If a baby with microtia undergoes auricular reconstruction surgery, can the parents’ rib cartilage be used?

Author: Yang Qinghua, Chief Physician, Plastic Surgery Hospital, Chinese Academy of Medical Sciences

Reviewer: Fan Jufeng, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

There are many types of congenital auricular malformations.

Some ear deformities are relatively mild, with the size of the ear being basically normal, but with some abnormalities in shape, such as folded external ear helix, protruding ears, cup-shaped ears, hidden ears, etc.

There is also a more serious type, such as microtia, where the entire outline of the child's ear is basically gone. This type of child can usually be repaired through auricular reconstruction.

1. What is the best age for children with congenital auricular malformations to undergo auricular reconstruction surgery?

There are minimum age and height requirements for auricular reconstruction for children with congenital auricular deformity. Generally, children must be 6 years old, 1.2 meters tall, and have a chest circumference of more than 55 cm. If the child has an uneven face, this indicator should be relaxed to a height of more than 1.3 meters.

Figure 1 Original copyright image, no permission to reprint

The reasons for these requirements are mainly from two aspects: one is psychological factors, and the other is physical factors.

In terms of psychological factors, after the child is born, the parents will have a heavy psychological burden and always hope for treatment as early as possible.

The second reason is that the growth of the auricle has a growth stage. Generally speaking, at the age of 6, the child's auricle can grow to about 90% of the adult's, so this time is usually chosen for auricle reconstruction.

In addition, when the child is 6 years old and has a height of 1.2 meters and a chest circumference of 55 cm, the amount of auricle frame carved out of the child's own rib cartilage is sufficient to meet our needs for auricle reconstruction.

Another situation is that children in our country generally start primary school at the age of 6 and a half, so if this disease is solved for children around the age of 6, they can have a healthy mentality to face society and classmates. Otherwise, the child's inferiority complex may accompany him throughout his life.

2. Is it possible to perform auricle reconstruction without taking the child’s rib cartilage?

Yes. Because as we age, the rib cartilage will calcify and turn into bone. We all know that cartilage, like the pork cartilage we eat, is elastic and can be bent, but bones are straight and cannot be bent. If the rib cartilage is calcified, it will be as hard as bone. Such rib cartilage cannot be used, so some materials can be used to replace it.

For example, the most widely used materials now are supor and medpore. This material is shaped like an ear, and after the skin expander is removed, the stent can be implanted.

Compared with taking one's own rib cartilage, the advantage of artificial materials is that there is no damage to the rib cartilage and the child may not feel much pain.

However, the disadvantages of artificial materials are also obvious. Because the human body has an immune system, artificial materials are foreign matter after all. The body's immune system will constantly reject it, and this rejection reaction will become more and more serious over time. Once the stent has a serious rejection reaction, the auricle material will be exposed, and once exposed, it will be difficult to repair.

Therefore, it is generally recommended to use your own rib cartilage as the material for reconstructing the auricle frame, which can achieve a permanent effect.

3. Can children use their parents’ rib cartilage for ear reconstruction surgery?

Many parents have concerns in this regard, because after all, removing cartilage will cause certain harm to the child. The child will be in pain, and the parents will feel very distressed. They always want to use their own rib cartilage to replace the child's rib cartilage.

But this is not allowed, why?

Figure 2 Original copyright image, no permission to reprint

In fact, this is just like other tissue and organ transplants, such as liver and kidney transplants. Why do we need to find donors? We need to find ligands? And we search over a large area to minimize rejection reactions.

Cartilage is also an organ, and the principle is the same. If your cartilage is placed on my body, or your mother's cartilage is placed on her child, it is considered a foreign body and is not much different from artificial materials. It will usually cause an immune response.

After the rejection reaction occurs, the macrophages in the child's body will eat up the cartilage bit by bit, and the outline of the reconstructed ear will be gone, and the parents' rib cartilage will be wasted.

4. How many rib cartilages are needed for auricular reconstruction? Will it cause chest deformity in children?

If the child is 17 or 18 years old and very tall, or if the child has grown into an adult, it is usually enough to take one costal cartilage, which is the 7th costal cartilage.

If the child is not too old, such as an 8-10 year old child, it may be enough to take the 7th and 8th rib cartilages.

But if the child is 6 years old, the 6th, 7th and 8th rib cartilages may need to be taken to make an auricle frame. The rib cartilage is carved into the shape of an ear and then implanted. In this way, an auricle reconstruction is completed.

At this point, many parents may worry about whether removing so much rib cartilage from such a young child will have any impact on the chest cavity.

In fact, there will be an impact at the beginning, because if the thorax is connected with cartilage, it is a complete arch. After the costal cartilage is removed, the arch is destroyed and the strength of the arch will be unbalanced, so there will be a temporary chest deformity. The thorax on the side where the costal cartilage is removed will be higher than the thorax on the healthy side.

However, as the child grows and develops, and the costal cartilage regenerates, by the time the child is 17 or 18 years old, the deformity will become less and less severe, because the arch will be completely restored and the chest deformity will no longer be obvious.

Therefore, parents do not need to worry that removing their children's own rib cartilage will have a great impact on their bodies. After recovery, children can withstand any heavy physical labor or high-intensity physical training.