A priceless Christmas gift

Posted on 8 Dec 2020

Dr Alexander Zühlke, a specialist practicing at Mediclinic Louis Leipoldt, has been working with the Smile Foundation to children in need of life-changing reconstructive surgeries since 2008. Recently, he helped construct an innovative Christmas gift for a young girl: a new ear.

Stacey-Lee is nine years old, and a little different from her friends. She has microtia, which means she was born without an ear on the left side.

This is not an easy condition for a young girl to live with, says her mom, Eloise. “It affects her hearing, of course, which can make it difficult at school, and her peers tease her about it too. Even now she will only play with others for a short time, or just choose not to interact at all, because she’s too shy.”

The family has struggled for years to find a feasible treatment for such a rare condition. But the girl is now on the road to a normal life, with a normal-looking ear, thanks to innovative reconstructive surgery.

Smile Foundation is a South African NGO that assists children with any type of facial or other conditions to receive reconstructive surgery within South Africa. Part of their efforts is a Smile Week at the Stellenbosch University Campus at Tygerberg Hospital, which took place in November 2020.

This is where Stacey-Lee met Dr Alexander Zühlke, a specialist plastic and reconstructive surgeon practicing at Mediclinic Louis Leipoldt. “Microtia is a congenital condition where children are born with an underdeveloped ear, usually on just one side,” he explains. “It can present either along with other facial anomalies or on its own, and affects about one in 6 000 children.”

Why is it underdeveloped? A missing pinna, or external ear, is known as anotia, whereas microtia causes the appearance of small cartilaginous bumps where an ear should be. But another issue lies deeper, Dr Zühlke explains, as children with microtia often experience some hearing loss due to the closure or absence of an external ear canal and an affected middle ear. If both ears are affected this hearing loss can affect a child’s speech development and a hearing aid is necessary from a very young age.

Reconstructive surgery to repair the effect of microtia involves a similar approach to treating the effects of a traumatic ear loss, Dr Zühlke explains. “We harvest cartilage from the rib cage, by making a small incision in the chest, and carve small, specifically shaped pieces from that tissue. We suture the pieces together, and construct an ear framework in that way.”

That framework is then placed underneath the thin, local skin on the side of the head. “We can then use a suction mechanism to help the skin adhere to the framework, and at a later stage – perhaps six months later – we elevate the new ear to create a post auricular sulcus, or groove between the scalp and the ear itself.”

Dr Zühlke is a full time consultant in the division of Plastic and Reconstructive surgery at Tygerberg Hospital Stellenbosch University. He has been playing a role in Smile Week since its conception at Tygerberg Hospital in 2008 and regularly helps to treat children with genetic facial abnormalities.

The surgeries he performs for Smile Foundation are a collaborative effort in partnership with the Western Cape Department of Health, and are no longer limited to annual Smile Week events, he says, but have become a regular part of his weekly theatre list.

Published in Patients