Ear Microtia

MARCH 2018
Gavino
Manahan
Baduria
History
General Data
 LG
 NB
 Female
 Pasig
 Admitted last Sept 23, 2018
Birth History
 FullTerm
 36 year old
 G2P2(2002)
 via STAT Repeat CS in labor
 38 6/7 weeks age of gestation by
LMP
 AS 8,9
 MT 38 weeks AGA
Maternal History
 1st trimester – history of alcoholic
beverage intake until 1 month AOG
 2nd trimester – unremarkable
 3rd trimester – unremarkable
 All PNCUs done in Macau
Maternal History
 PNCU Tests:
 OGTT - normal
 HbsAg – non-reactive
 GBS – not done
 CAS – not done
 MBT – B+
Maternal History
 Maternal History
 OB History
 G1 – 2009 Live term male delivered via PCS
for arrest in cervical dilatation, no
fetomaternal complications
Past Medical History
 2002 PTB s/p 6 mos treatment
 No known allergies
 No known co-morbidities
 No prior surgeries
Family History
 Hypertension
 Noknown family history of congenital
defects, deafness
Personal, Social and
Environmental History
 Mother s a college graduate working as a
singer in Macau
 Occasional drinker and smoker prior to
pregnancy
Birth History
Events
 No history of maternal fever and fetal
tachycardia or bradycardia
 STAT Repeat CS in labor
Objective
Physical Examination
 General
 Good cry and activity
 Clear amniotic fluid
 No cord coil
Physical Examination
 Anthropometrics
 Weight: 3430 g
 Length: 51 cm
 Head Circumference: 37 cm
 Chest Circumference: 34 cm
 Abdominal Circumference: 32 cm
Physical Examination
HEENT:
 Anterior and posterior fontanels open, soft, flat
and not bulging.
 No caput
 No cephalhematoma.
 Patent nares
Physical Examination
HEENT
 No cyanosis
 No Epstein pearls
 No crepitations on clavicular area.
 Small peanut shaped ear, left
Physical Examination
Chest and Lungs
 Equal and symmetric chest expansion
 No bony deformities
 Good air entry
Physical Examination
Cardiovascular
 HR 150s.
 Regular rhythm.
 Good S1 and S2 sounds.
 No murmurs were heard.
Physical Examination
Abdomen
 Abdomen is soft, non-distended
 Umbilical vessels with 2 arteries and 1 vein
Physical Examination
 Breast and Axillae: stippled areola with 3-
4mm bud
 Pelvis and Genitourinary Tract, Rectal:
Grossly female external genitalia with
equally prominent labia majora and
minora. Anus patent.
 Back and Spine: Spine straight, with sacral
dimpling, no tufts of hair
Physical Examination
 Extremities:
Warm extremities, full and
equal pulses, no cyanosis
 Integumentary: Pink, no jaundice.
Physical Examination
 Neurologic Examination
 Flexed posture. Symmetric and
spontaneous movements of both
extremities.
 (+) Moro Reflex
 (+) Sucking Reflex
 (+) Rooting Reflex
 (+) Palmar and plantar grasp
Assessment
Admitting Diagnosis
Live term baby girl delivered via STAT repeat CS in
labor to a 36 year old G2P2(2002) at 38 6/7 weeks
AOG by LMP AS 8,9 MT 39 weeks AGA
BW 3430g BL 51cm HC 37cm CC 34cm AC 32cm

Infant with Grade 3 left ear microtia

Course in the
Wards
Upon Delivery
 Admittedin LEVEL 2 for observation
 EINC done
 Given:
 Hepatitis B 0.5ml IM
 Vitamin K 0.1ml IM
 Erythromycin eye ointment
Course in the Wards

 Screening tests done between the 24th to

48th hour of life
 Hearing Screening : R ear passed
 Advisedto follow up with ENT and Pedia-
Genetics on OPD basis
DISCUSSION
Ear Microtia
Ear Microtia
 Congenital anomaly of the auricle
ranging from mild structural abnormality
to complete absence of the ear
 More frequently in males (20-40%
increased risk)
 Mostly unilateral (77-93%), most commonly
on the right (60%)
Ear Microtia
 Mendelian inheritance more likely in
syndromic and familial cases
 Multifactorial or polygenic causes more
probable in sporadic cases
 Risk factors indentified in studies: low birth
weight, higher parity, maternal acute
illness, use of medications, maternal
diabetes, advanced maternal age, use of
retinoids, alcohol intake
Ear Microtia
 Most commonly anomalies found with
microtia: vertebral anomalies, acrostomia,
oral clefts, facial asymmetry, renal
abnormalities, cardiac defects,
microphthalmia, holoprosencephaly, and
polydactyly
https://med.stanford.edu/ohns/healthcare/earinstitute/health-
info/conditions/microtia.html
Ear Microtia
 Evaluation:
 Ultrasound of kidneys
 Hearing Screening
 Consultation with ENT to evaluate severity
of microtia, discuss reconstruction and
hearing amplification options
 Consutation with Geneticist
Ear Microtia
 Treatment
 Rib Cartilage Graft Surgical Reconstruction
(5-6 years old)
 Medpor Graft Surgical Reconstruction (3
years old)
 Prosthetics
Ear Microtia
 Increased 5% risk of having another child
with microtia.
 The risk of a child with microtia eventually
having a child of his/her own with microtia
has been estimated to be 5%.