Evaluation of 4 Outcomes Measures in Microtia Treatment: Exposures, Infections, Aesthetics, and Psychosocial Ramifications

Rachel S. Mandelbaum, MD; Elizabeth J. Volpicelli, BA; Deborah B. Martins, MD; Sarah H. Park, MD; Emily Dubina, MD; Akira Ishiyama, MD; James P. Bradley, MD; Justine C. Lee, MD, PhD

doi:10.1097/GOX.0000000000001460

Plastic and Reconstructive Surgery, Global Open (Sep 2017)

Evaluation of 4 Outcomes Measures in Microtia Treatment: Exposures, Infections, Aesthetics, and Psychosocial Ramifications

Rachel S. Mandelbaum, MD,
Elizabeth J. Volpicelli, BA,
Deborah B. Martins, MD,
Sarah H. Park, MD,
Emily Dubina, MD,
Akira Ishiyama, MD,
James P. Bradley, MD,
Justine C. Lee, MD, PhD

Affiliations

Rachel S. Mandelbaum, MD: From the *Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; †Department of Head and Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; and ‡Department of Surgery, Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.
Elizabeth J. Volpicelli, BA: From the *Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; †Department of Head and Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; and ‡Department of Surgery, Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.
Deborah B. Martins, MD: From the *Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; †Department of Head and Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; and ‡Department of Surgery, Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.
Sarah H. Park, MD: From the *Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; †Department of Head and Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; and ‡Department of Surgery, Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.
Emily Dubina, MD: From the *Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; †Department of Head and Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; and ‡Department of Surgery, Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.
Akira Ishiyama, MD: From the *Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; †Department of Head and Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; and ‡Department of Surgery, Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.
James P. Bradley, MD: From the *Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; †Department of Head and Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; and ‡Department of Surgery, Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.
Justine C. Lee, MD, PhD: From the *Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; †Department of Head and Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; and ‡Department of Surgery, Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.

DOI: https://doi.org/10.1097/GOX.0000000000001460
Journal volume & issue: Vol. 5, no. 9
p. e1460

Abstract

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Background:. In craniofacial microsomia, microtia and canal atresia pose formidable reconstructive challenges. We review our institutional experience in treating microtia and atresia to identify variables associated with 4 outcomes measures: complications, surgical revisions, aesthetic outcomes, and psychosocial function. Methods:. Craniofacial microsomia patients treated at the University of California Los Angeles Craniofacial Clinic between 2008 and 2014 greater than 13 years of age (n = 68) were reviewed for microtia and atresia treatment and outcomes. Results:. In total, 91.2% of patients diagnosed with craniofacial microsomia presented with microtia, affecting 75 ears. Both a male and right-sided predominance were observed. Fifty-six patients (90.3%) underwent autologous external ear reconstruction at an average age of 8.5 years. Age, type of incision, and size of cartilage framework did not predict total number of surgeries or complications. Severity of ear anomalies correlated with increased number of surgeries (P < 0.001) and decreased aesthetic outcomes (P < 0.001) but not complications. In total, 87.1% of patients with microtia had documented hearing loss, of which the majority were conductive and 18.5% were mixed sensorineural and conductive. Hearing deficits were addressed in 70.4% of patients with external hearing aids, bone anchored hearing aids, or canaloplasty. Of all variables, improvement of psychosocial function was correlated only to hearing loss treatment of any type (P = 0.01). Conclusions:. On evaluation of surgical and patient characteristics, severity of microtia predicted the total number of surgical revisions performed and aesthetic ratings. In addition, we found that the only factor that correlated with improved patient and parent-reported psychosocial outcomes was treatment of hearing loss.

Published in Plastic and Reconstructive Surgery, Global Open

ISSN: 2169-7574 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://www.prsgo.com

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