Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Outcomes of Craniofacial Microsomia Treatment: Microtia Reconstruction
Rachel S. Mandelbaum, BA1, Deborah B. Martins, BS1, Sarah Park, BS1, Emily Dubina, MD1, Akira Ishiyama, MD2, James P. Bradley, MD1, Justine C. Lee, MD, PhD1.
1UCLA Division of Plastic and Reconstructive Surgery, Los Angeles, CA, USA, 2UCLA Department of Head and Neck Surgery, Los Angeles, CA, USA.

PURPOSE:
Craniofacial microsomia is a congenital anomaly characterized by microtia, mandibular hypoplasia, facial nerve weakness, and soft tissue deficiencies. Due to a wide phenotypic spectrum, treatment plans are highly individualized and have historically been difficult to evaluate, leaving significant knowledge gaps about the optimal timing of treatment and surgical approach.
METHODS:
We conducted a retrospective review of patients with a diagnosis of craniofacial microsomia treated at the UCLA Craniofacial Clinic (n=151) between 2008-2014. Patients greater than 14 years of age at the time of study initiation were included (n=42). We reviewed surgical and audiology reports to analyze characteristics of the ear deformity, treatment algorithms and outcomes, and incidence of post-operative complications such as cartilage exposure and infection.
RESULTS:
92.9% of patients presented with ear malformations (81.6% with grade III lobular-type microtia). 44.7% of patients were affected on the right, 28.9% on the left, and 26.3% bilaterally. 92.3% of patients underwent autologous ear reconstruction using a modified Nagata/Firmin technique, with the initial surgery starting at a mean age of 8.3 years. Age, type of incision, and size of cartilage framework did not predict total number of surgeries or complication incidence via a linear regression analysis. Severity of ear anomalies correlated to an increased number of surgeries (p=.001) but did not correlate to higher rates of post-operative complications (p=.548). Hearing deficits were addressed in 16 patients. 7.7% patients opted to only use external hearing aids and 33.3% had a bone-anchored hearing aid (BAHA) or formal atresia reconstruction with a canaloplasty. 50% of patients who received a BAHA procedure and 40% of the patients who had canaloplasty required additional revisional surgeries.
CONCLUSION:
Treatment of microtia and atresia in patients with craniofacial microsomia requires multiple stages of reconstruction for both the external ear and to address hearing loss. For total autologous microtia reconstruction, age, the type of incision, cartilage framework, and usage of fascial flaps did not predict requirement or lack thereof for surgical revisions or complications. In our cohort, hearing loss was frequently not treated due to patient and family preferences despite clinical recommendations. In patients who received canaloplasty or BAHA placement, surgical revisions were common. Further study and standardization are necessary to assess the aesthetic outcomes of these operations.


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