Timing for Surgery

Dr Lotz performs ear reconstructive surgery related to microtia no earlier than the age of 10 years old. Whilst some surgeons advocate surgery at an earlier age, Dr Lotz is convinced that operating earlier produces results that are not as good.  

The main reasons to wait are:

  1. Until the child is big enough, the rib cartilage is too small to carve a nice ear framework. It will not be thick enough to allow the carving of adequate contours, and also the length is too small, so that more needs to be taken which leads to a bigger deformity.
  2. Until age 10 the other ear is still growing. How much the cartilage in the newly created ear will grow is unpredictable, hence it requires some guesswork as to what size to make the ear. Waiting until the child is older removes this guesswork and leads to more predictable results.
  3. It is important that these children can understand why they are having surgery and are old enough to be co-operative. By the age of 10 they can usually comprehend what the surgery involves, and also be involved in the decision as to whether or not they wish to have the surgery. It is hard to change dressings or remove stitches on a six year old who doesn’t understand what is going on. I see teenagers who still are happy to not have surgery, and I think that giving them the choice is important.
  4. There are some suggestions that removing too much rib cartilage when the children are still young can interfere with the growth of the chest wall.

The experience with my patients is that the children do not see having a different ear as a negative thing until around the age of 8. There is not usually too much teasing, and hence I do not feel that this is a justification to perform the surgery earlier.

I think that the most important thing is to achieve the best possible long term results, and not the quickest result if this means sacrificing the quality of the reconstruction. It is for this reason that I wait, as in my opinion the results of ear reconstruction are definitely superior if performed after the age of ten.

Last Updated ( Wednesday, 01 October 2008 )