A KwaZulu-Natal teenager underwent complex ear reconstructive surgery at Nelson Mandela Children’s Hospital last week using a revolutionary technique for the first time in South Africa in a procedure that was not only “an act of healing, but a restoration of confidence” for the youngster.
The procedure on Andile Makhaye (15), led by ENT surgeon Dr Duane Mol and Dr Tercia Tsakani Nkuna-Shilenge, was for microtia, a rare congenital condition that affects both the appearance and function of the ear, reports The Citizen.
Microtia refers to the underdevelopment of the outer ear. In place of features like the lobe, tragus and helical rim, those affected often have only a small nub of cartilage.
The surgery used the Su-por technique – the first time this procedure has been performed in South Africa.
“This South African first represents not only a technological marvel but a true opportunity to change a child’s life – a big win for us. Our department is committed to improving the lives of children with ear, nose and throat conditions,” said Dr Mogau Lamola, head of the ENT department at the Nelson Mandela Children’s Hospital.
Daily Maverick reports that the procedure was funded by the Ear and Eye Clinic in Alberton and the Give an Ear Foundation, in partnership with the Nelson Mandela Children’s Hospital.
Mol, who co-founded the Ear and Eye Clinic, said the Su-por technique used a biocompatible, porous polyethylene implant to form the ear. He described the material as strong, flexible and very resistant to cracks.
Since 2004, Mol has reconstructed outer ears for many children using a rib cartilage graft technique, which he learned in Germany from Dr Henning Frenzel, an ENT specialist from Lübeck.
The method involves harvesting cartilage from the patient’s chest, sculpting it into an ear shape and implanting it beneath the skin.
“(Frenzel) was pretty much the only guy in Germany doing this procedure, and I told him we needed this in South Africa and that I would go for some training there. Eventually, I invited him to come to South Africa so we could start doing this here for kids. In 2014, we operated on our first child here, and since then, we’ve done three or four a year,” Mol said.
The rib cartilage graft technique requires two or three surgeries, but the newer Su-por method requires only one procedure. Over the past few years, Mol has spent time in Germany mastering this surgery alongside Frenzel.
There are two methods for creating the polyethylene implant. One, which is more expensive, involves sending a 3D impression of the patient’s ear to the company that makes the device. This is then used to form a matching ear for the other side. The other involves ordering one of 24 pre-set ear shapes from the company.
Microtia
Children affected by microtia often have only a small nub of cartilage in place of the ear, and sometimes, there is no visible ear at all. Atresia, which frequently accompanies it, is the absence or closure of the ear canal.
In South Africa, microtia occurs in about one in 8 000 live births, according to Mol. At the Ear and Eye Clinic, which he established in 2017 with two colleagues, there are 41 children waiting for ear reconstruction surgery.
Makhaye, who received the Su-por implant last week, has a syndrome called hemifacial microsomia, where one side of the face is underdeveloped.
During the surgery, the team raised and reconstructed his ear, while sealing an external ear canal that does not allow him to hear. Eventually, he will require a second operation to receive a hearing implant.
The surgery was long and complex, lasting around 12 hours. A team of about 10 health professionals assisted, including Mol’s wife, Dr Therina Mol.
The complicated aspect of the surgery involved raising the temporoparietal fascia flap on the patient’s head in preparation for the implant – a thin layer of connective tissue around 14cm long and 11cm wide.
“It takes you roughly half an hour per centimetre to raise that flap … so that’s where most of the time goes. Once it’s raised, you use that flap to give blood supply to this … polyethylene implant,” said Mol, who is a consultant at the Nelson Mandela Children’s Hospital.
The health facility said the surgery presented a “valuable teaching opportunity” that will help to expand local expertise, and was observed by various professionals, including nurses and aspiring specialists, who are training to treat microtia.
The technique
There have been several barriers to implementing the Su-por technique in South Africa until now.
As microtia is relatively rare worldwide, specialised surgical expertise has been slow to gain traction. Few local surgeons see enough cases to specialise exclusively, and those who do have had to seek advanced training abroad.
Currently, there is only one company that’s licensed to 3D-print the Su-por implants, and the cost of these devices is high. For this latest surgery, the implant alone cost about R80 000.
Mol said he hoped to attract funding to provide more of the procedures in South Africa in future.
“There’s one company that services the whole world … so unfortunately, you can’t really negotiate too much on the price of the device. We’re just trying to make sure this works, so I think that’s down the line,” he said.
The hospital noted that for the patient, the procedure marked more than just a surgical milestone: it was also a chance to “hear more fully, to have more confidence in his appearance, and to grow up feeling just like other children”.
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