This chapter discusses congenital anomalies of the ear, which occur due to errors during embryogenesis or as a result of intrauterine events that affect embryonic and fetal development. The most common auricular abnormalities are lop ear, Stahl’s ear, cup ear, and microtia. The convoluted appearance of the auricle is a result of the shape of the cartilaginous framework, which is composed of four main portions, which are the tragus, i. e. antitragus complex, the conchal complex, the helix–antihelix complex, and the lobule. The vascular supply to the auricle derives from the superficial temporal artery and the posterior auricular artery, both branches of the external carotid system. The auricle and external ear are derived from the mandibular and hyoid branchial arches. Microtia is thought to have a heterogeneous etiology, which includes teratogens, vascular anomalies, and genetic abnormalities. Microtia reconstruction is perhaps the most humbling endeavor undertaken by the reconstructive surgeon.