For correcting collapsed alae, blunt dissection of the septal mucoperichondrium through the transfixion incision is extended on both sides up to the vault of the upper lateral cartilages, which are severed from their insertion. I remodel the lower lateral cartilage and secure the lateral crus together with the upper alar groove in a less concave position with mattress sutures in cases of anterior valvular disturbance. The upper lateral cartilages are also fixed in a more convex position, particularly in cases of posterior valvular disturbance. In both anomalies a slightly convex septal or auricular slice cartilage graft placed over the concerned cartilage helps to keep the valve more open and the lateral wall in proper position. If necessary, in extreme secondary cases, one needs the help of bilateral cartilaginous or bony supports embedded subperiostally at the nasal bones.

For correcting collapsed alae, blunt dissection of the septal mucoperichondrium through the transfixion incision is extended on both sides up to the vault of the upper lateral cartilages, which are severed from their insertion. I remodel the lower lateral cartilage and secure the lateral crus together with the upper alar groove in a less concave position with mattress sutures in cases of anterior valvular disturbance. The upper lateral cartilages are also fixed in a more convex position, particularly in cases of posterior valvular disturbance. In both anomalies a slightly convex septal or auricular slice cartilage graft placed over the concerned cartilage helps to keep the valve more open and the lateral wall in proper position. If necessary, in extreme secondary cases, one needs the help of bilateral cartilaginous or bony supports embedded subperiostally at the nasal bones.

The reconstruction of the ear pavilion includes at least two stages, usually three, and in many cases more. Complete reconstruction must begin with the plastic surgeon, who sculpts the cartilaginous skeleton, assembles parts of three ribs, and inserts the finished framework under the expanded skin of the mastoid area. During the second stage, the otologist intervenes, performing the cophosurgery, carving an external auditory canal, and completing the ossicular chain in the middle ear. The plastic surgeon harvests the skin for lining the external auditory canal and for the retroauricular fold and forms the lobule with a part of the microtic vestige. The third stage is dedicated to refinements. Cophosurgery may also be performed during the third stage or in an interval between two stages of pavilion construction. Twenty-one cases are discussed.