Understanding Accessory Auricle: Causes, Symptoms, and Treatment Options

Accessory Tragus 

The accessory auricle consists of partially developed ear-piece residues that can be seen congenitally, often in front of the ear. It is a congenital external ear malformation that result of anomalous development of the first branchial arch during early embryonic development. Embryonic auricular components occur early in the fourth week of pregnancy. The ear circumference develops around the ear and gradually progresses laterally and dorsally during development. The position of the accessory auricle is related to the course of embryonic development of the three peak blocks of the first pharyngeal arch. Thus, abnormal developmental extensions may be placed in a curved triangle from the oral combined groove to the anterior atrium between the helical spine and the earlobe. Goldenhar syndrome, Wolf-Hirschhorn syndrome, Townes-Brocks syndrome, VACTERL syndrome and Treacher-Collins syndrome are can be asssociated with accessory auricle (source: Accessory auricle: Classification according to location ...).

Accessory auricle arises during fetal development due to irregularities in the formation of ear tissues. Genetic and environmental factors may contribute to its occurrence. Treatment depends on the size, location, and associated symptoms. Options include surgical removal for cosmetic reasons or if the tags cause discomfort or hinder hearing.

Symptoms

Symptoms include small skin tags or protrusions near the external ear, usually detected at birth. While typically benign, they may indicate underlying developmental anomalies.

Diagnosis

Diagnosis involves physical examination of the ear and surrounding structures. In some cases, imaging studies like ultrasound or MRI may be used to assess associated abnormalities.

Treatment of Accessory Auricle

Normally there is no problem for the patient except for the aesthetic appearance; follow-up of the patient is the right decision. Surgical treatment can be planned in order to diagnose the lesion or to eliminate the aesthetic problem and complete surgical excision is the preferred treatment method. During the operation, the excision area should include the cartilage portions associated with the accessory trauma. Incomplete excision may delay healing and increase the risk of postoperative chondrodermatitis.

Accessory atria do not disappear on their own, so surgery is required for a permanent solution. Treatment is often performed for cosmetic purposes:

Surgical Excision

This minor surgical procedure is performed under local anesthesia (local numbing).

The protrusion is completely separated from the surrounding tissue, and any cartilage within is also removed.

The procedure usually takes 10–15 minutes.

General anesthesia is sometimes preferred in children.

The scar is minimal, and stitches are used for cosmetic purposes.

Ligation – (Now Used Less Often)

This method, used in infants, involves tightly tying the base of the protrusion with special thread or plastic clips.

Because the blood circulation is cut off, it dries and falls off within a few days.

However, if there is underlying cartilage, a hardened tissue may remain under the skin.

For this reason, surgical removal is generally preferred today.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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