Begin by checking the upper pole or cephalic end of the oracle using the normal side as a reference and a rotting flexible curve. This is then repeated for the lower pole. Next the height of the normal oracle is measured to identify the corresponding framework size. The relationship isn't always perfect so a discrepancy may exist, but in this case the corresponding type A2 58mm template is the best match. We then measure the height of the lobule side. Ear positioning templates can be incredibly helpful in terms of capturing landmarks like the end of the eyebrow and the hairline. This process is then repeated on the affected side, tracing out the hairline. Multiple templates can be used to ensure all anatomic landmarks are being accounted for. Here the auricular rectangle is being identified to choose the ideal position of the constructed auricle. This utilizes the caudal end of the lobule to the top of the helix on the Frankfurt Horizontal Line. Here we are marking the W flap that begins with the anterior lobule portion which measures to about three centimeters here. The W flap is then continuing from the posterior to the anterior surface. The constructed auricle should be at least one ear length behind the lateral canthus. The asymmetry of the W flap can be noted here where the anterior lobule flap and the mastoid flap do not form a perfect W. This allows for adequate posterior inclination of the reconstructed auricle.

ear reconstruction

anatomical landmarks

auricular rectangle

Frankfurt Horizontal Line

symmetry