This congenital malformation is corrected by simple amputation, as described under minor auricular appendages. MALPOSITION OF THE AURICLE The most common deformity met with in ears is undue prominence. The ears stand out from the head at an obtuse angle, often lopping forward and downward, giving the patient a stupid appearance. This condition is usually inherited, but may be acquired during childhood by the careless wearing of caps that crowd the pinnæ forward and away from the head. The habit of ear-pulling is also said to be a cause, also the faulty position of the head during sleep. The deformity is usually bilateral, but in the majority of cases one ear usually projects more than the other. Where the deformity is recognized during infancy the ears should be simply bandaged to the head with a suitable bandage or ear cap, procurable for that purpose with the hope that the cartilages may thus be influenced during their period of hardening and growth. Invariably these patients are seen too late, and operative procedures alone will restore the ears to their normal position. The earlier in life such an operation is performed the more satisfactory is the result, inasmuch as the cartilage of the ear is more pliable, and hence more susceptible of readjustment; moreover, the operation when done early in life necessitates only the removal of an elliptical piece of skin from the back of the ear, according to Monks, and suturing of the wound, as shown in Fig. 138. [Illustration: FIG. 138.—MONKS’ METHOD.] The elliptical form of the incision must, however, be changed according to the varied prominence of various parts of the ear. When the ear lops forward, it should be broader above and narrower below, and _vice versa_ in the event when the concha is overprominent. When the patient is less than fourteen or fifteen years of age a general anesthetic should be employed, but in older patients the operation can be easily undertaken under local use of two-per-cent eucain solution. =Author’s Method.=—The method followed by the author is to thoroughly anesthetize the back of the ear, the patient lying in a recumbent position with the head to one side, sufficient to place the ear to be operated upon in as convenient position for operation as is possible. A rubber cap is drawn over the head to cover the hair. An incision is now made along the whole of the back of the ear as far down as the sulcus, where the retro-aural integument joins that of the neck. The incision should involve the skin only, and vary from three fourths to one half an inch from the outer border. At once the blood will ooze from the line of incision. The operator now presses the ear backward on the bare skin of the head, leaving an imprint of the bleeding line on the skin there. A second incision is made along this line, giving the total outlining incision a heart-shaped form, as shown in Fig. 139.