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American Association of Plastic Surgeons

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Lessons Learned From 552 Bilateral Microtia Patients
Claire van Hövell tot Westerflier, MD1, John F. Reinisch, MD2.
1University of Utrecht, Utrecht, Netherlands, 2University of Southern California, Los Angeles, CA, USA.

Purpose
Patients with bilateral microtia have a craniofacial condition, which affects appearance, hearing, speech, and may be associated with a syndrome, malocclusion, and sleep apnea. Review of the world’s largest series of bilateral microtia patients reveals important teaching lessons for plastic surgeons.
Methods
Demographics, surgical history and outcomes of consecutive patients with bilateral microtia were recorded.
Results
Of 2908 microtia patients seen, 552 (19%) were bilateral. There were 363 males and 189 females ranging in age from newborns to 56 years of age at the initial consultation. Syndromes were identified in 83 (15%) of bilateral patients. A total of 292 ears were reconstructed in 176 (32%) patients using an alloplastic implant. Average age at reconstruction was 5 years (3-42). In 116 patients both ears were reconstructed with an average of 6 months (3-36) between the two sides. Ear reconstruction was combined with hearing restoration in 101 of 176 patients.
Conclusions
1. Hearing restoration after age 4 years results in irreversible language deficiency.
2. Ipsilateral palatal dysfunction is seen in 96% of all microtia patients and results in noticeable VPI in 80% of bilateral patients.
3. Children prefer hearing with a canalplasty to a more sensitive bone conduction hearing aid.
4. Simultaneous atresia and microtia reconstruction in two outpatient procedures provides superior results and reduces the cost and burden of care for children with bilateral microtia.


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