In this episode of BackTable ENT, Dr. Gopi Shah discusses microtia repair techniques with Dr. Mai Thy Truong, fellowship director of pediatric otolaryngology at Stanford University.

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SHOW NOTES

First, the doctors discuss the preoperative workup for children with microtia. Dr. Truong explains that it is very difficult to catch microtia or anotia in a prenatal ultrasound, so the diagnosis is usually a surprise at delivery. She takes time in explaining the diagnosis to the family with her co-surgeon and assesses the family’s emotions. Her follow up plan is to get the child fitted for hearing devices if needed and sets up conversations about preferential seating and FM systems in school. She will follow up with patients once every year; during these visits, she orders an audiogram and measures the length of the normal ear and chest frame. The length measurements of the normal ear help her get a sense of when the normal ear stops growing and the measurement of the chest frame helps her decide whether the rib cartilage is robust enough for surgery. She notes that ears will stop growing in length around 7-10 years of age and ear stops growing and that a chest frame size of 60 cm indicates that there is enough cartilage to make the entire ear. Once the family has decided on surgery, she orders a CT scan to learn about the temporal bone anatomy and other problems in the underdeveloped ear. Then, she works with computer programmers to create a 3D model of a mirror image of the normal ear to guide her carving during surgery.

Dr. Truong is trained to use the Firmin technique of microtia repair. This is a 2 stage procedure that involves harvesting rib cartilage and using it to carve out ear subunits. Her co-surgeon always harvests the graft from the ipsilateral rib cartilage while she creates the skin pocket where the new ear will be placed. Additionally, she explains how to avoid causing a pneumothorax and instruments needed for the rib cartilage harvest. She also emphasizes the importance of creating a harmonious skin pocket and warns listeners against manipulating the anterior blood supply of the ear by mistake. Then, she discusses how she carves the rib graft into 5 different subunits of the ear with an 11 blade and a 15 blade. She uses steel sutures to suture each part together using a particular order. Finally, she is able to put the ear framework into the skin pocket, close the incision site, and apply dressing.

Lastly, she explains her postoperative care of microtia repair patients. Her patients remain in the hospital for 3 days and receive antibiotics (Augmentin) for a week. She also obtains a chest x-ray after the procedure.