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BACKGROUND Classic teaching of ear anatomy in the context of otoplasty states that if the antihelical fold is more prominent than the helical fold after surgery then the ear is "overcorrected." We set out to explore the role of the antihelix in normal ear anatomy, its relevance to aesthetic perceptions of the ear, and a snapshot of its incidence in nonoperated ears. METHODS To readily identify junior staff in our department, their color photographs, names, and contact details are posted on every ward. Using digital methods, we cropped the left ear out of the source images, making them unidentifiable. Clinical and nonclinical staff in our unit were asked to choose their favorite and their least favorite ears based on their aesthetic appeal. Responses were tabulated and the 2 most popular ears were compared. RESULTS The preferred ear did not conform to the traditional dogma because it had a prominent antihelix and was statistically significant when compared to other choices. We also noted that a prominent antihelix is common among the general population and among colleagues within the department, and hence "normal." Also interesting was that the helix of the ear chosen as the most aesthetic was also the ear where the helix was almost touching the side of the head. CONCLUSIONS We found that when judging the aesthetic nature of the "virgin" ear, antihelical fold prominence did not appear to be a negative attribute. Indeed, we noted that a prominent antihelix was a common attribute, and we conclude that this was a normal variant without undue negative aesthetic stigma. A surgically corrected ear should not necessarily be regarded as a poor outcome simply on the basis of antihelical prominence. Furthermore, we postulate that patients who have a prominent antihelix might be part of a spectrum of individuals who might have had the subtype of prominent ears featuring a deep conchal bowl. Finally, although not tested directly, it appears that we do not have an idea of our own ear shape, as none of the participants was able to recognize their own ear from the photographs.

Introduction Various postauricular incision sites can be used for prominent ear correction depending on technique and surgeon preference. No study has previously looked at the most aesthetic (least visible) location for the postauricular scar. We investigated the visibility of various scar locations on the posterior ear from a third person perspective through a “Visibility Arc”—a formal assessment of the range of degrees where a particular scar is visible. The objective was to determine the least visible incision—that is, the scar with the shortest visibility arc. Methods Normal ears were marked with 3 different color markers to simulate postoperative scar position, namely, (1) black in auriculocephalic sulcus, (2) blue in the sulcus of the antihelical fold/groove, and (3) green between black and blue. Starting laterally from the right ear toward the left ear, each head was photographed across 180 degrees posteriorly, at 10-degree intervals to determine which colored line (corresponding to a particular scar location) was visible over what “visibility arc.” Results Forty individual ears were analyzed. Scars located in the sulcus of the antihelical fold had the shortest average visible arc, which was a 70-degree arc. The auriculocephalic sulcus had the largest visibility arc, and was most obvious of all of the scar locations—a 100-degree arc. The scar location in between these 2 locations had an 80-degree arc. Conclusions The least visible scar for pinnaplasty rests in the groove of the antihelix posteriorly, with scars slightly medial to this almost as discrete. The most visible scars when viewed from behind will be those in the “traditional” location of the auriculocephalic sulcus.

A 26 year old man presented to the emergency department with a painful right ear after having been bitten three hours earlier during an altercation. He also reported receiving a blow to his right eye during the incident. He was normally fit and well and not taking any regular drugs. On examination, he was alert, orientated, and afebrile. His right ear and the immediate surrounding tissue were erythematous and swollen. Soft tissue from the helix was missing superiorly, and about a third of the skin covering the posterior surface of the auricle was absent. His right eye was purple and swollen, with conjunctival haemorrhage present. He had normal visual acuity and a score of 15 out of 15 on the Glasgow coma scale. ### 1 What are your most immediate concerns? #### Short answer The most immediate concern is the presence of a life threatening injury or fracture sustained through the head trauma. Human (and animal) bite wounds are also particularly susceptible to infection because of the multiple organisms found in saliva. #### Long answer The most immediate concern is the presence of a life threatening head injury and the next is the risk of infection. This patient sustained a traumatic insult to his right eye with periorbital bruising present on examination. The general principles of trauma management therefore apply. This should begin with an ABCDE (airway, breathing, circulation, disability, exposure) approach (according to Advanced Trauma Life Support guidelines) to rule out any life threatening injuries. The bruised eye should then be clinically assessed during the secondary survey, and …