdeveloped or absent ear canal) or hemifacial microsomia (underdevelopment of one side of the face).

Grades of Microtia

Grade I: Mild deformity with all ear structures present but smaller than normal
Grade II: Moderate deformity with some normal structures but significant underdevelopment
Grade III: Severe deformity with only a small peanut-shaped remnant of ear tissue
Grade IV (Anotia): Complete absence of the external ear

What is MEDPOR?

MEDPOR is a porous high-density polyethylene material that has been used safely in reconstructive surgery for over 30 years. Its unique porous structure allows the patient's own tissue and blood vessels to grow into the implant, creating a stable, permanent framework that becomes integrated with the body.

MEDPOR vs. Rib Cartilage Reconstruction

There are two primary surgical approaches to microtia reconstruction:

MEDPOR Framework Method: Uses a pre-carved polyethylene implant covered with a temporoparietal fascia flap and skin graft, typically completed in 1-2 surgeries
Autologous Rib Cartilage Method: Uses the patient's own rib cartilage to construct an ear framework, typically requiring 3-4 surgeries over 1-2 years

The MEDPOR approach offers advantages including fewer surgeries, no rib harvest site, earlier reconstruction timing, and well-defined ear details. However, it requires meticulous surgical technique and careful patient selection to achieve optimal outcomes.

Ideal Timing for Surgery

MEDPOR microtia reconstruction can typically be performed when the child is 3-4 years old, earlier than rib cartilage reconstruction which usually requires waiting until age 6-10. Early reconstruction can provide psychological benefits by reducing teasing and improving self-esteem before school age.

However, each case is unique, and Dr. Kim will recommend the optimal timing based on the child's individual anatomy, overall health, and family circumstances.

The Surgical Procedure

MEDPOR microtia reconstruction is typically performed in 1-2 stages:

Stage 1 - Ear Framework Construction (4-6 hours):

A pre-carved MEDPOR framework is selected and customized to match the opposite ear
The temporoparietal fascia (TPF) flap is harvested from the scalp area
The MEDPOR framework is positioned and secured
The TPF flap is draped over the framework to provide blood supply
A skin graft (usually from the scalp) is applied over the flap
The ear is dressed with supportive bolsters and bandages

Stage 2 - Earlobe Transposition & Tragus Construction (optional, 2-3 hours):

Performed 3-6 months after the first stage if needed
The earlobe remnant is repositioned to match the new ear
Additional refinements and contouring may be performed

Ideal Candidates

Children age 3 and older with microtia
Good general health without bleeding disorders
Adequate tissue quality at the reconstruction site
Realistic family expectations
Commitment to post-operative care
Non-smokers (for older patients)

Recovery Timeline

First Week: Bandages remain in place, pain managed with medication

1-2 Weeks: Initial dressings removed, delicate care required

3-4 Weeks: Return to school with protective headband

2-3 Months: Gradual return to full activities, avoiding contact sports

6+ Months: Final contours established, full activity clearance

Expected Results

MEDPOR microtia reconstruction can create a natural-looking ear with well-defined anatomical features. Results include:

A three-dimensional ear with appropriate projection from the head
Detailed features including helical rim, antihelix, and concha
Symmetry with the opposite ear (in unilateral cases)
Stable, permanent reconstruction that grows with the child
Improved self-confidence and quality of life

While the reconstructed ear will not have sensation or hearing function (hearing is addressed separately if needed), it provides excellent cosmetic restoration.

Potential Risks & Complications

As with any major surgery, MEDPOR reconstruction carries potential risks:

Implant exposure or extrusion (rare with proper technique)
Infection requiring implant removal and replacement
Skin graft partial loss or poor take
Hair loss at scalp donor sites
Framework malposition requiring revision
Need for additional refinement surgeries

Dr. Kim's extensive experience in microtia reconstruction minimizes these risks through meticulous surgical technique and careful post-operative management.