Auricular reconstruction for microtia: part I. Anatomy, embryology, and clinical evaluation.

In the first of a two-part series, we review issues pertinent to the anatomy, embryology, and criteria for comprehensive management of children with microtia. The salient aspects of external ear anatomy, including the nerve and blood supply, lymphatic drainage, and aesthetic anatomic relationships, are described. An overview of the embryologic development of the external and middle ear and its relationship to auricular deformities is presented. The clinical spectrum of microtia and its classification are discussed. The appropriate initial evaluation of these patients and the rationale and criteria for middle ear surgery are reviewed. Options for treatment, optimal timing, and coordination of the otologic and plastic surgical management of these children are discussed. The surgical techniques for external ear reconstruction, including autologous and prosthetic methods, both historic and contemporary, are briefly discussed.