Microtia is a congenital condition in which the ear does not develop properly. (The word microtia means “small ear.”) Microtia occurs about once in every 6,000 to 12,000 births, with a higher frequency among Hispanics, Asians, Native Americans, and Andeans.
The cause of microtia is not well understood, particularly the role of environmental and genetic factors. Genetics are thought to be a cause in only 5% of all patients. Multiple theories have been proposed to explain the cause of microtia during fetal development, such as neural crest cells disturbance, vascular disruption, and altitude, but these have not been proven.
It is important to understand that nothing a mother does during pregnancy, such as drinking coffee, alcohol use, or even drug abuse, has been shown to cause microtia. However, when taken in the first trimester of pregnancy, some medications like Thalidomide and Accutane have been linked to the condition.
Microtia usually occurs on only one side (more commonly on the right ear), but approximately 10% of patients have microtia on both sides (Bilateral Microtia).
Microtia is often seen as an isolated condition, but it may also occur with other syndromes including Hemifacial Microsomia, Goldenhar Syndrome, or Treacher Collins Syndrome. Other syndromes with microtia can also affect the kidneys, the heart, the eyes, the craniofacial bones, and the skeletal system. Children with these abnormalities are often cared for by a Craniofacial Team.
Microtia occurs in many different variations, ranging from just a small ear to complete absence of the ear, called anotia meaning “no ear.” In some cases, the ear canal is very small (aural stenosis) or absent (aural atresia). All types of ear surgery for microtia are technically difficult to perform. Most plastic surgeons would agree that ear reconstruction is one of the most challenging operations performed — requiring a combination of technical skill and artistry. The reason for this difficulty is related to the very complex shape that must be created for the ear in order for it to look natural.
Meet our Microtia Expert
Dr. Sheryl Lewin, M.D.
Dr. Lewin is a Craniofacial trained Board Certified Plastic Surgeon who has dedicated her career to ear reconstruction. She is a specialist in Microtia surgery using the Medpor technique. Since there is no natural substitute for the thin, bendable cartilage supporting the natural ear, reconstructed ears cannot bend. The framework (Medpor) needs to be able to withstand the forces of scar tissue that would distort a more pliable framework. Dr. Lewin has performed more than 400 surgeries on children with microtia and has made important surgical advances in Medpor ear reconstruction to reduce scarring, improve visual outcomes, and eliminate the need to take skin grafts from other parts of the body.
Dr. Lewin received her undergraduate degree in Architecture from the University of California, Berkeley. During her studies there, Dr. Lewin founded a student volunteer organization called CalCare that helps disadvantaged children in the Berkeley community. Her involvement in that organization led to a turning point in her career path: She decided to switch from architecture and to the field of medicine, where her combination of skills could change the lives of children in a significant way.
Dr. Lewin went on to attend Stanford University School of Medicine, where she was awarded a Medical Research Scholarship to pursue scientific research while completing medical school. Following medical school, she entered a prestigious Plastic Surgery Residency at the University of Southern California, one of very few residency positions at the time to combine both general and plastic surgery training. Dr. Lewin then completed advanced training with a focus on Microtia Reconstruction through a fellowship in Craniofacial and Pediatric Plastic Surgery at Children’s Hospital Los Angeles (CHLA). This fellowship was under the direction of her mentor, Dr. John Reinisch, the founder of Medpor Ear Reconstruction. After working together at CHLA for 3 years, Dr Lewin and Dr. Reinisch joined the Cedars Sinai Medical Group, where they continued their practice for an additional four years. While at Cedars Sinai, Dr. Lewin held the position of Associate Director of Craniofacial and Pediatric Plastic Surgery, as well as Director of Microtia Reconstruction at CHLA.
Dr. Lewin established her own private practice, Aesthetic Ear Reconstruction, in February of 2012 with the goal of providing patients with the highest quality of care and a comprehensive approach to treating microtia. She currently maintains her affiliation with the Keck School of Medicine at the University of Southern California and Children’s Hospital of Los Angeles as voluntary Clinical Faculty, teaching and mentoring residents.