Accessory auricle

Accessory auricle

An accessory auricle is considered a developmental anomaly resulting from the persistence of a structure which variably recapitulates the normal external ear.

Signs and symptoms

Well-developed accessory auricle on the side of the neck

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.^{[1][2][3][4][5]}

Genetics

A study of a family with 11 affected showed the accessory auricle were inherited in an autosomal dominant manner.^[6]

Diagnosis

File:Ear Accessory Auricle LDRT.tif 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).^[3][4] 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.^[7] The second ear appears as a mirror image folded forward and lying on the posterior cheek.^{[citation needed]}

Differential diagnosis

These structures are distinctly different from squamous papilloma and benign teratoma.^{[citation needed]}

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.^[8] 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)^[9] and with Wildervanck syndrome.^[10][11][12] There may also be an association with congenital cartilaginous rest of the neck.^{[citation needed]}

Management

Simple surgical excision is curative.^[13] The recommended treatment is that the skin is peeled off the extra-auricular tissue and protruding cartilage remnants are trimmed.^[14] 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.^[15][16]

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.^[17]

References

Further reading

• Lester D. R. Thompson; Bruce M. Wenig (2011). Diagnostic Pathology: Head and Neck. Hagerstown, MD: Lippincott Williams & Wilkins. pp. 7:2–3. ISBN 978-1-931884-61-7. 

External links

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