On Monday (Nov. 4), good news from the hospital revealed that after two years of research and technical improvement, the doctors at the hospital’s Plastic Surgery Department have successfully performed MER using self-costal cartilages with only one operation under the support of an endoscopy. This is one of the most demanding challenges in plastic surgery and the well-known medical facility is the first hospital in Vietnam and one of the very few centres in the world to successfully carry out the most advanced MER, making it a routine operation. Assoc. Prof., Dr. Nguyen Hong Ha, Head of the Department of Plastic Surgery at the Vietnam - Germany Hospital, said that microtia maybe congenital or acquired due to an accidental loss of ear or burn. Although it is not dangerous to the life of the patient, it can leave a huge negative impact on aesthetics and psychology, especially for children at a pre-school age. Currently, there are two popular methods of ear reconstruction in the world, in which the use of autologous rib cartilage has been implemented in the past 50 years, but requires at least 2-3 major surgeries with full risks during anesthesia and surgery to build the ear canal, by removing rib cartilage No. 6,7,8 or 9 from rib cage and sculpting into an ear cartilage frame. The newer method is to shape the coronary ear with an artificial cartilage frame that patients only need one surgery at a very early age as 4-5 years old, in which could bring better aesthetic results than other methods. “So far, the latter using artificial cartilage has the most advantages. However, the disadvantage is that the artificial cartilage frame is very expensive and has not been covered by health insurance like other high-tech medical supplies such as artificial hip and knee joints. In Vietnam's economic conditions, only a few families are capable of purchasing artificial ear cartilage frames to implement this method for their children,” said Dr. Ha. In order to help Vietnamese children with congenital microtia, doctors at the hospital have improved the technique and successfully applied the new method of ear reconstruction, using rib cartilage with the help of laparoscopic surgery, which brings the same results as the artificial cartilage method, but the cost is much lower. “In this technique, we still use the patient's own cartilages to make an ear canal. But instead of having to bury the mold under the skin to wait a year later for the second surgery, the doctors immediately used the superficial temporal flap to cover the cartilage frame, and only with one surgery, the patients are able to get a new ear with almost normal function,” Dr. Ha said. According to him, the most difficult point of this surgery is how to cover the whole cartilage frame with the superficial temporal flap. Even a small 1-2 mm exposure in the frame can lead to infection or necrosis for the cartilage frame. Previously, to get the superficial temporal flap, doctors often had to carry out open surgery that would leave a 15-20 cm T-shaped scar on the temple area, causing hair loss or keloids. Currently, thanks to the application of laparoscopic technique, the hospital’s doctors can get the entire superficial temporal flap without having to make any scars. The application of laparoscopic not only minimises the smallest aesthetic scars, but also plays an important role in helping enlarge tiny blood vessels like hairs on the screen for close observation, helping to preserve all of these small blood vessels to ensure the superficial temporal flap can be 100% viable. After two years of technical research and improvement, the doctors at the hospital have successfully performed a range of MER surgeries using self-costal cartilages with the help of laparoscopy. "So far, only one or two of the most advanced centres in the world are able to perform this technique on a regular basis as at our hospital," Dr. Ha said. Integrating the advantages of both the most popular MER surgical methods in the world has created a new opportunity for patients in Vietnamese conditions, helping them still approach the most modern high-tech techniques in plastic and cosmetic surgery. From November 9 to 17, the Cosmetic Surgery Department at the hospital will collaborate with the world's leading team of UK experts on MER to offer free examinations and sharing experience in the field as well as face and neck plastic surgeries.

Microtia plastic surgery using a  plastic frame  is also called  MedPor ear reconstruction . First introduced by Dr. John Reinisch, Medpor is a surgery that uses a foam  polyethylene  ear frame with autologous tissue to shape the ear. The polyethylene frame is sculpted to resemble a healthy ear frame is implanted in the appropriate position  and then covered by a thin layer of tissue that turns down from the subcutaneous layer (called the temporal flap) and cover with a skin graft taken from patient’s own thigh or abdomen. All of these steps are performed in one operation. Advantages Disadvantages Can be done with three-year-olds, before they go to school; For children with hearing loss, surgery to restore the ear canal   can be done before or at the same time with reconstructing the defective ear; Minimizes pain relief while allowing children to go home (outpatient) one hour after surgery; Reconstructive surgery is performed once and in 80% of cases are outpatient; The reconstructed ear is formatted to correspond to the normal ear in size and appearance; The reconstructed ear can withstand most sports. The ear frame is the plastic that replaces the body’s tissue; Only a few surgeons are trained in this surgery, an inexperienced ear surgeon with a defective ear will lead to unexpected results.

Microtia plastic surgery using autologous rib cartilage is also simply called “reconstructive ear using rib cartilage”. This method has been in use for more than 50 years. According to this method, the surgical process consists of . The first is to remove a few pieces of cartilage from the ribs on the thorax, sculptural grafting them into the ear frame (Figure 1) and then transplanted under the scalp behind the defective ear (Figure 2). Then, it takes many operations to lift the ear frame off the scalp, create grooves behind the ears, cover the cartilage frame, skin graft on the scale and adjust other details of the ears.     Advantages Disadvantages Using tissues of the patient’s own body; With a good surgeon, the patient can get excellent, long-term results; The reconstructed ear can withstand most sports. Only children over 7 years old will have enough rib cartilage to make ear frame, need many operations (many stages) in a long time to make children go to school always with remarkable different ears; The rib cartilage dissection causes pain, permanent scarring of the chest and potentially deforming the chest wall; Ear canal surgery must wait after ear reconstruction is complete thereby delaying hearing recovery for many years.

There is no scientific answer to what causes Microtia. Currently, there is no sound scientific evidence that can say or show that Microtia is completely genetic. Although it appears to be more frequent in certain ethnic backgrounds, it also appears to be completely random in many others. There are many families who give birth to a child with Microtia when no one on either side of the family has ever had Microtia as far back as history can show. Microtia does not appear to be present in the bloodline for many families. One child may be born with Microtia where his/her twin sibling may not show any signs of having Microtia. There is no evidence proving that the use of fertility drugs can cause Microtia. There is also no proof that the mother has used some drug, medicine or by eating drinking something wrong during pregnancy period can cause Microtia. Some people infected with Agent Orange can give birth to children with various defects including handicapped ears.

In Vietnam, Dr. Nguyen Hong Ha, after a period of acquiring techniques from his mentor Pr. Reinisch, who is known worldwide for his design and development of the Medpor ear reconstruction technique. Dr Ha with his associates, has successfully performed many ear reconstruction surgeries using Medpor or Omnipore plastic implant at Vietnam-Germany Friendship Hospital. The ear reconstruction using the Medpor, Omnipore plastic implant done in the US or at Vietnam-Germany Friendship Hospital is similar in terms of technique. Before making any decision, you need to know more about the process of shaping ears using plastic implant. The plastic implant ear shaping method is one that only requires one-time operation (one-stage surgery). The rib cartilage classic method need 2-4 stage of surgery. Thus, if including the time of pre-operative examination and pre-operative counseling, the patient and caregiver take only about 1-2 month. The rib cartilage classic technique takes at least 2-3 years to complete this procedures.

Cryptotia is a congenital (present at birth) infant ear deformity characterized by an auricular muscle abnormality that causes the upper portion of the external ear cartilage to be partially buried underneath the skin on the side of the head. Because a portion of the ear is beneath the skin, the condition is sometimes referred to as hidden ear, buried ear, or pocket ear deformity. While the upper part of the ear may appear to be missing, the ear cartilage framework is actually present under the skin. In some cases of cryptotia, the buried portion of the ear may present with other malformations as well. The cause of cryptotia is not known, however it does occur more commonly in people of Asian descent (reports show up to 1 in 400 births). It typically does not affect hearing however, wearing eyeglasses or sunglasses is often difficult or impossible as the temple pieces of the glasses have no resting place. Studies also show that cryptotia can affect self-esteem and result in teasing as the child becomes old enough to attend school. Treatment for cryptotia involves separating the buried portion of the ear from the head which leaves a raw area both at the back of the ear and the side of the head. Covering the raw areas entails maneuvering tissue from the back of the ear or, in some cases the scalp, to close the gap. Can Cryptotia be Corrected Without Surgery? While most congenital ear deformities require seeking medical treatment shortly after birth to enable non-surgical correction, cryptotia can often be treated without surgical intervention well beyond the neonatal time window (even up to age 5). In cryptotia cases where the cartilage framework is normal but simply hidden under the skin, ear molding can be a treatment option that can be utilized for a longer period of time since the cartilage does not need to be soft and pliable at the time of correction as in many infant ear deformities. The Earwell™ Infant Ear Correction System can be used to release the buried portion of ear cartilage and then expand the skin needed for the newly exposed cartilage. When correcting cryptotia, The Earwell™ Infant Ear Correction System can be applied in reverse order from its typical application. First, the Earwell™ retainer tapes are applied in order to: Retract the ear cartilage framework Expand the skin Lengthen the muscle Approximately two weeks later, the molding portion of the four piece Earwell™ System is placed to reshape the released cartilage. Benefits of the EarWell™ Infant Ear Correction System include: Permanent non-surgical method to correct infant ear deformities FDA approved Pain free procedure Over 90% success rate Results within weeks of application Less expensive than otoplasty (surgical ear reconstruction) Typically covered by insurance as a congenital condition Surgical Correction for Cryptotia Surgical ear reconstruction (otoplasty) for cryptotia involves dividing muscle fibers through a small incision. The available skin is moved from the depression behind the ear (auricular sulcus) to the needed portion in the superior area of the ear. Several correctional surgery options are available for cryptotia treatment and are recommended on a case by case basis. Most cryptotia surgeries involve the use of skin flaps however, skin grafts may be necessary when the condition is severe. Goals of cryptotia surgery are: Restore the natural groove between the upper ear and the side of the head, also known as the auriculocephalic sulcus Replace insufficient skin with local skin flaps or grafts to ensure embedded cartilage is covered Release tethered ear muscles Reinforce collapsed cartilage Cryptotia ear deformity repair is typically performed under general anesthesia on an outpatient basis, and the patient is able to return home the same day as surgery. If your child has symptoms of this ear deformity, please see our physician locator for a list of experts who are qualified in treating cryptotia with The Earwell™ Infant Ear Correction System. For patients who require surgical correction, we are pleased to offer referrals to plastic surgery experts who are highly skilled in performing otoplasty.