Congenital microtia is more common clinically, about 1/7000, and is more common in males. In mild cases, the ear is nearly normal in outline but smaller than normal in size, and the auricle is partially curled (Figure 1); in some cases, there is no normal outline but only a small mass of cartilage or skin that is wrinkled and deformed, resembling a bologna (Figure 2), or there is only an upwardly displaced earlobe like tissue, or worse, there is no ear and the area is depressed. Microtia often has external and middle ear abnormalities, no external auditory canal or a narrow external auditory canal, and some hearing impairment. Severe cases are often associated with bony facial dysplasia, bilateral asymmetry, incomplete or complete facial nerve paralysis, etc. Timing of treatment: For bilateral malformations with atresia, an electroaudiometric evaluation should be performed as early as possible to prevent the impact on later language development. Because of the psychological impact of external ear deformities on the child and parents, early surgery is often required. At present, it is believed that surgery can be performed around the age of 6 years, because the development of the external ear is close to 85% of that of an adult, and the development of the thorax can meet the need for sculpting an ear scaffold from autologous rib cartilage, which is also conducive to the healthy psychological development of the child. In addition, the outer ear canal and middle ear surgery is best performed after the outer ear reconstruction is completed in order to maintain the integrity of the skin in the ear area and facilitate the reconstruction. Treatment: Due to the complex three-dimensional structure of the outer ear, with as many as a dozen anatomical structures, ear reconstruction has always been the most difficult of all head and facial organ reconstructions. Most of the current scaffolds for ear reconstruction advocate cutting 2-3 autologous rib cartilages for sculpting, and skin coverage can be roughly divided into expansion method, mastoid flap method and temporal fascia skin grafting method, the first two of which require two surgeries. We currently believe that the mastoid flap method has a better appearance and fewer complications, depending on the specific shape of the microtia, the skin condition of the mastoid area and the surgeon’s technical condition. Figure 1 Figure 2