Accessory auricle: Classification according to location, protrusion pattern and body shape

Abstract

BackgroundAccessory auricles (AAs) are common congenital anomalies. We present a new classification according to location and shape, and propose a system for coding the classifications.MethodsThis study was conducted by reviewing the records of 502 patients who underwent surgery for AA. AAs were classified into three anatomical types: intraauricular, preauricular, and buccal. Intraauricular AAs were divided into three subtypes: intracrural, intratragal, and intralobal. Preauricular AAs were divided into five subtypes: precrural, superior pretragal, middle pretragal, inferior pretragal, and prelobal. Buccal AAs were divided into two subtypes: anterior buccal and posterior buccal. AAs were also classified according to their protrusion pattern above the surrounding surface: pedunculated, sessile, areolar, remnant, and depressed.Pedunculated and sessile AAs were subclassified as spherical, ovoid, lobed, and nodular, according to their body shape. Cartilage root presence and family history of AA were reviewed. A coding system for these classifications was also proposed.ResultsThe total number of AAs in the 502 patients was 1,003. Among the locations, the superior pretragal subtype (27.6%) was the most common. Among the protrusion patterns and shapes, pedunculated ovoid AAs were the most common in the preauricular (27.8%) and buccal areas (28.0%), and sessile lobed AAs were the most common in the intraauricular area (48.7%). The proportion of AAs with a cartilage root was 78.4%, and 11% of patients had a family history. The most common type of preauricular AA was the superior pretragal pedunculated ovoid AA (13.2%) with a cartilage root.ConclusionsThis new system will serve as a guideline for classifying and coding AAs.

A Case Report and Literature Review of Bilateral Cervical Chondrocutaneous Branchial Remnants

“…Given that accessory auricular displays a similar cartilaginous tissue structure to CCBRs, we further elaborated on its genetic features. Of the 502 patients with accessory auricles reported by Hwang et al, 11% had a familial history [ 17 ]. Teja and Cooper reported on a family in which both the brother and sister had accessory tragus [ 18 ], while Bendet reported on a family with four generations of accessory tragus [ 19 ].…”

Accessory tragus: Report of a case in a rare location on the nasal vestibule

“…Accessory tragi are malformations that are almost exclusively located in areas derived from branchial arches. Most common is a preauricular location; less common locations include the cheek in an area extending from the angle of the mouth to the ear, as well as the lateral neck anterior to the sternocleidomastoid muscle . These locations can, in part, be understood based on the embryologic development of the external ear which begins with the formation of six hillocks located on the first and second pharyngeal arches.…”

“…These first appear during the second month of gestation in the area of the prospective angle of the mouth and subsequently move posteriorly along the cheek and fuse to form the external ear. The location of accessory tragi on the cheek and in the preauricular location has thus been explained in terms of an incomplete, arrested migration of these hillocks . A more recent, alternative hypothesis is based on observations that in mice forced expression in the first branchial arch of the protein encoded by the homeobox gene HOXA2 results in a homeotic transformation with the first branchial arch partially assuming the developmental fate of the second arch, resulting in duplication of several portions of the ear including the pinna .…”

A Post-Auricular Accessory Tragus

“…AT can also be associated uncommonly with VACTERL syndrome, Wolf-Hirschhorn syndrome, and Townes-Brocks syndrome. Accessory tragi most often occur in the preauricular region anterior to the tragus but also commonly occur within the triangular area between the oral commissure and the anterior auricle [ 1 ]. Other rare localizations include the cheek, middle ear, glabella, and the lateral aspect of the neck [ 2 , 3 ].…”