Total ear reconstruction

Enquiries about the content of the report should be directed to the above address. The Medicare Services Advisory Committee is an independent committee which has been established to provide advice to the Commonwealth Minister for Health and Aged Care on the strength of evidence available on new and existing medical technologies and procedures in terms of their safety, effectiveness and cost-effectiveness. This advice will help to inform Government decisions about which medical services should attract funding under Medicare. v Executive summary The procedure The total ear reconstruction procedure attempts to reconstruct a near-normal external ear in cases where the ear is absent due to a congenital abnormality or trauma. Cartilage is harvested from the patient's rib cage and modelled to form an auricle, which is implanted at the ear reconstruction site. The second stage of the operation finalises the position of the new ear. The Medicare Services Advisory Committee (MSAC) is a key element in the Commonwealth Government's strategy to strengthen the role of evidence in health financing decisions in Australia. MSAC advises the Commonwealth Minister for Health and Aged Care on the evidence relating to the safety, effectiveness and cost-effectiveness of new and existing medical technologies and procedures, and under what circumstances public funding should be supported. A rigorous assessment of the available evidence is the basis of decision making when funding is sought under Medicare. The medical literature available on the technology is searched and the evidence is assessed and classified according to the National Health and Medical Research Council (NHMRC) four-point hierarchy of evidence. A supporting committee with expertise in this area then evaluates the evidence and provides advice to MSAC. Congenital deformities of the external ear are relatively rare. The incidence in Australia is estimated to be approximately 1 in 20,000 live births per year. Even when cases that occur as a result of trauma are included, only a small number of procedures (15 to 20) are therefore expected to be performed each year. Safety The principal complications of the procedure are due to necrosis of the skin overlying the graft site, protrusion of the donor cartilage and chest deformities at the site where donor cartilage was harvested. Perioperative complications include haematoma and pneumothorax. However, the complication rate is acceptable given the excellent outcomes of the reconstruction procedure. Effectiveness The total ear reconstruction procedure can build an ear that is nearly normal in terms of its …