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Evaluation of Techniques and Outcomes in Pediatric Partial Ear Reconstruction: A 15-Year Experience
Miriam Meghnagi
*, Jesse A. Taylor, Jordan W. Swanson, David Low, Scott Bartlett, Cassandra A. Ligh
Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
Background: Partial ear reconstruction challenges surgeons to blend native and reconstructive auricular segments while preserving contralateral symmetry. The diverse etiologies and anatomical differences of these defects require individualized approaches. This study reviews our institutional experience managing partial auricular defects to assess the reconstructive methods utilized. To our knowledge, this is the largest reported cohort of pediatric traumatic ear defects in the literature.
Methods: A retrospective review was conducted of pediatric patients who underwent partial ear reconstruction between 2009 and 2024. Patients were categorized based on etiology (acquired or congenital). Demographic data, operative details, and outcomes were collected.
Results: Seventeen ears from 16 patients were included, comprising 8 acquired (47.1%) and 9 congenital defects (52.9%). The acquired group was older at first surgery (10.3±3.9 yrs vs 8.4±3.5 yrs, P=.17). Time from injury to surgery was 3.03±3.3 yrs. Most cases (87.5%) were avulsion injuries (6 dog bites & 1 MVC); 1 was a thermal injury. Conductive hearing loss was present in 44.4% of the congenital group. Most defects involved the upper third of the ear (n=13, 76.5%). All 17 ears underwent autologous costal cartilage reconstruction. Half of the acquired cases had inadequate local skin, whereas 77.7% of congenital cases had adequate local skin. Local tissue was used for soft tissue coverage in 5 acquired and 8 congenital ears; temporoparietal fascial flaps were used in 3 acquired and 2 congenital ears. One framework exposure and one explantation occurred in the acquired cohort. Mean follow-up was 2.5±2.02 yrs.
Conclusion: At our institution, a standardized structural approach using autologous costal cartilage reconstruction demonstrated reliable outcomes in pediatric partial ear defects, regardless of indication. Soft tissue coverage options can be limited by local skin quality, defect size, and anatomical location. Ongoing data collection will further inform long-term patient satisfaction in partial ear reconstruction.
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