Mom wins a quicker fix for boy's microtia

Tag : medical material.
He was born with what the 6-year-old calls "a little ear," anddoctors call microtia, a congenital ear deformity. But getting to10 with a deformed ear hardly bigger than a lobe could scar theyoung boy's personality, his mother worried.

One early incident confirmed her fears. The family was at a schoolrecital. Mavric, then 1, was toddling around the auditorium when athird-grader pointed at him. "She said, 'Ewww, gross. Look at thatbaby,' " Herrera says. She wanted to protect her son from nine moreyears of that.

In Texas now, the family was living in Orange County when Mavricwas born. Herrera had never heard of microtia, but what disturbedher was that when she went to a pediatric ear, nose and throatdoctor, the technician administering a hearing test had never heardof it either.

"She didn't know where to tape the testing equipment," she said.Mavric's doctors had heard of it, but none had seen it. "You neverwant your child to be the first case a doctor has ever seen."

The physicians close to home offered a surgical technique decadesold. It involved creating a new ear from material fashioned fromthe child's rib. The unacceptable catch for Herrera was that theprocedure could be done when the child reached the age of about 10to allow the ribs to grow and develop enough material to borrow.

"One doctor just told us not to worry, and come back in nineyears," she says. Meanwhile, the boy's hearing was compromised inthe deformed ear, and he'd also have to wait to have ear canalsurgery and any chance of improved hearing. Herrera worried thathis language development and learning would be slowed.

A second specialist told her to return every six months forcheckups, but insisted nothing could be done for a decade.

Years went by, and as Mavric got closer to school age, his motherworried more that crucial years of educational and socialdevelopment would pass before he could be helped.

Then her brother, who worked for the children's healthcare advocacygroup Children's Miracle Network in Los Angeles, heard that Dr.John Reinisch, director of craniofacial and pediatric plasticsurgery at Cedars-Sinai Medical Center in Los Angeles, haddeveloped a technique for children with microtia. Herrera got onthe Internet, read about the technique and made an appointment.

Because of his disability, Mavric's medical care was covered underCalifornia Children's Services.

"They try to put you in a box, and don't want you to deviate," shesays. That meant Mavric would have to wait years to have theprocedure done the old way. "The other process was 50 years old,"she says. "They've been doing it one way forever."

But with Reinisch's help, she persisted, showing evidence of thesurgeon's success with the technique since 1991, when he firstdeveloped it.

Children's Services agreed to pay for the surgery, and last year,at age 5, Mavric had the procedure done by Reinisch.

Using a porous polyethylene substance called Medpor, Reinischcreates an ear with the material and covers it with flaps of thechild's own skin. It eliminates the need for the child to grow intoan adequate rib size, and it means that children with the deformitydon't have to endure a decade of compromised hearing, or thepossibility of 10 years of being ostracized.

"The tissue actually grows into the pores [of the artificialmaterial]," he says.

"I did the first one in 1991. It wasn't perfect by any means, buteven right away seemed to have a better shape to it. We've gottenbetter every year," Reinisch says. "We probably do 100 or so ayear." That's more than any surgeon in the country, and he wants topass the torch before he retires. "I have one [training fellow] whohas the patience and delicacy for this procedure. I feel good aboutthat, that there will be someone who can take care of thesechildren."

Some of the pediatric specialists Herrera had been seeing cautionedher that her son was too young for the long surgical procedure. Andduring the more than seven-hour surgery, she had her own doubts.When he emerged from the operating suite with bandages, swellingand draining tubes, the doubts mounted. But every day, the healingimproves and the ear looks more normal.

Seven months after surgery, he still has scars. The new ear isslightly larger than his normal ear, but he'll grow into it. Mavricis proud of his new ear. "It's getting better every day," he says.



-- Susan Brink