dr. Putri with a microtia patient, Febriyanto, three days before the surgery. (Photo: Sefya Hayu)
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UNAIR NEWS – Febriyanto (11 years old) has just undergone external ear reconstruction surgery at Universitas Airlangga Hospital, last Friday, October 6.  The boy from Kendari, Southeast Sulawesi apparently had microtia, or ear congenital deformity. Not only Febriyanto, in Surabaya many children had similar conditions.

In principle, the function of the pinna (external ear) is not just for the earrings or the glasses support only. Physiologically the pinna has an important role to ‘catch’ the sound and direct it into the ear canal.

People with microtia are different. They were born with ear deformity causing the hearing process to be disrupted. As a result, the process of growth is hampered.

The cause of microtia has not been known for sure. But plastic surgeon Craniofacial consultant FK UNAIR Indri Lakshmi Putri, dr., Sp.BP-RE (KKF) estimated that microtia is caused by several factors that may be experienced since the child was still in the womb. It could happen due to infection, nutritional factors, exposure to radiation, toxic drugs, etc.

“Through 4D ultrasound, we can detect whether the fetus has microtia or not,” she said.

Microtia can actually be resolved through reconstruction surgery, an artificial pinna surgery. E.N.T. doctor and plastic surgery team coordinate with the microtia patient.

If the patient has hearing impairment, a hearing aid is required while pinna replacement will be made from polyethylene shaft material or using ribs from the patient’s own body.

That is why this surgery should be performed on children at least 10 years of age. Because at that age, a person’s cartilage is relatively flexible to be formed.

“If the surgery is done to teenagers over 16 years old, doctors will have trouble. Meanwhile, if less than 10 years, the donor is not enough. The patient’s chest circumference is at least 60 cm, “explained dr. Putri at a MICROTIA seminar held in RSUA.

The prevalence of children with microtia is high. Apart from Surabaya, there are also patients who come to RSUA from outside Java.

“The are a lot of cases and until now Surabaya is the center of most microtia cases , ” she said.

Within a month, the dr. Putri admitted to operate up to two patients. Demand for operations increases during school holidays. In a week there are about two new patients asking for surgery.

Like Febriyanto’s parent, Sadaria was willing to come all the way from Kendari in order to get his son treated. Sadaria feels fortunate as the surgery was covered by BPJS.

Febrianto not afraid of surgery?

“Not at all, after the operation I want to have my hair cut, to look more handsome,” said the boy.

Luckily, Febrianto has the confidence to accept his physical state. This kid did not even feel inferior with his physical limitation. Dr. Putri compared to many children with microtia who eventually withdraw from social life, embarrassed by their physical limitations.

“Children with microtia are often bullied, because they have different shapes of external ears. Here, the role of parents is significant to help these children understand their condition, so microtia children remain confident despite the limitations, ” she said.

Microtia cases are varied. The most complex is a microtia case with an asymmetrical face syndrome.

“If the case is so complex, facial reconstruction surgery needs to be done as well,” she explained.

Frustrated At First

Handling a microtia patient is not easy. That was felt by the doctor in the beginning she decided to learn microtia surgery techniques in 2015. According to her, microtia  surgery is the most complicated plastic surgery.

In order to master the perfect surgery technique, the woman who was born on November 11, 1983 studied surgery techniques to several microtia  experts  from a number of countries, such as the Netherlands and Japan. Dr. Putri learned a lot of microtia surgery techniques, one of them was with Moshe Kon, MD, Ph.D from University Center Utrecht, who now serves as President of International Society Of Auricular Reconstruction.

“In this field, I was frustrated at first. The less perfect surgery result make the patient and myself less satisfied. But I realize that it all needs process and hours of experiences. Slowly and it’s much better now, ” she said.

UNAIR Hospital provides complete services for children with microtia as plastic surgeons, ENT specialists, and psychiatrists work together.

“We work on our respective portions to avoid overlapping , “said the alumnus of FK UNAIR in 2006.

In Febriyanto’s experience, after a dozen years of life without having a pair of external ears, his dream to have them finally comes true. Learning from Febriyanto, we can learn a lesson that whatever God has given to us, we must always feel grateful. (*)

Author: Sefya Hayu

Editor: Binti Q. Masruroh

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