1. Introduction

Reconstruction of congenital microtia with an autogenous cartilage framework remains one of the most challenging procedures in reconstructive surgery because of the complex three-dimensional shape of the ear. The reconstructive surgeon must delicately carve and assemble the rib cartilage into a realistic framework that recreates the ear’s sophisticated shape and then position this framework in the proper location for the ear. In this procedure, sculpting and positioning the graft represent the greatest challenges. The following steps describe the fabrication and use of a three-dimensional appliance, known as the microtia surgical positioner, to more accurately position and better sculpt an autogenous rib cartilage graft during microtia reconstruction.