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Distinguishing isolated anomalies from syndromic conditions remains a major diagnostic challenge in fetal medicine. In this illustrated, state of the art case\u2010based review, we propose a practical, imaging\u2010driven diagnostic framework for the prenatal evaluation of auricular anomalies. Drawing on a decade of clinical experience and a curated series of representative cases, we integrate high\u2010resolution ultrasound features with a structured anatomical approach and current advances in molecular genetics. Syndromes associated with microtia and PATs are organized into 3 clinically relevant groups: branchial arch disorders, overlapping syndromic entities, and conditions in which auricular findings are non\u2010specific. Our approach is based on systematic assessment of 3 key craniofacial regions: the auricle and pretragal area, the mandible, and the zygomatic\u2010mandibular complex, combined with evaluation of craniofacial symmetry and targeted screening of extra craniofacial structures. This strategy enables pattern recognition that refines differential diagnosis and guides the appropriate use of genetic testing. Although molecular analyses contribute to etiologic characterization, their diagnostic yield remains limited in certain conditions, particularly craniofacial microsomia, reinforcing the pivotal role of detailed morphological assessment. This integrated imaging\u2010genomic approach provides a clinically applicable framework for improving diagnostic orientation, prenatal counseling, and perinatal management, and highlights the central role of ultrasound in navigating the complexity of auricular anomalies.<\/jats:p>","DOI":"10.1002\/jum.70411","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T05:57:02Z","timestamp":1786514222000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prenatal Ultrasound Approach to Auricular Anomalies and Preauricular Tags"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3462-1975","authenticated-orcid":false,"given":"Pierre","family":"Mac\u00e9","sequence":"first","affiliation":[{"name":"Diagnostic pr\u00e9natal Institut M\u00e9diterran\u00e9en d'Imagerie M\u00e9dicale Appliqu\u00e9e \u00e0 la Gyn\u00e9cologie, la Grossesse et l'Enfance IMAGE2  Marseille 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