Prominent ears are the most common deformity of the external ear in children. Since 1881 various treatments have been described but the choice of procedure still remains at the surgeon's preference. A posterior auricular muscle malposition is frequently present in prominent ear deformity even though this muscle shows only a rudimentary function in man. This article presents a technique to reposition the posterior auricular muscle as an adjunct to conventional otoplasty. A quadrangular cartilage paddle, where the muscle inserts, is raised with the muscle as a chondro-muscular flap that can be advanced and reset more peripherally. Eighty consecutive patients, followed up for at least 12 months, have been reviewed. The posterior auricular muscle repositioning combined with a lozenge shaped conchectomy has been successfully performed in 103 ears. The cartilage paddle proved to be a strong support which facilitates the re-insertion of the muscle. Repositioning of posterior auricular muscle allows a more anatomical correction of both ear's projection and slope improving symmetry with the contralateral side.
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