Printer Friendly

Unusual anomaly of the external ear.

A 1-month-old white, female infant was referred to the otolaryngology service because of the unusual appearance of her left auricle. She was delivered by cesarean section at term after an attempt at vaginal delivery, following an uncomplicated pregnancy. The mother used acetaminophen sparingly during pregnancy and 1% hydrocortisone cream briefly in the third trimester. There was no family history of congenital anomalies.

Examination revealed a normal-appearing right external ear, external auditory canal, and tympanic membrane. The left ear demonstrated an unusual anomaly in which a prominent helical crus fused with the midportion of the antihelix, pinching the meatus (figure). Medial to the meatus, the external auditory canal and tympanic membrane were of normal caliber. The infant passed screening otoacoustic emissions bilaterally. The neck examination was devoid of pits, cysts, sinuses, and fistulas; there was no palatal cleft.


Morphology of the external ear follows ontogeny and embryology of the 6 hillocks of His. The first 3 tubercles are first branchial arch derivatives and form the (1) tragus, (2) helical crus, and (3) helix. Tubercles 4 through 6 arise from the second branchial arch and form the (4) antihelix, (5) antitragus, and (6) lobule. Between 6 and 12 weeks of gestation, the hillocks form and fuse, and by 20 weeks, the auricle takes on its usual appearance.

This unusual anomaly, with the helical crus bridging the concha to unite with the antihelix, represents a malformation of the first and second branchial arch derivatives. Similarly, Fischl in 1976 described a third crus of the antihelix and a prominent crus of the helix. (2) Union of the inferior crus to the helix, as well as to the convex conchac, has been reported. (3,4) Anomalies has been described with the maternal use of tretinoin cream, (5) but no external causative factors are readily apparent in this case. As in the case of prominent ears, surgical correction, if desired, should be delayed until the child is school age, to prevent interruption of auricular growth.


(1.) Lee KJ, ed. Essential Otolaryngology. 7th ed. Stamford: Appleton and Lange, 1999:11-12.

(2.) Fischl RA. The third crus of the antihelix and another anomaly of the external ear. Plast Reconstr Surg 1976;58:192-5.

(3.) Kayikcioglu H, Tuncali D, Safak T. An unusual anomaly of the antihelix. Plast Reconstr Surg 1998;102:578-9.

(4.) Yii NW, Walker CC. Unusual conchal deformity in otherwise normal ears. Plast Reconstr Surg 1996;98:726-9.

(5.) Camera G, Pregliasco P. Ear malformation in a baby born to mother using tretinoin cream. Lancet 1992;339:687.
COPYRIGHT 2004 Medquest Communications, LLC
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2004, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:Special Topics Clinic
Author:LaFrentz, John R.
Publication:Ear, Nose and Throat Journal
Date:Aug 1, 2004
Previous Article:Blindness: a sequela of sinonasal small cell neuroendocrine carcinoma.
Next Article:Hearing loss as the initial presentation of Creutzfeldt-Jakob disease.

Related Articles
Tinnitus location found in the brain.
Congenital atresia of the external auditory canal.
Initial report of a cutaneous T-cell lymphoma appearing on the auricular helix.
Fibrous dysplasia of the temporal bone.
Aberrant internal carotid artery as a cause of pulsatile tinnitus and an intratympanic mass. (Imaging Clinic).
An unusual primary intratympanic meningioma.
Glomus jugulare.
Metastasis of colonic adenocarcinoma to the external ear canal: an unusual case with a complex pattern of disease progression.
External auditory canal polyp.
Atypical presentation of cutaneous tuberculosis and a retropharyngeal neck abscess.

Terms of use | Copyright © 2018 Farlex, Inc. | Feedback | For webmasters