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August 13, 2004

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Publication Date: Friday, August 13, 2004

Ear after ear Ear after ear (August 13, 2004)

El Camino Hospital sculptor and surgeon reconstructs ears

By Diana Reynolds Roome

The bronze sculpture of clasped hands just outside the main entrance to El Camino Hospital is titled "Hope and Confidence." The sculptor has molded in loving detail the muscle, ligament, joint and bone beneath the textured skin. It's clear that he understands the materials of the human body and how they are interconnected. He also knows the vital pact between a doctor and patient.

So it's hardly a surprise to discover that the artist is Dr. Burt Brent, a plastic surgeon whose skill and artistry brings people from all over the U.S. and the world to El Camino Hospital.

For more than 30 years, Brent has been reconstructing ears that are malformed, oversized, undersized or missing. He once operated on a baby whose ear was nibbled by kittens. He also reconstructed the ear of a judge, which was bitten off -- and swallowed -- by a criminal who jumped out of the box and attacked him after hearing the sentence. To date, Brent has done 1,650 ear reconstructions.

Brent is especially celebrated for an operation he developed, which creates a fully formed ear where there was only a rudimentary one before. Often the surgery addresses microtia, a condition that affects one in 7,000 to 10,000 children from birth, where there is no ear or only a small, vestigial one.

Even when there are no other physical problems, many parents are concerned about the remarks and teasing their child may have to face later in life as a result of this anomaly.

"Sarah started noticing at around 4 years-old," said Vicky Filippi, who recently brought her daughter, now 8, to Mountain View from Cleveland for the final stage of her ear reconstruction with Brent. "She wouldn't let anybody see it, though we told her that her little ear was a special ear."

The long process began for Sarah, one of non-identical triplets, after a neighbor told her family about a documentary she had seen about Brent on the Discovery Channel.

Their pediatrician had never told them that plastic surgery might be an option, said Filippi, who thought a prosthetic ear might be the only choice for her daughter and wasn't happy with the idea. "We cried after we saw the program and read the materials from Dr. Brent. We were so happy we had another option."

Sarah had the first of three or four operations that are required for the reconstruction a year ago. Probably the most critical of the series, it involves obtaining cartilage from a rib, which Brent sculpted into the correct shape to match the existing ear.

This Brent does at a small table in the operating room while the child is still under anesthesia. He works fast, with an artist's instinct for form and shape, using a small scalpel that looked much like a potato peeler.

"This is the hardest part, the whole crux," said Brent as he deftly turned, shaped and whittled. "If you mess this up, you don't have another chance."

He is guided by a template based on careful measurements of the opposite ear, taken previously at his office in Woodside. Each person's ear is unique, with arcs, pits and curls that he tries to match as exactly as possible. Once the shape and size are right, he sews together two sections of cartilage for the upper arc of the ear, which is later inserted beneath the skin behind the "nubbin" of the existing ear bud.

"I call it the ear that didn't bloom," Brent said, with a gentleness that his patients and their parents find endearing. There is also a mischievous sparkle in his eye and a readiness to pun and make jokes.

"No bones about it," he quipped, referring to the fact that the material he is working with is not bone even though it comes from the rib cage, and feels "like a very fibrous potato or carrot."

Brent doesn't necessarily know from which rib he will harvest when he goes into the chest area. "This is always a challenge. It's like going into a lumber yard and picking out the right board. Cartilage doesn't show up on X-rays, so you go in and you've got to make it work with whatever you've got."

He does, however, take it from the rib on the opposite side of the ear itself, as the curvature is more suitable. "They don't call them spare ribs for nothing" he added, of the floating ribs at the bottom, which he often uses.

Brent never had an art lesson, though by his own admission, he "came out of the womb doing art." His Lithuanian grandfather, who started painting at 72, taught him to build wood cabinets, though his father, also a doctor, told him, "Son, art's a hobby."

When the young Brent realized he "really liked helping people," he went to the University of Illinois Medical School and discovered his interest in plastic surgery. He started to work with Dr. Radford Tanzer, who had developed a method of reconstructing ears that was revolutionary at the time. Thus began Brent's quest of the perfect ear.

"It's like building a ship in a bottle," said Brent with obvious pleasure as he surveyed the results of an internal stitch that makes an earlobe appear where there was none before. Even his operating room team, including Carol Lord Glaser, who has worked with him for 17 years, seemed to appreciate the moment though they had seen it countless times before.

"When you meet him, you instantly know that he loves what he does," said Ron Jauregui, father of 10-year-old Diego, who came from Los Angeles with his family for the first-stage operation.

The love also comes through in the objects he has made -- a meticulously carved miniature shadow-box room for example -- which delight his patients. Many of them also make a point of visiting his sculpted animals: a polar bear in San Diego Zoo, for example, and the large hippo in the maternity wing of El Camino Hospital.

"This is definitely art imitating life," said Jauregui, as his son waited to go into surgery. "What [Brent] does is a piece of art for the ear."

E-mail Diana Reynolds Roome at [email protected]

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