{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T18:08:35Z","timestamp":1789063715354,"version":"build-2803163510"},"reference-count":30,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Microtia is frequently associated with temporal bone malformations, but the extent to which external ear phenotype reflects underlying CT-defined anatomy remains uncertain. This study aimed to compare the relationships of Marx severity grading and Nagata morphological classification with temporal bone anatomy in patients with microtia. Methods: This retrospective study included 26 patients with 27 affected ears who had both preoperative external ear photographs and temporal bone computed tomography (CT) examinations. Each affected ear was classified according to the Marx and Nagata systems, and temporal bone anatomy was assessed using the modified Jahrsdoerfer CT scoring system. Associations were evaluated using Spearman rank correlation and permutation-based Jonckheere\u2013Terpstra analysis, with an additional patient-level sensitivity analysis. Results: Considerable variation in Jahrsdoerfer scores was observed within external ear phenotypic categories, with substantial overlap between Marx Grades II and III and lower scores concentrated in Grade IV. The inverse association between Marx grade and Jahrsdoerfer score did not reach conventional statistical significance (\u03c1 = \u22120.380, p = 0.051), whereas the Jonckheere\u2013Terpstra test identified an overall decreasing trend (permutation p = 0.025). This trend no longer reached statistical significance in the patient-level sensitivity analysis. Nagata classification did not significantly discriminate CT-based radiological severity. Conclusions: Greater external auricular severity may be associated with less favorable temporal bone anatomy, but the relationship was not uniform across successive Marx grades. Marx and Nagata classifications provide complementary phenotypic information, but neither consistently reflected the extent of underlying temporal bone malformation. These preliminary findings emphasize phenotype\u2013CT variability and support individualized CT-based anatomical assessment when imaging is clinically indicated.<\/jats:p>","DOI":"10.3390\/jcm15187031","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T17:35:01Z","timestamp":1789061701000},"page":"7031","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Relationship Between External Ear Severity and Temporal Bone Malformation in Microtia: A Computed Tomography Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5091-0251","authenticated-orcid":false,"given":"Ekrem","family":"Solmaz","sequence":"first","affiliation":[{"name":"Department of Anatomy, Faculty of Medicine, Selcuk University, Selcuklu, Konya 42131, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8587-1125","authenticated-orcid":false,"given":"Gokce","family":"Yildiran","sequence":"additional","affiliation":[{"name":"Department of Anatomy, Faculty of Medicine, Selcuk University, Selcuklu, Konya 42131, Turkey"},{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Selcuk University, Selcuklu, Konya 42131, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5103-090X","authenticated-orcid":false,"given":"Zeliha","family":"Fazliogullari","sequence":"additional","affiliation":[{"name":"Department of Anatomy, Faculty of Medicine, Selcuk University, Selcuklu, Konya 42131, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Zekeriya","family":"Tosun","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Selcuk University, Selcuklu, Konya 42131, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1001\/archotol.1995.01890010045008","article-title":"Microtia and significant auricular malformation. Ninety-two pediatric patients","volume":"121","author":"Eavey","year":"1995","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1001\/archotol.131.4.326","article-title":"Correlation between microtia and temporal bone malformation evaluated using grading systems","volume":"131","author":"Ishimoto","year":"2005","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.ejrnm.2010.08.006","article-title":"Patients with dysplasia of the auricle and external ear abnormalities: Evaluation of the temporal bones malformation with thin-section computed tomography","volume":"41","author":"Abowarda","year":"2010","journal-title":"Egypt. J. Radiol. Nucl. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.otc.2006.10.003","article-title":"Microtia and congenital aural atresia","volume":"40","author":"Kelley","year":"2007","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"176","DOI":"10.21053\/ceo.2018.00857","article-title":"Analysis of inner ear anomalies in unilateral congenital aural atresia combined with microtia","volume":"12","author":"Park","year":"2019","journal-title":"Clin. Exp. Otorhinolaryngol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1001\/archotol.1988.01860140035016","article-title":"Correlation between high-resolution computed tomography and surgical findings in congenital aural atresia","volume":"114","author":"Mehra","year":"1988","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1288\/00005537-198909000-00004","article-title":"Congenital aural atresia","volume":"99","author":"Schuknecht","year":"1989","journal-title":"Laryngoscope"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.1097\/00005537-199812000-00007","article-title":"Congenital aural atresia: Stability of surgical results","volume":"108","author":"Lambert","year":"1998","journal-title":"Laryngoscope"},{"key":"ref_9","first-page":"131","article-title":"Die Mi\u00dfbildungen des Ohres","volume":"Volume 6","author":"Denker","year":"1926","journal-title":"Handbuch Der Hals-Nasen-Ohrenheilkunde"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1016\/j.ijporl.2013.07.002","article-title":"HEAR MAPS a classification for congenital microtia\/atresia based on the evaluation of 742 patients","volume":"77","author":"Roberson","year":"2013","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1055\/s-0037-1603957","article-title":"Otologic and audiology concerns of microtia repair","volume":"31","author":"Ali","year":"2017","journal-title":"Semin. Plast. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/00006534-199308000-00001","article-title":"A new method of total reconstruction of the auricle for microtia","volume":"92","author":"Nagata","year":"1993","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1177\/10556656241310101","article-title":"An Overview of the Currently Used Congenital Auricular Anomalies (CAA) Classifications for Surgical Reconstruction: A Scoping Review","volume":"63","author":"Lin","year":"2026","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1097\/00004728-199609000-00007","article-title":"CT evaluation of congenital aural atresia: What the radiologist and surgeon need to know","volume":"20","author":"Yeakley","year":"1996","journal-title":"J. Comput. Assist. Tomogr."},{"key":"ref_15","first-page":"Doc05","article-title":"Classification and diagnosis of ear malformations","volume":"6","author":"Wulke","year":"2007","journal-title":"GMS Curr. Top. Otorhinolaryngol. Head Neck Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2377","DOI":"10.3174\/ajnr.A8842","article-title":"Practical guide to microtia scoring: Step-by-step","volume":"46","author":"Greenhill","year":"2025","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_17","first-page":"6","article-title":"Grading system for the selection of patients with congenital aural atresia","volume":"13","author":"Jahrsdoerfer","year":"1992","journal-title":"Am. J. Otol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1001\/archotol.134.8.873","article-title":"The Jahrsdoerfer grading scale in surgery to repair congenital aural atresia","volume":"134","author":"Shonka","year":"2008","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.neurad.2012.10.002","article-title":"Does microtia predict severity of temporal bone CT abnormalities in children with persistent conductive hearing loss?","volume":"40","author":"Tekes","year":"2013","journal-title":"J. Neuroradiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1001\/archotol.1995.01890080053010","article-title":"Microtia grade as an indicator of middle ear development in aural atresia","volume":"121","author":"Kountakis","year":"1995","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"111838","DOI":"10.1016\/j.ijporl.2023.111838","article-title":"Analysis of predictive factors related to long-term hearing and temporal bone development in congenital microtia","volume":"176","author":"Wang","year":"2024","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"110764","DOI":"10.1016\/j.ijporl.2021.110764","article-title":"Congenital abnormalities associated with microtia: A 10-YEARS retrospective study","volume":"146","author":"Paul","year":"2021","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/S0030-6665(20)30313-3","article-title":"Congenital malformations of the external auditory canal","volume":"29","author":"Lambert","year":"1996","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1136\/jmg.2008.062158","article-title":"Genetics of microtia and associated syndromes","volume":"46","author":"Alasti","year":"2009","journal-title":"J. Med. Genet."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"303","DOI":"10.3109\/03005369909090114","article-title":"Clinical and radiological evaluation in children with microtia","volume":"33","author":"Calzolari","year":"1999","journal-title":"Br. J. Audiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1148\/radiol.2253010942","article-title":"Facial canal anatomy in patients with microtia: Evaluation of the temporal bones with thin-section CT","volume":"225","author":"Takegoshi","year":"2002","journal-title":"Radiology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1097\/MAO.0000000000001048","article-title":"The association of external and middle ear anomaly and mandibular morphology in congenital microtia","volume":"37","author":"Takano","year":"2016","journal-title":"Otol. Neurotol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1097\/00005537-200304000-00009","article-title":"Difference in facial canal anatomy in terms of severity of microtia and deformity of middle ear in patients with microtia","volume":"113","author":"Takegoshi","year":"2003","journal-title":"Laryngoscope"},{"key":"ref_29","first-page":"821","article-title":"Clinical aspects of temporal bone anomalies","volume":"13","author":"Jahrsdoerfer","year":"1992","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"204","DOI":"10.5152\/iao.2019.7383","article-title":"International consensus recommendations on microtia, aural atresia and functional ear reconstruction","volume":"15","author":"Zhang","year":"2019","journal-title":"J. Int. Adv. Otol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7031\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T17:36:05Z","timestamp":1789061765000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7031"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,10]]},"references-count":30,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15187031"],"URL":"https:\/\/doi.org\/10.3390\/jcm15187031","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,10]]}}}