Russell H. Griffiths, MD

Microtia reconstruction is traditionally covered by most major medical insurance policies. Out-of-pocket costs can vary depending upon the patient’s individual plan. Primary costs involve the hospital fees, anesthesia fees, and the surgeon fees. Dr. Griffiths' office will work with your individual insurance plan to obtain pre-certification for the reconstruction of your child’s ear and try to provide a very close estimate of out-of-pocket costs. If you do not have traditional medical insurance or if you are traveling from outside the United States, Dr. Griffiths’ office can provide quotes for you.

Dr. Russell H. Griffiths performs his surgeries at St. Luke's Children’s Hospital in Boise, Idaho.

Please call Dr. Griffiths’ office or contact us online if you would like to arrange an appointment to meet in the office. If you live out of state or out of the country we can arrange for a video conference to take place. It will be important for you to fill out medical history paperwork and send detailed photographs of your child’s ear prior to the video consultation. The video consultation time can be arranged with appropriate translation services for non-English-speaking families and patients.

The optimal time for reconstructing an external ear using autogenous rib cartilage is six years of age. If a Medpor framework is chose, the surgery can be done as early as age four.

After a patient returns home, Dr. Griffiths likes to have photographs emailed to him periodically so he can carefully monitor the healing. It is important that a local physician be available to communicate with Dr. Griffiths and provide localized care if needed. A plastic surgeon is best suited for this role but a qualified ENT would also work. These arrangements should preferably be made prior to having your child travel to Boise for the operation. Dr. Griffiths will assist you in arranging follow-up care through a backup physician if necessary for those who live out of the state or out of the country.

Patients with Treacher Collins syndrome often have bilateral microtia and aural atresia. Your child will benefit greatly from wearing vibrating hearing aids held on with a soft headband. These hearing devices help accelerate speech development and also help maintain the health of the brain's auditory cortex.

Microtia surgery can be carried out on patients with Hemifacial microsomia or Goldenhar syndrome, but Dr. Griffiths has to pay special attention to the individual physical examination findings of each patient. He has to work with a lower hairline, a lower ear remnant (often located on the cheek), and an underlying skeletal abnormality all at once. He often counsels patients and parents to expect slightly less refined results in comparison to the results that can be achieved for a patient without Hemifacial microsomia.

The first thing to focus on is hearing. If your child also has aural atresia (missing ear canals) then he or she would benefit greatly from wearing vibrating hearing aids held on with a soft headband as soon as possible. A patient with bilateral microtia will require a minimum of two separate operations: - A single-stage reconstruction of one ear will be followed several months later by single-stage operation on the other. - A full thickness skin graft from another area of the body will usually be necessary. - If the patient with bilateral microtia also has bilateral aural atresia, then hearing restoration surgery (canalplasty or a bone anchored implant) is usually performed at the same time as the microtia surgery.

If your child is not a candidate for canalplasty, there are other options to consider. Bone anchored hearing aids convert sound into vibrations and then transmit the vibrations directly to a titanium abutment that is attached to the cranial bone. Common devices include the Cochlear™ Baha® Connect system, and the Oticon Ponto Pro. An alternative device attaches to the scalp with a magnet rather than an abutment which eliminates the percutaneous abutment. Common devices include the Sophono™ Alpha 2 made by Medtronic, the Cochlear™ Baha® Attract system, and the MED-EL BONEBRIDGE. Our otologist would be happy to review your options with you.

The goal of canalplasty is to create an opening through the temporal bone and to reconstruct the tympanic membrane (ear drum), which would allow sound waves to move the inner ear bones. The inner ear bones then transmit the sound vibrations to the cochlea. The surgery is performed by our otologist using a high powered surgical microscope. After the canal is created, the ear drum is reconstructed with a small fascia graft. The canal is then lined with a split thickness skin graft. A special stent is fabricated to hold all the tissues in place during the healing phase.

Yes, it is possible to reconstruct the ear canal at the same time as reconstructing the external ear. Dr. Griffiths works with an otolaryngologist at St. Luke’s Children’s Hospital who performs the ear canal reconstruction on patients who have been evaluated by temporal bone computed tomography (CT) scan and found to be good candidates for canalplasty. The canal can be reconstructed while Dr. Griffiths is carefully carving and constructing the ear framework. By working together, Dr. Griffiths and our otolaryngologist have condensed what can be up to five separate operations into one.

Some surgeons incorporate the aid of a tissue expander to stretch the overlying skin prior to inserting the framework for a three stage-reconstruction. Tissue expansion does involve multiple visits to the physician’s office to inflate the tissue expander. The first stage is to place the tissue expander. The second stage is to remove the tissue expander, place the framework, and rotate the lobule. The third stage is used to create the ear canal if the patient is a candidate.

The one-stage procedure performed by Dr. Griffiths involves the use of a thin vascularized membrane that is placed underneath the scalp to cover the carved framework Patients can choose wether they would like a rib graft or a Medpor framework. This thin membrane is called the temporoparietal fascia. This thin highly vascular membrane is then wrapped around the ear framework to provide a complete vascular covering. Skin grafts that have been carefully chosen to provide the best texture and color match are then used to cover the fascia flap.

Rib cartilage for microtia reconstruction is harvested from the anterior chest from the sixth, seventh, and eighth ribs. Because we use your tissue, it will grow with you. In addition, you are less likely to develop infection or complications. In the hands of artistic, experienced microtia surgeons, cartilage can be craftfully carved into an ear framework that closely matches the contralateral (normal) ear.

The MEDPOR™ auricular prosthesis is made of porous polyethele. Advantages include avoidance of chest incision, lower operating room time, and the ability to be used by less experienced surgeons who do not have the artistic ability to carve ear framework out of cartilage.

Type I microtia can often be reconstructed with an otoplasty. Type II requires a reconstruction of the upper half of the pinna. Type III and type IV require complete ear reconstruction. Ear reconstruction options include a prosthesis, a silicone or Medpor polyethylene plastic framework covered by living tissue, or living rib graft cartilage framework covered by living tissue.

Microtia is classified into 4 types: Type I Microtia: A slightly small ear with identifiable structures and a small but present external ear canal. Type II Microtia: The upper 1/2 to 2/3rd of the ear is missing with the tragus, earlobe, and antitragus present. Usually the ear canal is stenotic or missing (aural atresia). Type III Microtia: Complete absence of the canal with a small peanut-shaped remnant of pinna and lobule. Type IV Microtia (Anotia): Complete absence of the canal pinna and lobule.

Prosthetic ears can look very natural and can nicely match the contralateral ear when fabricated by a skilled technician. They attach to the patient’s head with either an adhesive or osseointegrated implants. It is Dr. Griffiths’ opinion that prosthetic ears are best suited for those who are not candidates for ear reconstruction surgery, or for a child who wants to buy time before pursuing surgery.

The simple answer is that if you donated cartilage for your child, your child would have to take immunosuppressant medications the rest of his or her life. This increases your child's risk for life-threatening infections. The risks of the immunosuppressants are acceptable when your child has a life-threatening condition such as renal failure. However, when your child has microtia alone, other safer options are typically recommended. Each patient has extra cartilage that can be borrowed from one area of their body and transferred to another area.

We accept most major medical insurance policies.

Russell H. Griffiths, MD offers ear reconstruction surgery, microtia reconstruction, rhinoplasty, hearing loss treatment, and more.