The art of rebuilding an ear

• Rare disease What is microtia?

It's been eight years since Loreto (24 years old) decided he wanted surgery. When he was born, his left ear was not like the right . It had not fully developed due to a strange congenital malformation. Now, four months after undergoing reconstruction surgery, the young woman can finally look in the mirror and see the symmetry on her face. His father describes it as "a work of art" and, indeed, it is. So much that any surgeon could not do it. There are very few who are trained in this master's degree because there are hardly any patients and for this reason, specialists advocate a health policy that involves the centralization of cases.

"This would benefit the patient and the costs, allow the resources to be better used and the team in charge to improve," argues Ana Isabel Romance, head of the Oral and Maxillofacial Surgery section of the 12 de Octubre University Hospital in Madrid. Currently, there are four hospitals for the treatment of this disease: October 12 and the Infant Jesus, in Madrid, and the San Juan de Dios and the Vall d'Hebron, in Barcelona. "Yes or yes, patients should be referred to these centers, but there is no obligation, it depends on the professional's will or that the parents ask for it." The United Kingdom would be an example, says the expert, "because not everyone can treat it there."

Precisely on October 12 Loreto operated on March 6 and Dr. Romance was responsible for the intervention. "It has taken me many years of training to be able to say that the ear will look good and as I do more, they look better," the specialist acknowledges. To this day, it will have rebuilt around 50 ear pavilions . Of these, between 20 and 30 had a good result.

There are hardly any cases because the disease that causes this type of external ear defects, microtia, is rare and occurs in one in 7,000 newborns. It almost always affects only one ear (in 90% of cases), although sometimes both. There may be four degrees , from a smaller than usual atrial canopy to the total absence of this part of the body. Depending on how this aesthetic issue impacts the patient's life, he will decide to operate or not for years.

Loreto chose to take the step. She was about 16 years old when she started not feeling comfortable or seeing herself well. "It wasn't about being pretty or pretty. I noticed it and that was enough." His parents never wanted surgery "for fear of the operating room," although they did talk about it. There he started a long-running race that tested his desire to move on. He inquired and inquired, he went through public and private health. "Some promised me great results and others refused to do so due to lack of experience."

In the end, he found a doctor at the Hospital La Paz in Madrid that showed him with complete candor several photographs of the reconstructive surgery interventions he had performed on different ears. The best and the worst. Indeed, rebuilding this part of the body is not a simple task. If it is already difficult to draw it, sculpting it from rib cartilage is a true work of art. For an artist and for a surgeon. And so his mother explained it to her, which is restorative.

"We have to always explain very well this type of interventions, teach different cases and even make the patient go through neuropsychological assessment so that he does not create unreal expectations," Romance proposes. We do not do it systematically, but I think it would be convenient to include it in the clinical guidelines that are currently being developed at European level for microtia. "

Loreto also did not lack this step to achieve a goal he already had set in his brain. "They made me go through the psychologist's consultation to make me aware of the possible results and what the pre and post operative supposes." A year later, he entered the waiting list. "They called me twice and canceled the third time, I entered, spent the night and 10 minutes after entering the operating room, it was canceled again."

It seemed an impossible mission. "I always lived waiting and conditioned to this operation." He stopped, rethink it and decided to take a break. He finished his degree and went to work in a daycare center in London. From there, he contacted the doctors again to try again and returned to Spain, without work, to close this waiting stage.

The intervention

Without hesitation, he put himself in the most experienced and recommended hands. He had been told about the plastic surgery specialist Beatriz González-Meli and Ana Romance. It was the latter who performed the intervention four months ago. It was about eight hours in the operating room.

First cartilage was removed from the ribs . In the second place, a kind of sculpture was carved in the likeness of the healthy ear, which was then introduced under the skin. This should stick to the cartilage, which eventually becomes part of the patient's living tissue, and the last phase is about six months or a year until it heals completely.

What is summarized in this report in some lines, requires great training of the plastic surgeon and the young woman knows it. "The success of these operations will increase as a doctor specializes. It is not the same to reconstruct the first ear as the 200".

Four months have passed since the intervention and " the results have been much better than I expected . I look in the enchanted mirror," says Loreto. But it must be recognized "that it is necessary to take time after the operation to be able to assume the new image. In addition, in my case, there is a part that does not end healing, itches, it hurts, I can not get in the pool because of the chlorine, the sun affects me ... I'm just waiting for a small intervention in September. "

"It is important to prepare mentally for the pre and post and the possible results and I would like to remember that you can live with microtia and nothing happens. Reconstructive surgery does not have to be the solution. I would have liked to be strong enough to accept me just as I was born because I think it's wonderful. We are all different. "

Hearing problems

Apart from the aesthetic result, in 65% of cases, microtia can be accompanied by what is known as aural atresia. That is to say, an external auditory canal and poorly developed middle ear structures, which implies a diminished hearing. "I was born with an 11% hearing on the left side, although I finally lost it," says the young woman.

Loreto has learned to compensate for this defect in functionality with several formulas: "I change sides when they speak to me in the left ear, I sit in the front rows of class, I have developed a lot the right ear and I have the ability to read the lips" . As she explains, neither her school development nor her professional life has been affected at all. "I am a child teacher and I have been working in a nursery in London for a year without a problem," he says.

Sometimes, when the microtia is bilateral, "as soon as it is born, the first treatment indicated is the headphones attached to the ear pavilion that transmit the sound by bone," says surgeon Ana Romance. In cases where there is no flag, a vibration headband is used that impacts the cranial bone and from there strengthens the auditory nerve. "Many have to be operated, but older. The result is more stable after six years, when the cranial vault is already developed."

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