to correcting the isolated lower-pole and lobule prominence. The latter feature of conchal shape, while not the sole cause of lobular prominence, appears to play a key role. As the cartilage angle, between the concha cavum and the antitragus, becomes more acute (i.e. as the antitragus tips closer towards the concha), this supporting structure outwardly projects the lobule and the lower-third of the ear. This feature has a greater influence upon the lobule position than does the commonly described helical tail. Protruding antihelix and protruding concha combined The combined effects of an effaced antihelix and a deep concha also contribute to severe auricular protrusion (a very prominent ear). Protruding mastoid process Auricular prominence The occurrence of a prominent mastoid process tends to push the concha forward, which extends the pinna (external ear) away from the side of the head. The external ear is mounted upon the bony base of the underlying temporal bone, therefore, anomalies and asymmetries of the skeletal shape can cause either pinna, or both pinnae, to become prominent. In relation to the protruding mastoid process, the most recognizable skeletal anomaly is the change in the position and in the projection of the pinna, as associated with non-synostotic plagiocephaly (the positional flattening of the side of the head, not caused by the inappropriate union of two bones). Hence, in the occurrence of a flattening of the skull (parallelogram deformation of the cranial vault), the side of the head afflicted with occipital plagiocephaly presents a prominent ear. In subtle cases, the prominent ear might be more readily evident in an elder patient, whose ears are asymmetrically positioned, reason for which the residual occipital flattening (occipital plagiocephaly), and mild facial asymmetry, are unapparent at first view. This effect, of the shape of the patient's head, upon the outward and extended position of the ear is notably indicated in the 1881 illustrations that describe the Ely otoplasty technique. Hemifacial microsomia The undersized development of one side of a person's face, demonstrates the influence of skeletal development upon the position of the external ear on the head, as caused by the deficient morphologic development of the temporal bone, and by the medial positioning of the temporomandibular joint, the synovial joint between the temporal bone and the mandible (upper jaw). Moreover, in severe cases of hemifacial microsomia, without the occurrence of microtia (small ears), the normal external ear might appear to have been