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Due to the variety of abnormalities, surgery of the auricle is one of the most complex challenges in facial plastic surgery. They reach from mild protruding ears or isolated abnormalities of the supporting structures, mainly the helical rim and antihelix, over cup ear deformities and miniears all the way to severe microtia and anotia. In this article, the authors present a short overview of auricular abnormalities and malformations and their treatment options based on their experiences gained over three decades of special service for patients with auricular malformations., Competing Interests: None., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Importance: For optimal aesthetic construction of the auricle in patients with severe microtia, it is important to construct an exquisite framework and place it in the correct natural position. In addition to its accurate vertical and sagittal positioning, normal elevation is of utmost importance because this determines the auricular width from the common anterior view in interpersonal communication. Many techniques have been described to stabilize the constructed auricle in the elevated position. Some of the techniques are prone to relapse (eg, simple skin transplantation), while others are intricate (eg, using cartilage, huge pedicled flaps, and free skin grafts)., Observations: The objective of the study was to describe a simple and reliable periosteal flap technique and present our experience in 158 patients with complete unilateral or bilateral ear deformity (with possible defects of the external auditory meatus) who were operated on between February 3, 2005, and August 27, 2012. Principles of the technique include elevating the framework from the posterior aspect, stabilizing it with autogenous rib cartilage, covering this with a novel periosteal flap, and skin grafting., Conclusions and Relevance: The periosteal flap technique proved to be straightforward and reliable. All flaps had unrestricted microcirculation. Good and stable projection of the auricle was achieved in all patients.

The construction of an auricle from autologous tissue is highly complex and demanding for a reconstructive surgeon. Depending on the characteristics of the underlying malformation, there are various surgical techniques available, which in specialized hands, promise regularly achievable attractive and stable results. To achieve this goal, a long-term training in super specialized centers is required. Training models available today, can partially systematize this training. The future of auricular reconstruction lies probably in the tissue engineering of organ complexes, including their nerve and vascular supply., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Severe auricular trauma is a rare injury. In addition to the type of injury, the location and the extent of the involved auricular structures have an important influence on the selection of an appropriate replantation or reattachment technique. A satisfactory primary reconstruction is not always possible to obtain and the remaining defects must be reconstructed secondary. The localization of the defect, its extent, and the condition of the tissue surrounding the defect are essential criteria for further treatment planning. This article provides an overview of the treatment of acute auricular trauma and of important aspects of secondary defect repair of the pinna., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: To compare the auricular projection results across 3 different techniques of sulcus construction in microtia repair (using a temporoparietal fascial flap, a retroauricular fascial flap from the mastoid region, or a superficial muscular aponeurotic system advancement flap)., Methods: All the patients had been photographed at least 3 months after the second stage (construction of the retroauricular sulcus) in auricular reconstruction for microtia. The auricular projection of each patient was measured, and the results of 3 different techniques were compared., Results: No statistically significant differences in the auricular projection results were observed among patients operated on using the 3 techniques., Conclusions: The superficial muscular aponeurotic system advancement flap is suitable for patients requiring middle ear and auricle reconstruction. The performance of this flap is easier, quicker, less expensive, and associated with fewer perioperative complications compared with the other 2 techniques described herein.

Although several techniques can be used for microtia repair, some standard procedures have been developed over the past few decades. In specialized centers, these techniques are performed most frequently. They include two to four operative steps using autogenous rib cartilage for the framework and local skin for its tegument. We have been using this technique presented here in more than 800 cases over the past two decades with good and mostly stable results., (Copyright Thieme Medical Publishers.)

Although the use of autogenous cartilage is the gold standard in auricular reconstruction, its main disadvantage is the morbidity due to harvesting the cartilage. This includes postoperative pain, visible scar, and possibly asymmetry and reduced stability of the thorax. To reduce all of these drawbacks, we describe some modifications that reduce pain to a low tolerable level, hide the scar invisibly in the submammary fold in females, and induce regeneration as well reestablish stability of the rib defect., (Copyright Thieme Medical Publishers.)

Auricular reconstruction is a challenging, mostly multistaged procedure that requires many different techniques. Whereas standard techniques have been developed for the standard severe, third-degree dysplasia, we are often confronted with severely scarred patients due to excess trauma or prior operations. These special situations need a variety of special techniques; some of those are described here to be considered as alternative options., (Copyright Thieme Medical Publishers.)