Abstract A review of Brent’s method for reconstruction
of microtia with minor modifications is presented. The
treatment was performed when correcting the classic
deformity in four operations and in three operations for
concha-type microtia. There is a low incidence of
complications and good, long-lasting, aesthetic results
can be obtained with this technique.
Keywords Ear · Microtia · Reconstruction
Since the pioneering efforts of the 1940s and 1950s,
when ear reconstruction was said to be the most unsatis-
factory procedure in plastic surgery , this field has
always been considered demanding. Even after Tanzer’s
breakthrough contribution , auricular reconstruction
has remained a challenging procedure [3, 4, 5] and a
form of surgical art [6, 7]. One of the principal difficulties
still encountered by surgeons is the carving of the
cartilage . This motivated Cronin to propose the use
of a Silastic framework . After several complications
were reported [10, 11, 12], Cronin’s method was gradually
abandoned. With new materials such as porous high-
density polyethylene implants , the insertion method
remains laborious and prone to complications, as with
any alloplastic material superficially implanted beneath
the skin [7, 14]. It is now generally accepted that auto-
genous costal cartilage is the material of choice for partial
and total ear reconstruction [15, 16, 17, 18]. Experimental
research in tissue engineering is underway; this could
lead to the development of autologous material suitable
for ear reconstruction and would obviate having to resort
to chest surgery for cartilage harvest [19, 20, 21].
Here I present my experience in microtia reconstruction
using Brent’s method with slight modifications.
The reconstruction should begin when the patient is
7–8 years old . At this age, the amount of cartilage is
appropriate for building an ear of correct proportions.
Also, the child is developed enough for the risk of chest
wall deformities and eventual thoracic scoliosis to be
reduced . At first consultation, the parents should be
fully informed about the surgery and its possible compli-
cations and that a yearly follow-up will be necessary
until the patient is psychologically mature. It is only then
that surgery should be performed. Hearing problems and
associated deformities should be addressed with other
surgeons, as this is a team approach.
The classic microtia is corrected in four operations.
When a tragus is present (concha-type microtia), only
three operations are needed. A period of not less than
3 months should elapse between each surgical stage.
Planning the reconstruction
The symmetry of the face and the position and inclination
of the contralateral normal ear are assessed. A template
of the normal ear is made by overlaying an X-ray film.
This template helps determine the location of the recon-
structed ear, taking into account the ear-to-canthus
distance and the major axial inclination of the normal ear
. The pattern must be designed 2 mm shorter than
the normal ear to allow for the additional thickness of
the skin cover . Despite accurate and detailed studies
about dimensions, proportions, and position of the ear
[25, 26], it is always worthwhile to remember some other
practical guidelines: it is better to place the framework
under nonhairy skin even if this shortens the ear-to-canthus
distance by a few millimeters, and the surgeon must try
as much as possible to preserve the symmetry of the
upper pole level of the reconstructed ear with that of the
normal side. Approximately 30% of patients with microtia
have facial microsomia , and the placement of the
framework must be done by compromise [15, 26].
G. Osorno (
Division of Plastic Surgery, Universidad Nacional de Colombia,
Cra. 18A #53–51, Bogotá, Colombia
Eur J Plast Surg (2001) 24:107–113
Received: 14 March 2001 / Accepted: 21 March 2001 / Published online: 14 June 2001
© Springer-Verlag 2001