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Sculpting ears for children with deformities

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/ Korea Times
/ Korea Times

By Jung Min-ho, Kim Eil-chul


We take many things for granted ― like having two regular ears.

But one out of every 7,000 babies is born with microtia, a congenital malformation in which the pinna (external ear) is underdeveloped. Some babies are born with anotia, a congenital malformation in which the pinna is completely missing.

Children with microtia may have a hearing impairment, albeit in most cases, the impairment is not serious. A bigger challenge for them rather is the psychological problems associated with having a physical deformity, according to Park Chul, director of the Seoul Center for Developmental Ear Anomalies at Korea University Anam Hospital.

"The reason they want surgery is to feel complete as a person. It is not about mitigating a physical inconvenience," Park, 67, said in an interview. "Most children with microtia do not have hearing difficulties because they still have one good ear as well as the microtia-affected ear that works to a certain extent."

Microtia, which is much more common than anotia, can affect one or both ears but mostly affects only the right ear. The condition is about twice as common in boys than girls.

It is unclear why microtia occurs, although it seems to be hereditary in some cases: studies have shown that an individual with microtia has a less than 5 percent chance of passing it on to a child. Nevertheless, no specific gene for microtia has been identified.

Microtia becomes a problem when the children begin to mingle with their peers. Many suffer from a lack of confidence. "They often get ostracized because of their abnormality, so they grow their hair to hide their small ear," he said.

Park is the biggest hope for children with ear deformities in Korea. He pioneered the field of ear reconstruction surgery in the mid-1980s, when few doctors in the country were familiar with the procedure. Over the past three decades, he has repaired ear defects in 2,800 patients, most of them children with microtia.

"It wasn't long ago, when children with microtia had to live with it without any medical ways to help them. But today, this is no longer the case," he said. "After reaching a certain age, they can have surgery to get a new ear. I tell them not to worry."

The most common type of ear reconstruction surgery is to use the child's own cartilage to make a new ear. The main advantage of the method is that the body does not reject the cartilage because it is from the child's own tissue.

"But the method cannot be used if the cartilage is too small or too stiff. That's why the method is used only for children aged 12 to 20," Park said.

For the surgery, the doctor first has to extract a piece of rib cartilage. Then, he or she sculpts the harvested cartilage into a framework that is shaped like an ear. The doctor then implants the framework in a skin pocket underneath the mastoid region near the ear vestige where the new ear will be located. It is important for the doctor to make sure that the new ear integrates with the surrounding skin and blood vessels.

"A rich understanding of human anatomy is required for this sophisticated job," Park said.

He is one of the world's most renowned experts in ear reconstruction surgery, especially in the area of vascular anatomy. "Preserving the blood vessels is what allows a new ear to stay and look realistic. Having knowledge of the vascular pattern surrounding the auricle is very important for a successful surgery," he said.

<span>Park Chul is the biggest hope for children with ear deformities in Korea. The 67-year-old pioneered the field of ear reconstruction surgery in the mid-1980s, when few doctors in the country were familiar with the procedure. Over the past three decades, he has repaired ear defects in 2,800 patients, most of them children with microtia. / Korea Times</span><br /><br />
Park Chul is the biggest hope for children with ear deformities in Korea. The 67-year-old pioneered the field of ear reconstruction surgery in the mid-1980s, when few doctors in the country were familiar with the procedure. Over the past three decades, he has repaired ear defects in 2,800 patients, most of them children with microtia. / Korea Times

‘Your child is fine. Don't panic'


When parents see that their son or daughter has microtia, they are often traumatized. They may blame each other for the condition of the newborn, perhaps until the baby becomes old enough to understand what they are saying.

According to Park, this situation is perhaps the worst one to raise a child with microtia.

"The child doesn't know what's wrong and, in fact, there is nothing wrong," he said. "Parents need to raise the child just as they would raise any other child without microtia, especially during the child's critical stages of mental development."

Parents, though, may want to keep an eye on possible hearing impairment in their child. However, even if the child has a hearing problem, which is rare, it can be resolved with many options, such as the implantation of a bone-anchored hearing aid, also known by its acronym, BAHA.

"The way parents deal with the child's condition can affect his or her character profoundly. I have seen some children with severe depression, and I have also seen other children who talk and act just like their peers," Park said. "The child can and will grow into fine young person if the parents raise him or her well."

"Try not to draw unnecessary attention to the child's small ear and just support the child with love."

Of course, the child may want to have surgery later, if bullying becomes very serious. In that case, parents can consider the option. But it is important for them not to make their child's condition seem like a problem before anyone else does, he said.


‘Everything happens for a reason'


Park himself went through a health problem, a stomach disorder, which forced him to take a three-year leave from high school.

"After spending three years at home, I told myself, ‘I will not waste any more time once I go back to school,'" he said. "The three years at home greatly affected my mentality and my attitudes toward challenges later in life."

Park later enrolled at Yonsei University College of Medicine, graduating in 1976. He started his career as a plastic surgeon at the school-affiliated Severance Hospital in Seoul.

At the time, Korea was way behind the United States in most areas of plastic surgery, but the passionate Park nevertheless looked for an area where he can get ahead of American doctors.

He then saw a future in ear reconstructive surgery, a little-known field in both countries. From there, he devoted everything he had to studying the field.

Park soon started to be recognized in Korea and beyond as he began publishing articles in prestigious scientific journals, such as Plastic and Reconstructive Surgery, at a time when few Korean doctors even tried to do so. But his career-changing opportunities came after he was forced to leave his hospital for a hospital in Wonju, Gangwon Province.

"Working far away from Seoul, I felt left out at first," he said. "So I studied really hard at the new hospital, especially about vascular anatomy of the ear, which was poorly understood at that time," Park said. "There, I also got an opportunity to study in the United States."

From 1989 to 1992 at the Buncke Clinic in the Davies Medical Center, San Francisco, he worked with Harry J. Buncke, the late American plastic surgeon referred to as the "father of microsurgery." Buncke helped him grow as a researcher and expert in vascular anatomy, in which he later made his career, Park said.

After returning to his home country, he eventually settled in Korea University Anam Hospital, where he flourished as a researcher.

Park is the second Korean scholar to publish an article in Plastic and Reconstructive Surgery in 1988 (the first is Baek Se-min, who did so in the United States). During his career, he has published 39 articles in that journal alone, helping surgeons around the world to improve clinical guidelines for ear defects.

"Looking back, I'm glad that I went through the things that made me," he said.

"The final goal of my career is to foster people who can succeed my work in Korea as well as in developing countries."

Jung Min-ho mj6c2@koreatimes.co.kr


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