Microtia and External Ear Abnormalities
John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed in Paediatrics, The Ear, Skull Base, 2018
The pinnae are paired structures with a cartilaginous framework. The inferior part of the pinna (lobule) does not have a cartilaginous framework and is only supported by a fibrofatty matrix. The helix is the outermost cartilaginous curvature of the pinna. The curve of the antihelix runs inside and parallel to the curve of the helix. The antihelix divides superiorly to forms two crura: the superior crus and the inferior crus. The depression between the two crura is called the triangular fossa. Anterior to the antihelix is the concave depression called the concha. The conchal bowl is subdivided into the cymba concha superiorly and the concha cavum inferiorly. The elevation of cartilage anterior to the entrance of the external ear canal is called the tragus. The antitragus is the inferior-most prominence of the antihelix curvature opposite the tragus, and the gap between the tragus and the antitragus is called the intertragal notch. The cartilage of the pinna is continuous with the cartilaginous ear canal, thereby fixing it to the temporal bone along with muscles and ligaments (anterior, posterior and superior ligaments). The intrinsic muscles of the pinna are poorly developed; the extrinsic muscles (anterior, posterior and superior) may be well developed in some individuals.
Anatomy
Stanley A. Gelfand in Hearing, 2017
The antihelix is a ridge that runs essentially parallel to the posterior helix. Its upper end bifurcates to form two crura, a rather wide superoposterior crus and a narrower anterior crus, which ends under the angle where the helix curves backward. A triangular depression is thus formed by the two crura of the antihelix and the anterior part of the helix, and is called the triangular fossa. From the crura, the antihelix curves downward and then forward, and ends in a mound-like widening, the antitragus. Opposite and anterior to the antitragus is a backward-folding ridge called the tragus. The inferoanterior acute angle formed by the tragus and antitragus is called the intertragal incisure. The tragus, the antitragus, and the crus of the helix border a relatively large and cup-shaped depression called the concha. Sebaceous glands are present in the skin of the concha as well as in the ear canal. At the bottom of the concha, protected by the tragus, is the entrance to the ear canal.
Partial and Total Ear Reconstruction
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
Auricular surface anatomy is characterized by a series of ridges and depressions (Figure 96.1).2 The outer border of the upper two-thirds of the ear is framed by the elevated helix. Darwin’s tubercle is a prominence that sits on the posterior upper helix. The crus or root of the helix slopes downwards and curves posteriorly from the anterior upper third of the ear, over the superior aspect of the EAM. This ridge separates the conchal depression into the upper cymba concha and lower cavum concha. A complex elevation—the antihelix, separates the wide and deep concha from the narrow and shallow scaphal depression. The upper part of the antihelix follows the curve of the outer helix before dividing to form ‘V-shaped’ delicate ridges called the superior and inferior crura. These crura border a depression called the triangular fossa. The antihelical elevation extends towards the ear lobule to meet a short semicircular ridge – the antitragus—which is separated from the tragus by the more inferiorly placed intertragic notch or incisura. The tragus is a prominent quadrangular ridge which points posteriorly and lies over the anterior aspect of the EAM. The flat ear lobule sits inferior to the tail of the helix at the lower quarter of the ear, below the antitragus and the incisura. On the medial (cranial) surface of the auricle, the scaphal and conchal eminences are convexities that correspond to the scaphal and conchal depressions on the lateral surface described previously. The conchal eminence meets with the mastoid process to form the postauricular sulcus.
Bilateral second branchial cleft fistulae coexisting with bilateral pre-auricular fistulae: A rare case report
Published in Acta Oto-Laryngologica Case Reports, 2020
Hongli Gong, Chunping Wu, Liang Zhou, Lei Tao
A physical examination found that two small cervical openings located at the junction of the lower third of the neck and the anterior border of the SCM muscle on both sides of the neck. There was grey pigmentation on the skin surrounding the openings; the left area was approximately 5 mm × 5 mm, and the right area was approximately 2 mm × 3mm (Figure 1(A)). We also found pre-auricular fistulae on the crus of the antihelix of both ears (Figure 1(B,C)). A computed tomography (CT) scan with contrast revealed bilateral fistulae with inflammation appearing from the upper portion of the hyoid bone to the lower portion of the superior thyroid (Figure 2). Ultrasonography testing found bilateral cervical fistulae tracts that appeared to be inflamed; a renal examination revealed normal kidney structure. Kidney function showed normal results in blood tests. Pure-tone audiometry testing found normal hearing status. Based on the patient’s history, physical examination, and radiographic studies, a diagnosis of bilateral second branchial cleft fistulae and bilateral pre-auricular fistulae was made.
Devastating effect of untreated facial squamous cell carcinoma
Published in Baylor University Medical Center Proceedings, 2021
Nasim Khalfe, Ya Xu, Elizabeth May Schuele, Doris Lin
A 57-year-old nonsmoking male roofer presented to the emergency department with a progressively enlarging and painful lesion on the right side of the temple that was associated with eye pain, hearing loss, tinnitus, and headache. He first noticed a small plaque in the same area 7 years earlier but didn’t seek treatment. Two days prior to admission, he experienced a syncopal event associated with tunnel vision, lightheadedness, tinnitus, and urinary incontinence. He had taken excessive ibuprofen and smoked marijuana to quell the facial pain and headache prior to the event. Examination revealed a large erythematous and ulcerated lesion with purulent, malodorous discharge and a crusted, irregular border present at the right temple, extending medially toward the lateral canthus (Figure 1). In addition, he had multiple scaly pink macules on the left shoulder, lip, and right ear antihelix. His mental status was intact, visual acuity of the right eye was diminished, and right-sided facial sensation and gross hearing were diminished.
Second intention healing of nasal ala and dorsum defects in Asians
Published in Journal of Dermatological Treatment, 2021
Wenyan Jin, Shan Jin, Zhouna Li, Zhehu Jin, Chenglong Jin
There are some important factors in determining the method used in the reconstruction. Location is the most important predicting factor for the cosmetic outcome. In general, healed wounds are often imperceptible in NEET areas (concave surfaces of the nose, eye, ear, and temple). Wounds in FAIR areas (forehead, antihelix, eyelids, and remainder of the nose, lips, and cheeks) heal with satisfactory results accompanied by flat hypopigmented scars to many patients. However, wounds in NOCH areas (convex surfaces of the nose, oral lips, cheeks and chin, and helix of the ear) heal with more variable esthetic results. For instance, superficial wounds heal with acceptable appearance, but deep wounds heal with depressed or hypertrophic scars (12). As evidenced in this study, defects of anterior ala showed better cosmesis when compared to defects of the dorsum. Furthermore, we observed that although defects that extended from the alar groove to the cheek would develop slightly elevated scars after second intention healing, this was not obvious on frontal view. Indeed, the epithelialization and complete healing of these defects were achieved in a shorter time.