Many different congenital malformations of the external ear are encountered in otology and plastic surgery practice. However, there has been only one report in the literature of reverse (convex) conchal deformity in otherwise normal ears. Eight such cases were encountered in the combined otology and plastic surgery practice at the authors’ institution. The condition was bilateral in two patients and unilateral in six patients; these patients had no other otological abnormalities. Two patients sought surgical correction. Modified conchoplasty, done by excising and replacing the conchal cartilage in reverse fashion, is presented. Controversies surrounding the embryogenesis of concha are also addressed.

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The Z plasty is a common procedure used in scar revision. It is used to break the line of a scar. It can also be used to change the direction of a scar. This article presents a mathematical model to help select an appropriate angled Z to enable the planned change in the direction of the final scar.

M inor variations in the external ear are numerous. These include anotia, microtia, macrotia, cryptotia, prominent ears and question mark ear, in addition to the anomalies of the lobule, accessory auricle, preauricular sinus and fistula. However, Yii and Walker (1) reported one additional anomaly of the auricle. In a 12-year-old boy of Asian origin, they found that the conchae were completely reversed, being convex rather than concave, producing an obvious deformity in otherwise normal ears. The present series of eight patients with similar anomalies suggests that this condition may be underdiagnosed or neglected because of lack of other otological abnormalities. However, some patients may be affected psychologically due to the cosmetic disfigurement produced by this anomaly. The surgical correction of this anomaly, in the form of a modified conchoplasty technique, offers a simple and effective means of restoring the patient's self-confidence and well being. CASE PRESENTATIONS At the authors' institution, eight patients (Table 1) with similar anomalies of the concha, in the form of reverse conchal bowl, were encountered over a three-year period between

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