HJAR Nov/Dec 2025

HEALTHCARE JOURNAL OF ARKANSAS I  NOV / DEC 2025 39 Sagar Mehta, MD Pediatric Plastic Surgeon and Chief of Plastic & Reconstructive Surgery Arkansas Children’s approach requires multiple surgical stages and longer operative times and recovery periods. Generally, standards of care recommend waiting until the patient is 8 to 10 years old for rib carti‑ lage reconstruction, allowing sufficient harvest of costal cartilage. 2. Synthetic implants: The synthetic ear implant option, on the other hand, can often be performed on patients as young as age 5 and sometimes re‑ duces the number of surgeries need‑ ed. The increased risk of infection and long‑termmaintenance complications weigh against the advantages of ear im‑ plants. Active children may be at great‑ er risk of damaging or exposing the ear implant, requiring additional surgeries. Most research on efficacy and patient satisfaction with synthetic ear implants focuses on the first year following the procedure. Few published studies of‑ fer consistent multiyear follow-up on how synthetic ear implants perform re‑ garding health, aesthetics, and patient quality of life beyond the initial year. When presenting treatment options, par‑ ents or caregivers should be informed about the benefits, drawbacks, and gaps in knowl‑ edge for both methods. Innovative Use of Tissue Expanders in Anotia Cases Using a tissue expander in preparation for reconstruction has proven beneficial for many patients and their families. Asurgeon places the expander under the skin at the site of the future ear, gradually inflating it over weeks or months. This process creates additional skin with a texture and tone that more closely match the surrounding area, reducing or eliminating the need for grafts from other parts of the body. The aesthetic benefits translate to improved psychoso‑ cial outcomes. The expander also allows patients and families to learn how to care for the eventual ear implant post-surgically. This staged approach supports better healing in severe cases and helps the care teammonitor skin integrity and vascularity before moving into full reconstruction with rib cartilage or an ear implant. Hearing Evaluation and Support Because microtia and anotia often involve malformations or absence of the external ear canal and middle ear structures, many patients experience conductive hearing loss. Children with unilateral hearing loss often manage well with hearing in their typical ear but may still benefit from amplification. Bone conduction devices, followed by sur‑ gical options like bone-anchored hearing aid implantation or atresioplasty when ana‑ tomically feasible, are the primary strategies for restoring hearing in pediatric patients. While the prognosis for patients with mi‑ crotia and anotia is generally good, treat‑ ment can be complicated and span several years. Multidisciplinary expertise and col‑ laboration among plastic surgeons, oto‑ laryngologists, audiologists, and pediatric psychologists provides the level of com‑ prehensive care necessary to result in pos‑ itive outcomes and support patients and their families from the initial consultation through surgical follow‑ups to hearing re‑ habilitation. n A Diagnosis of Microtia/Anotia Congenital issues, like craniofacial mi‑ crosomia, can result in microtia or anotia and present other confounding conditions. A four‑grade classification is used to describe the severity of microtia and anotia: • Grade I: mildly small or slightly de‑ formed external ear, with most func‑ tional structures present. • Grade II: partially developed ear with missing or underdeveloped structures. • Grade III: majority of the external ear missing, often a small remnant or nub remains. • Grade IV: complete absence of external ear (anotia). For grade I, surgically implanted ears are often unnecessary, and for grades II, III, and IV, surgically implanted ears, middle ear sur‑ geries such as tympanoplasty or ossicular chain reconstruction, and hearing devices (bone anchored hearing aid or cochlear implant) address aesthetic and functional needs. Two Proven Surgical Pathways At Arkansas Children’s, most microtia cas‑ es treated are grades II through IV, requir‑ ing more extensive reconstructive work and closer monitoring. We rely on two proven surgical pathways to reconstruct the ear and improve appearance and function: 1. Autologous Reconstruction Using Costal Cartilage: Rib cartilage recon‑ struction is the gold standard for more severe grades of microtia or anotia. By harvesting cartilage from the patient’s rib cage, surgeons can sculpt a custom ear with a reduced risk of rejection, and more durable and natural results. This