Combined Atresiaplasty and Tragal Reconstruction for Microtia and Congenital Aural Atresia: Thesis for the American Laryngological, Rhinological, and Otological Society

Objective: To describe a new technique for combining atresiaplasty with tragal reconstruction by performing the tragal reconstruction with cartilage grafting at the same time as the atresiaplasty for patients with microtia and congenital aural atresia. Hearing and canaloplasty outcomes for this combined technique are reported. Patients: Patients with aural atresia (n = 19) with (n = 16) or without (n = 3) microtia, and a Jahrsdoerfer grade of 6 or higher. Mean age was 8.3 years. Atresiaplasty was performed in 20 ears, with the new combined technique in 15 ears (75%). Methods/Interventions: During the meatoplasty portion of atresiaplasty, the tragus was reconstructed with a cartilage graft and an anteriorly pedicled skin flap. Outcome Measures: Hearing results, complications including canal stenosis, infections, sensorineural hearing loss, and facial nerve injuries. Results: The mean postatresiaplasty pure tone average (PTA) and air bone gap (ABG) were 37.5 and 29.4 dB, respectively. Eleven (55%) of the ears had an ABG of < 30 dB, and 10 (50%) had speech reception thresholds (SRT) of < 30 dB. Six ears (30%) had postoperative infections. Revision surgery was performed in four ears (20%) for canal/meatal stenosis and in six (30%) for conductive hearing loss Bone Anchored Hearing Aid (TM) was performed In six patieits (30%). There was no sensorineural heafing loss or facial nerve injury. Conclusions: The new combined tragal reconstruction and atresiaplasty technique yielded satisfactory hearing, canal/meatal patency, and cosmetic results, with acceptable rates of complications. This combined tragal reconstruction and atresiaplasty technique is a valuable option in the armamentarium of microtia and atresia surgeons.