Surgical reconstruction for congenital auriculomandibular deformities.

The patient with ear, jaw, and cephalofacial soft tissue deformity presents a challenge, the resolution of which requires a careful program of surgical reconstruction. Restoration of the concavity in the ear region caused by the underdeveloped temporal bone and the hypoplastic paratid gland should precede otoplasty to insure proper spacial positioning of the new ear on the skull. The parotid-mastoid mound may be effectively augmented with autogenous jump-flap pedicled tissue, autogenous bone grafting, microvascular free-flap tissue transfer and alloplastic implants. Cartilage of Silastic frames may be used for subsequent otoplasty. When Silastic frames are used in ear reconstruction, we strongly recommend prophylactic use of a protective fascial-periosteal "fan" flap.