I get emails every other week with questions regarding cartilage engineering and where we are with this technology. I felt I should write a few thoughts down.

Well, another article just came out recently about cartilage engineering for microtia ear reconstruction. It states that researchers in Japan are about five years away from implanting (into humans) lab-grown ears made out of a patient’s own cartilage.

I had previously posted exciting news about the “future of microtia surgery” after visiting experts in the cartilage engineering field at the Harvard/MIT Research lab last year in Boston. What I saw was very exciting, and the effort of these scientists was extremely admirable. Once this technology becomes a reality, it will revolutionize the treatment of microtia, but it is very important to emphasize that it appears we are still years away from this being the mainstay of treatment. It could still be three, five, maybe ten years away. Funding is needed to help these extraordinary researchers.

As you can see, this technology has existed for many years but has not quite made it to actual clinical practice in humans. I feel very confident that with the advances in tissue engineering techniques and with the dedication of scientists all over the world, this will become a reality…we are just not quite sure how soon.

How do I think this technology will change the present management of microtia? Let’s begin with the options out there.

  • The most common technique preferred by microtia expert surgeons worldwide has been and continues to be the patient’s own natural cartilage. It makes sense…if the ear is normally made out of cartilage, why not use cartilage to make the ear in a patient with microtia? When cartilage engineered tissue becomes a reality, we will not have to use the cartilage from small pieces of the patient’s own ribs. I dream of the day when it will take about 20-30 minutes to complete the main surgery by placing the patient’s own “lab-grown” ear, instead of my typical 2½ – 3 hours it takes for the same result. Believe me, that will be great (and my sore back thinks so too!).
  • How will cartilage engineering affect the polyethylene implants (made out plastic) such as the medpor and others? Let’s think about this. If on one hand, you are holding an ear made out of the child’s own cartilage and on the other hand you are holding a polyethylene implant shaped like an ear…why would anyone choose a foreign body? A world-renowned polyethylene implant expert surgeon recently stated… “we will obviously probably not be using medpor in the future”.
  • The ear prosthetic should always be given as an option in the management of microtia. Whenever offered, it is usually the option of last resort (when there are suboptimal surgical results).
  • No intervention: This should always be an option that surgeons should present to all patients. Some parents want to wait until the child is ready. Some don’t want any surgery at all.

Even when the cartilage engineering technology for microtia reconstruction becomes a reality, all of the tissue handling techniques must still be respected. If soft tissues are not handled correctly or if postoperative care is not managed correctly, the results will vary dramatically, so surgeons must never become complacent.

Finally, times are very exciting…especially for parents with newborns who are still 5-6 years away from making decisions about microtia reconstruction. The hope is that we will at least be closer to the reality of cartilage engineering. We will keep our fingers crossed!

Dr. Bonilla

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