FREQUENTLY ASKED QUESTIONS Dr. Arturo Bonilla

Yes. The vast majority of patients with microtia and atresia (no ear canal) have moderate to severe conductive hearing loss. This means that because there is no ear canal, the sound cannot make it to the inner ear where the hearing nerve (almost always normal) is located. As a result, the sound has to rely on vibrations hitting the skull and going directly to the inner ear instead of going through the absent ear canal. A full explanation on hearing loss in patients with microtia is found on our “microtia hearing loss” section.

We will never say that we are the only ones who should perform microtia surgery. In fact, we value opinions and there are several excellent surgeons across the country with a high interest in microtia. We believe all parents should look at all of the options (cartilage, medpor, prosthetic) before making a decision. What separates Dr. Bonilla apart is that he is the world’s only surgeon that specializes EXCLUSIVELY in pediatric microtia. We do not perform any other plastic surgery except pediatric ear and microtia surgery. With over 5,000 pediatric microtia patients worldwide and over 25 years of experience, pediatric ear surgery is Dr. Bonilla’s passion. To learn more, visit the “About Dr. Bonilla” page.

Over the past 50 years, the “gold standard” for ear reconstruction has been cartilage. There are many reasons why cartilage is the most used technique in the world: There is no other material in existence that can compare to our own living tissue. The ear is made out of cartilage and this is the best material to reproduce a new ear. Using the child’s own cartilage, there is much less risk of rejection or infection versus non-tissue options. Because the cartilage is from the child, the new ear will grow with the child. Cartilage lasts a lifetime. The risk of fracture of cartilage is rare compared to other techniques There is no worry of exposure or rejection for the rest of the child’s life compared to other techniques.

CLICK HERE to see the difference.
The advantage of cartilage surgery over medpor/supor surgery is the material used. There is nothing that can compare to our own “living” tissue. Cartilage is soft and can bend (if sculpted correctly). Even though the rib is thicker, it is thinned during the sculpting to match the normal ear. It will grow with the child and last a lifetime. The medpor/supor is a manufactured porous polyethylene (plastic) material that is more firm and thick and will not grow with the child. The medpor/supor surgery takes 6-12 hours. The rib cartilage procedures take between 1.5 to 3 hours, depending on the stage. Less surgical time decreases the anesthetic risk to the child.

The average incision to remove the cartilage is very small…approximately 1 to 1.25 inches (about 2.5 to 3 cm).

As previously stated, most patients need two to three surgeries to complete. If a child has microtia on both sides, then four surgeries are needed. In one-sided cases, the ear is completed in approximately 4-5 months. If both sides are affected, the ears are completed in approximately 4-6 months, depending on the circumstances. It is important to remember that the plastic polyethylene can take from 6 to 12 hours per ear, the cartilage technique lessens the anesthesia time for your child.

Over the past 20 years (first surgery only), our patients have received an intraoperative epidural while they are asleep. The average pain is a 1 to 2 on a 10 pain scale. After surgery, most of our patients require no pain medication except for some tylenol with codeine by mouth. A pain pump is not used as some say. After the first surgery, the child goes home the next morning. After this procedure, all surgeries are outpatient and rarely require pain medication after the surgery.

We will not (and never will) rush the surgical procedures. It is the end result that counts. Parents have been confused because there are some that are touting less surgeries…and unfortunately many parents are being led to believe that a great result can occur with one procedure. This is not the case. Attempting to do everything in one surgery (while it seems tempting) is assuming that tissue reactions, scarring, etc… will occur perfectly every time. This cannot be reproduced time and time again. Therefore, we are adamant that staging the surgeries gives the most consistent results, not rushing them.

Doctors do not fully understand the cause of microtia, although it is thought that it may be an artery that was giving the ear its blood supply that somehow became compressed or compromised. Interestingly, most microtia patients worldwide present with a very similar malformation (Microtia Grade 3). Although medications during pregnancy have been known to cause microtia, these are less likely since extreme care has been given to limit these during pregnancy.

Although microtia cannot really be prevented, certain factors such as avoiding medications during pregnancy and getting proper nutrition during pregnancy have been stated as helpful.

Although genetic causes of microtia are being researched, it is not thought to be genetically inherited in most circumstances. There are syndromes associated with microtia such as Treacher Collins syndrome that does have a 50% chance that a child will be born with the disorder. There is usually no family history in most cases of microtia.