Ear and nose deformities

Rady Children’s surgeons are specialized in a variety of surgical procedures for the ears and nose, such as:

  • Microtia
  • Otoplasty
  • Nasal reconstruction
  • Rhinoplasty

Microtia

Microtia means "small ear" and results from failure of its embryologic components to develop. It occurs with an incidence of one per 4,000 births and usually affects just one ear. Microtia more frequently affects boys and the right ear. The ear canal is usually absent and the middle ear is underdeveloped.

Reconstruction of an ear requires four operations:

  • Sculpturing rib cartilage into an ear framework
  • Moving the ear lobe into proper position
  • Elevating the new ear from the side of the head
  • Creating a tragus and deeper conchal bowl

In order for the rib cartilage to be large enough to sculpture an ear framework, surgery is performed when the child reaches 6 years of age. By performing one of the surgical stages every three months, the ear reconstruction is completed in one year.

If both ears are affected, CT scans are obtained and evaluated by an otologist specialized in reconstruction of the eardrum and middle ear.

Our pediatric craniofacial surgeons are very experienced and accomplished in the art of ear reconstruction and take special pleasure in treating each child with microtia.

Otoplasty

Otoplasty is a surgical procedure used to correct prominent ears. The most common cause of prominent ears is lack of an antihelical fold, normally present just inside the rim of the ear. A wide concha or bowl of the ear can also contribute to prominence of the ear.

Children become self-conscious about their appearance at age 5-7 years, therefore making this the most common time for otoplasty procedures.

Children can typically be treated any time after 4 years of age, when the ear is nearly adult sized. The technique of otoplasty uses an incision on the back of the ears that is hidden from view. Through this incision, the antihelical fold can be created and the height of the conchal bowl can be reduced. Nicely positioned ears are symmetrical and their rims are between 15 and 20 mm from the side of the head.

The surgery itself is simple and reliable in most cases, providing an expert carries out the operation. Usually, the child can go home on the day of surgery. Our pediatric craniofacial plastic surgeons have tremendous experience with a wide range of ear operations and are well-suited to handle this delicate procedure.

Nasal Reconstruction

Nasal Reconstruction is often necessary for children and young adults with complex craniofacial disorders. The nose may be small and underdeveloped, cleft or divided in halves, or missing on one side. Soft tissue defects from bites or injuries may also lead to disfigurement requiring nasal reconstruction.

Nasal reconstruction can be complex due to the need for inside mucosal lining, bony and cartilaginous skeletal support, and outside skin covering, all contoured to fit a child’s individual face. A variety of techniques, including cranial bone grafting, cartilage grafting and soft tissue reconstruction with techniques such as the forehead flap may be necessary.

Because a reconstructed nose may not grow in proportion to the child’s face, it is frequently necessary to touch up the reconstruction in the teen years.

Our pediatric craniofacial plastic surgeons are thoroughly familiar with soft tissue techniques and the latest types of cartilage and bone reconstruction. These surgeons address some of the most complex cleft and craniofacial disorders and, as a result, they are very experienced with the associated complex nasal reconstructions.

Rhinoplasty

Rhinoplasty is a procedure performed on the nose for either a congenital or acquired deformity or for cosmetic purposes. Reconstructive rhinoplasty is often required in children with cleft lip and palate who have abnormal nasal cartilage as a result of their cleft deformity. Children with craniofacial disorders also have a wide array of nasal problems, all of which are amenable to surgical reconstruction.

Because our surgeons are extremely familiar with techniques of nasal reconstruction in more serious disorders, they are quite at home with cosmetic rhinoplasty techniques. In their hands, elegant results can often be achieved with relatively straightforward and simple maneuvers.

Profile views of the nose, taken with a digital camera, can be manipulated on the computer to help determine the desired surgical changes.

It is critical that a skilled surgeon with a fine artistic eye see your child when considering aesthetic rhinoplasty. Typically, girls and boys around 13 or 14 years of age can be treated successfully with minimal complications and outstanding results. Rady Children’s surgeons are familiar with the entire array of surgical options and techniques and have developed a number of new types of internal nasal splinting for more complex disorders.