Luke's Broken Ear / Microtia: CHaD - Lebanon, New Hampshire

About the Title

Since Luke was 15 days old, our family has referred to Luke's microtia as his "broken ear." Luke's brother (21 months at the time) waited all day with his Gramy for us to return home from Children's Hospital in Boston. Not completely understanding why his baby brother was gone all day without him, Anthony was thrilled to see Luke again when we got home. Naturally, as all curious toddlers explore, Anthony carefully marveled at Luke sleeping in his carrier. Suddenly, he noticed that Luke's ear looked different and said, "his ear is broken!" Immediately we realized how simple describing Luke’s ear would be for the next six years. The best part about Luke's Broken Ear is that it can be fixed! We invite you to join us on our journey while Luke gets what he wasn't born with - a complete right ear.

CHaD - Lebanon, New Hampshire

Luke with his surgeon, Dr. Stotland. This is Luke's new doctor at
CHaD (Children's Hospital at Dartmouth).
We had a great day talking about Luke's first stage surgery.
Dr. Stotland explained a lot of details and how excited he was to start building Luke his ear.
http://chad.dartmouth-hitchcock.org/craniofacial/craniofacial_clinic_patient_stories.html

What is Microtia?

Microtia is a congenital deformity where the pinna (outer ear) is very small and underdeveloped. It can be unilateral (one side only) or bilateral (affecting both sides). It occurs in one out of about 8,000-10,000 births. In unilateral microtia, the right ear is most typically affected.

There are four grades of Microtia:

· Grade I: A slightly small ear with identifiable structures and a small but present external ear canal.

· Grade II: A partial or hemi-ear with a closed off or stenotic external ear canal producing a conductive hearing loss.

· Grade III: Absence of the external ear with a small peanut vestige structure and an absence of the external ear canal and ear drum (Luke is grade III).

· Grade IV: Absence of the total ear or anotia.

Surgical Process: Rib Cartilage Graft Reconstruction: It involves sculpting Luke’s own rib cartilage into the form of an ear. Because the cartilage is Luke’s own living tissue, the reconstructed ear continues to grow with Luke. In order to be sure that the rib cage is large enough to provide the necessary donor tissue, some surgeons wait until the patient is 8 years of age; however, some surgeons with more experience with this technique may begin the surgery on a child aged six – such as, the case with Luke. This surgery varies from two to four stages depending on the surgeon's preferred method. The major advantage of this surgery is that Luke’s own tissue is used for the reconstruction.

It is the night before Thanksgiving (2010) – Luke has just gone to sleep with his last words slurring, “I had a big day, Goodnight.”

Luke started his day at CHaD around 7:30 am greeted by the most amazing nurse – Shawn! Shawn also took care of Luke during his first stage surgery; and he took amazing care of Luke then . . . and again today. Luke was delighted to see Shawn again. It honestly made such a difference in Luke’s mood for surgery – just look at the picture!

Dr. Stotland decided to use a FTSG (Full-Thickness Skin Graft) instead of STSG (Split-Thickness Skin Graft). Both types have risks and benefits. FTSG results look more natural and can handle trauma better. Both the epidermis and dermis are fully grafted using FTSG and therefore cause the blood vessels to work harder to penetrate the newly transplanted skin, which can affect skin graft survival. Our family supports this decision and with either choice, we would still have to wait for at least 7 days before we know if the skin graft survives. Dr. Stotland took the skin from Luke’s groin area using a scalpel. Luke has a perfect incision in the crease of his groin area, but Luke said the sight of it makes him nervous.

Dr. Stotland also removed extra cartilage that was taken from his ribs during his first surgery that he stored in Luke’s scalp to save for this operation. And, he also removed a small bump Luke had on his cheek that remained from his macrostomia repair done at Children’s Hospital/Boston when he was 8 months old. Luke’s birth defects are categorized as hemi-facial microsomia with severe right ear microtia.

Luke is truly a brave boy, but was too exhausted to have his picture taken today after surgery. The best news is that Luke’s ear looks amazing! We can actually see and watch the recovery closely over the next week; and can truly see how beautiful it is – even with all of the swelling and stitches.

Luke is a champ! And, the surgery was a huge success! We can actually see signs of an ear – it is incredible! To our surprise, the type of “bandage” Luke has to protect his ear lets us peek easily.

It is late and Luke is resting in his private room now. Luke was taken to the O.R. just before nine o’clock this morning, June 30th and Dr. Stotland completed his surgery at 5:05 pm. Dr. Stotland is quite meticulous and spent some extra time to ensure that his measurements for Luke’s ear were precise.

Dr. Stotland was very pleased with each step of Luke's surgery and commented that Luke had a substantial amount of cartilage to harvest. Unfortunately, Luke was feeling a lot of pain in his ribs, but the wonderful PACU nursing staff treated him with lots of pain medicine – the good stuff!!

You’ll notice that Luke has a new friend, Monster that he received as a gift to take to the hospital. Monster ended up going to the O.R. with Luke. Needless to say they are both very tired and still feeling some pain.

We’ll continue to keep you posted with Luke’s recovery. To our family and friends – we thank all of you for your warm hearts and caring support.

7/27/2010 – Update

Luke had surgery less than 30 days ago!

GREAT News!! Dr. Stotland told Luke that he could officially start enjoying summertime by swimming and playing more actively with his brother and his friends. This is very exciting news since it has been less than 30 days from his first surgery. We’re looking forward to lathering on the sunscreen and having fun!

We are planning Luke’s next surgery around Thanksgiving. This will involve skin grafting and lifting Luke’s ear away from his head. Part 2 of the video link (referenced below) shows this operation performed on another brave boy, but with the difference being that Luke will not have the skin grafting done from his “back-side.” Instead, Dr. Stotland will use skin from his upper thigh or groin area.

Mrs. Gould, Luke’s first grade teacher, and family friend went with us to become more engaged with planning the date of Luke’s surgery. And, Mrs. Gould assured us that she would help Luke stay up to speed with his studies while he was away from school for his next operation.

Luke’s speedy recovery was contributed by all of the love and support he received from family and friends, his schools (Clark-Wilkins and Little Einsteins), and our community. Everyone in New England, the South, Chicago, and CHaD . . . You’ve made us feel very blessed. Thank You!!

Luke is proud to share his journey and hopes other families born with microtia are encouraged by his story.

ABOUT LUKE

I can’t wait to become a first grader! It will be great to see my old friends again and meet new ones too. Last year, my favorite part of the day was recess – which is still on the top of my list, but I am also looking forward to lunchtime!

This summer moved fast. I only got to the beach once, but had the best time! I did go swimming a lot; and my mom did a great job keeping my ear covered with zinc oxide (while my ear is healing, we didn’t want any scarring from the sun).

My journey continues as my family helps me prepare for my next surgery in November. I am a little nervous, but will keep feeling positive about it.

Luke's Broken Ear / Microtia

About the Title

CHaD - Lebanon, New Hampshire

eleanor

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