Accessory auricle explained

Accessory auricle
Field:	dermatology

An accessory auricle is a congenital anomaly typically seen as a skin coloured nodule, most frequently just to the front of the ear.^{[1] [2]}

Signs and symptoms

The general presentation is of a skin-covered nodule, papule, or nodule of the skin surface, usually immediately anterior to the auricle. However, it may be anywhere within the periauricular tissues. Bilateral presentation can be seen.^[2]

Genetics

A study of a family with 11 affected showed the accessory auricle were inherited in an autosomal dominant manner.^[3]

Diagnosis

The lesions presents as a nodule or papule, either sessile or pedunculated. They may be soft or have a cartilaginous structure. By histologic examination, it is a recapitulation of normal external auricle. There will be skin, cartilaginous structures, and cartilage (although the later is not seen in all variants of this disorder).^{[4] [5]} Some investigators believe that the tragus is the only hillock which is derived from the first branchial arch. This is clearly suggestive that true cases of Accessory Auricle represent a true duplication of the hillocks that were part of the second branchial arch.^[6] The second ear appears as a mirror image folded forward and lying on the posterior cheek.

Differential diagnosis

These structures are distinctly different from squamous papilloma and benign teratoma.

Classification

The several components or degrees of development range from an ear tag, preauricular appendage, preauricular tag, or accessory tragus, to supernumerary ears or polyotia.^[7] It is a relatively common congenital anomaly of the first branchial arch or second branchial arches. Other anomalies may be present concurrently, including cleft palate, cleft lip, or mandibular hypoplasia. There is a known association with Goldenhar syndrome (oculo-auriculo-vertebral syndrome)^[8] and with Wildervanck syndrome.^{[9] [10] [11]} There may also be an association with congenital cartilaginous rest of the neck.

Management

Simple surgical excision is curative.^[12] The recommended treatment is that the skin is peeled off the extra-auricular tissue and protruding cartilage remnants are trimmed.^[13] Normal appearance is achieved in majority of cases. The reconstruction successful in true cases of accessory auricle, as it also is in individuals with auricular appendages.^{[14] [15]}

Epidemiology

These lesions usually present in neonates, although they may not come to clinical attention until adulthood (for cosmetic reasons). There is no gender predilection. They are present in approximately 3-6 per 1000 live births.^[16]

Further reading

• Book: Lester D. R. Thompson . Bruce M. Wenig . Diagnostic Pathology: Head and Neck . . Hagerstown, MD . 2011 . 7:2–3 . 978-1-931884-61-7 .

Notes and References

1. Hwang . Jungil . Cho . Jaeyoung . Burm . Jin Sik . Accessory auricle: Classification according to location, protrusion pattern and body shape . Archives of Plastic Surgery . September 2018 . 45 . 5 . 411–417 . 10.5999/aps.2018.00430 . 30282411 . 6177632 .
2. Book: Cardesa, Antonio . https://books.google.com/books?id=ag4bDgAAQBAJ&pg=PA397 . Pathology of the Head and Neck . Slootweg . Pieter J. . Gale . Nina . Ann . Sandison . 2016 . Springer . 978-3-662-49670-1 . Franchi . Alessandro . 397 . en . 8. Ear and temporal bone.
3. Yang . Y . 1196716 . et al . A locus for autosomal dominant accessory auricular anomaly maps to 14q11.2–q12 . . 2006 . 120 . 1 . 144–147 . 10.1007/s00439-006-0206-1 . 16775710.
4. Jansen . T. . Romiti . R. . Altmeyer . P. . 2000 . Accessory tragus: Report of two cases and review of the literature . . 17 . 5 . 391–394 . 10.1046/j.1525-1470.2000.017005391.x . 11085670 . 19325370.
5. Brownstein . M. H. . Wanger . N. . Helwig . E. B. . 1971 . Accessory tragi . . 104 . 6 . 625–631 . 10.1001/archderm.1971.04000240049006 . 5131708.
6. Book: Stevenson . Roger E. . Hall . Judith G. . Human Malformations and Related Anomalies . . 2005 . 978-0199748082 . 339–340 . 2nd.
7. Lam . J. . Dohil . M. . 10.1111/j.1525-1470.2007.00560.x . Multiple Accessory Tragi and Hemifacial Microsomia . . 24 . 6 . 657–658 . 2007 . 18035991 . 19272462 .
8. Konaş . E. . Canter . H. I. . Mavili . M. E. . Goldenhar complex with atypical associated anomalies: Is the spectrum still widening? . . 17 . 4 . 669–672 . 2006 . 16877912 . 10.1097/00001665-200607000-00011.
9. Tadini . G. . Cambiaghi . S. . Scarabelli . G. . Brusasco . A. . Vigo . P. . Familial occurrence of isolated accessory tragi . . 10 . 1 . 26–28 . 1993 . 8493161 . 10.1111/j.1525-1470.1993.tb00006.x. 20872067 .
10. Gao . J. Z. . Chen . Y. M. . Gao . Y. P. . A survey of accessory auricle anomaly. Pedigree analysis of seven cases . . 116 . 10 . 1194–1196 . 1990 . 2206506. 10.1001/archotol.1990.01870100088019 .
11. Resnick . K. I. . Soltani . K. . Bernstein . J. E. . Fathizadeh . A. . Accessory tragi and associated syndromes involving the first branchial arch . . 7 . 1 . 39–41 . 1981 . 7204730 . 10.1111/j.1524-4725.1981.tb00591.x.
12. Pan . B. . Qie . S. . Zhao . Y. . Tang . X. . Lin . L. . Yang . Q. . Zhuang . H. . Jiang . H. . 10.1016/j.bjps.2009.06.037 . Surgical management of polyotia . . 63 . 8 . 1283–1288 . 2010 . 19617017 .
13. Book: Scott-Brown's Otorhinolaryngology . Hodder Arnold . 978-0-340-808-931 . 969 . 7th. 2016-06-15 .
14. Ku . PK . Tong . MC . Yue . V . Polyotia- a rare external ear anomaly . . 1998 . 46 . 1–2 . 117–20 . 10.1016/S0165-5876(98)00152-9. 10190712 .
15. Bendor-Samuel . RL . Tung . TC . Chen . YR . Polyotia . . 1995 . 34 . 6 . 650–2 . 7661545. 10.1097/00000637-199506000-00015 . 220587660 .
16. Book: Rapini, Ronald P. . Bolognia, Jean L. . Jorizzo, Joseph L. . Dermatology: 2-Volume Set . . St. Louis . 2007 . 978-1-4160-2999-1 . 894.