Microtia Surgery at Lucile Packard Children’s Hospital Stanford: Rib Cartilage Graft Reconstruction

At Lucile Packard Children’s Hospital Stanford, we use a team approach to treat children with microtia and ear canal atresia. At your consultation here, you will meet Dr. Kay Chang, Dr. Mai Thy Truong and a member of our audiology group to thoroughly review all the issues and concerns you have. You will also be introduced to our Stanford Craniofacial Team.

Dr. Kay Chang and Dr. Mai Thy Truong work together to perform the 2-Stage Firmin Technique with rib cartilage graft. Using 3D printed models created from a mirror image of the patient’s normal ear, Dr. Chang and Dr. Truong utilize the child’s own ear to model the new reconstructed ear during surgery.

A detailed chapter that we wrote as a reference for other surgeons utilizing the Firmin Technique can be seen here.

Stage 1:

During the first stage of microtia surgery, rib cartilage is harvested from the 6, 7th and 8th ribs, and part of the floating rib (see Image 1).

Image 1: Rib cartilage harvest.

The rib cartilage is then used to create the framework for the new ear. Each part of the framework is uniquely created to match the patient’s opposite ear, and assembled (see Image 2).

Image 2: Creation of the cartilage framework for the new ear.

3D printed models created from the mirror image of the opposite ear are used during microtia surgery to aid in the creation of the framework (see Image 3).

Image 3: Cartilage framework (left). 3D printed model created from mirror image of opposite ear (right)

Once the framework is complete, it is set into a skin pocket utilizing the patient’s own ear remnants to create the fleshy part of the ear, or the lobule (see Image 4). This is allowed to heal for 3-4 months before Stage 2 repair.

Image 4: The cartilage model is placed in a skin pocket and the ear remnants are used to form the lobule, or the inferior fleshy part of the ear.

Stage 2:

During the second stage of microtia surgery, the reconstructed ear is then elevated to allow the ear to project, or “stick out”, to match the other side. This requires obtaining skin and cartilage grafts and placing it behind the ear as it is lifted away from the head (see Image 5).

Image 5: During Stage 2, a skin and cartilage graft is placed behind the reconstructed ear to allow it to appear projected, or “stick out”, to match the opposite ear.