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Prominent ear, microtia and auricular reconstruction
A prominent ear results from an absent antihelical fold or an excess conchal bowl, and is corrected with Mustardé and Furnas sutures at age 5 to 6; microtia is reconstructed with a costal cartilage framework at age 6 to 10, before any canal-opening surgery.
Why it matters in the exam
An ear is considered prominent when the angle between auricle and skull exceeds about 30 degrees or the helix-to-mastoid distance exceeds about 2 cm. In an infant, ear moulding in the first weeks of life works because maternal oestrogen affects the cartilage. In an older child: Mustardé sutures create the antihelical fold, Furnas (concha-mastoid) sutures set back the concha, and anterior scoring of the cartilage (Stenström) weakens it. The preferred age is 5 to 6, when the ear has reached most of its size. Complications: haematoma — severe one-sided pain in the first days requires opening the dressing and evacuation; "telephone" deformity — overcorrection of the middle third; "reverse telephone" deformity; recurrence; and narrowing of the ear canal from a concha-mastoid suture placed too far forward.
Microtia (sometimes with canal atresia and as part of microsomia) is reconstructed with a framework from costal cartilages 6 to 8 — by the Brent technique (several stages, from about age 6) or Nagata (two stages, from about age 10, when chest circumference reaches about 60 cm) — or with a porous polyethylene framework (Medpor) covered by a temporoparietal fascia flap. The external ear is reconstructed before the canal is opened, because scars from opening endanger the skin's blood supply. For hearing, a bone-conduction hearing device is used. An auricular haematoma after trauma is drained and bolstered to prevent "cauliflower ear". The "pixie ear" deformity after a facelift — a lobule pulled downward by tension — is prevented by tension-free closure at the lobule. The auricle's blood supply comes from the posterior auricular and superficial temporal arteries.
Key points
- Prominent ear — missing antihelix or excess concha.
- Mustardé for the fold, Furnas for the concha; age 5 to 6.
- Moulding in the first weeks.
- Microtia — costal cartilage, age 6 to 10, before canal opening.
- Auricular haematoma — drainage and pressure.
Summary table
| Condition | Finding | Treatment | Age |
|---|---|---|---|
| Prominent ear in an infant | Wide angle, missing fold | Moulding | First weeks |
| Prominent ear in a child | Missing antihelix or excess concha | Mustardé, Furnas, Stenström | 5 to 6 |
| Microtia | Absent or small auricle | Costal cartilage or Medpor framework | 6 to 10 |
| Auricular haematoma | Swelling after trauma | Drainage and bolster | Immediately |
| Post-operative haematoma | Severe one-sided pain | Opening and evacuation | Immediately |
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Sources
- Plastic Surgery (Neligan), 5th edition (2023) — Otoplasty; Microtia reconstruction
- Brent and Nagata techniques of autogenous costal cartilage ear reconstruction, 1999 and 1994 — Timing and stages
- American Academy of Otolaryngology clinical consensus on neonatal ear molding, 2020 — Timing of molding
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.