Surgical Approach to Microtia and Ear Reconstruction Determines Post-Operative Cutaneous Sensation Preservation

SDCC 

Introduction: This study compares sensory outcomes in pediatric patients undergoing microtia reconstruction using alloplastic (Medpor, porous polyethylene) fascia-skin graft reconstruction and single and two-stage cutaneous flap-based reconstruction

Methods: In this IRB-approved, single-site, retrospective study, pediatric patients diagnosed with microtia (ICD-10 code Q17.2) or ear differences were included. Sensory recovery was assessed using the Semmes-Weinstein Monofilament Test (range: 0.07g to 4g monofilaments) before initial reconstruction and after single and two-stage reconstruction. Mann-Whitney U tests compared sensitivity between autologous cutaneous flap-based approaches versus alloplastic Medpor fascia-skin graft-based techniques. A Friedman test was carried out to compare sensitivity scores for the following regions: tragus, conchal bowl, lobule, and helix/antihelix followed by subsequent Dunn-Bonferroni post hoc tests.

Results: Seven Medpor patients (nine ears total) who underwent fascia-skin graft-based soft tissue coverage and 18 autologous cartilage patients who underwent single and two-stage cutaneous flap (Nagata technique; 18 ears total) were included. The total cohort included 20 grade III and 6 grade II microtic ears; one cauliflower ear that underwent Medpor-based reconstruction was included. The mean time from index procedure to sensory exam was 46 months in the Medpor group and 25 months in the cutaneous flap group. Overall, cutaneous flap-based reconstruction resulted in improved sensory outcomes when compared to Medpor reconstruction. There were significant differences in reported sensation between autologous and Medpor groups, including the tragus (0.07g vs. 4g; p<0.001), the conchal bowl (0.2g vs. 4g; p<0.001), and the helix/antihelix (0.2g vs. 4g; p<0.001), respectively. There were no significant differences in the lobule between either technical approach. Between the two groups, the most sensitive area was the lobule, while the least sensitive areas of the Medpor group were the tragus, bowl, and helix distributed equally (p=0.023). Meanwhile, only the helix/antihelix (p=0.009) showed reduced sensation in the autologous cutaneous flap-based approach but still demonstrated improved sensation in Medpor fascia-skin graft patients.

Conclusions: Cutaneous flap-based reconstruction results in improved sensation over Medpor fascia-skin graft-based reconstruction. These results add to the list of advantages and disadvantages of each approach and should be considered when treating patients with ear differences.

Craniomaxillofacial/Head and Neck

PSTM 2024