Initial Visit to Dr. Sheryl Lewin - September 3, 2008

September 3, 2008.  We first visited Dr. Lewing when Ben was shy of three years old.  Initially we went to see Dr. Lewin because (1) our pediatrican had referred us to her, (2) we knew she worked with "the best surgeon for Medpor," (3) I had heard from someone at LAUSD that her ears were actually very good, and (4) she was covered by my insurance.

After visiting with Dr. Lewin, we were definitely impressed by the number of microtia repairs she had done, and by how good they looked.  Check out this YouTube video of a number of before and after Dr. Lewin patients.  Also, Dr. Lewin is very personable and nice.  While both she and Dr. Reinisch clearly have a deep love of their patients, she has a more maternal and playful personality than Dr. Reinisch.  (Update as of August 2012: As of the beginning of 2012, Dr. Lewin is no longer practicing with Dr. Reinisch.  Click on this link to see her independent practice website.)  By this point, Ben was about three +, and that is around the age when the surgery can be considered.  By the time we met with Dr. Lewin, I think that both my husband and I thought that, if we were to do Medpor, she would be just as good to go with as Dr. Reinisch, her mentor.

Dr. Lewin said that if we were considering getting the atresia repair surgery or the combined microtia/aural atresia surgery, we needed to get a CAT scan of Ben's ear anatomy to see if canalplasty were an option.  A short summary of the timing and key differences for the two methods:

• Medpor approach:
• The Medpor approach uses a synthetic medpor frame to create the shape of the ear.  The main disadvantage is concern that if the ear is traumatized through an accident or sports and the ear is cut, the medpor could be exposed and necessitate surgery to repair.
• If the patient is going to have canalplasty, the canalplasty surgery happens first, then the medpor microtia repair follows.  Surgery can begin as young as three years of age.
• This method is much newer than the rib graft method, so there aren't examples of people who have had the medpor framework for 20+ years like there are for rib graft.  However, medpor has been used in bodies for a long time; and medpor seems to last.
• Dr. John Reinisch is the pioneer of the medpor method.
• Rib Graft approach:
• The rib graft approach has been used for a much longer period of time and has a long-term track record of success.  It uses the individual's own cartilage (from between the ribs) as the framework of the ear, so any injury to the ear would heal the way the body heals.
• If using the rib graft approach to microtia repair, the microtia repair happens first and then the canalplasty follows.  Because this method requires that the cartilage be large enough to be sculpted into an ear frame shape, the child must be at least eight years of age to start surgery.  Removing the cartilage essentially requires one more "step" than the medpor approach - but the benefit is the 100% organic origins of the framework.
• Having a skilled and experienced surgeon is critical for both approaches, but it's particularly important for the rib graft approach because the cartilage framework is carved by the surgeon during the surgery.
• Dr. Burt Brent is one of the best and leading pioneers of the rib graft method.