LAUSR

C ongenital auricular anomalies have been categorized as malformational or deformational as suggested by Tan et al and Porter and Tan. Porter and Tan made a more detailed classification that encompassed all forms of congenital auricular anomalies. Malformation, such as microtia and anotia, was defined as absence of tissue of the external ear. By the ninth gestationalweek, the fetal auricular cartilage framework is fully developed. Without tissue loss, a distortion of skin or cartilage leads to auricular deformity, including prominent ear, Stahl's ear, and others. Surgery is performed in malformation cases. Various molding and splinting methods have been recommended for infants in the first 3 months of life, and if conditions do not improve, surgery would be considered. Constricted ear, including cup ear and lop ear, was classified into 3 major groups and 2 subgroups by Tanzer. Most authors regarded it as auricular deformity, whereas others believe it is a congenital malformation. No discussion or unified view about the categorization of this special auricular abnormality has been presented before. On the basis of the description of Tanzer and Tan et al and our experience, we recommend that surgeons regard constricted ear as a complex auricular abnormality. Patients in groups I and IIA have complete aesthetic units and no decrease in the size of ear. Nonsurgical methods are effective for them in the first 3 months after birth. Even if surgery is needed in some older patients, repairs could be finished without supplemental tissue. In the cases of groups IIB and III, we found that early ear molding techniques made less sense in recovering the symmetry of size between both ears. In addition, these patients would suffer loss of aesthetic units and auricular structure, which require subtotal or total ear reconstruction. Therefore, in clinical treatment, we believe that surgeons should treat constricted ears in groups I and IIA as auricular deformity, and in groups IIB and III as auricular malformation.