Prenatal Ultrasound Approach to Auricular Anomalies and Preauricular Tags: A Structured Imaging-Based Diagnostic...

Auricular anomalies, including microtia and preauricular tags (PATs), are frequently overlooked findings on prenatal ultrasound, yet they may represent the earliest and sometimes the only clue to a wide spectrum of craniofacial and multisystem disorders. Distinguishing isolated anomalies from syndromic conditions remains a major diagnostic challenge in fetal medicine. In this illustrated, state of the art case-based review, we propose a practical, imaging-driven 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-resolution 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-specific. Our approach is based on systematic assessment of 3 key craniofacial regions: the auricle and pretragal area, the mandible, and the zygomatic-mandibular 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-genomic 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.