CASE REPORT

Cervical aurical:A rare congenital anomaly in a one year old girl

Syed Asad Ali, S.M.Tahir, A. G. Somro, A.S. Memon, Noushad A Shaikh
Department of Surgery, Liaqaut University of Medical and Health Sciences, Jamshoro, Sind.

ABSTRACT surgical exploration and histopathology of the

One year old girl presented with history of a lesion showed hyaline cartilage covered with skin.
polypoidal neck lesion. This was present at birth (Rawal Med J 2010;35: 104-105).
and remained asymptomatic and parent's only Key words:
worry was nature of the lesion. She underwent Cervical auricle, congenital anomaly.

INTRODUCTION The girl was otherwise asymptomatic and the

What we see frequently is the accessory auricle but parents' only concern was its cosmetic appearance.
its presence at neck is rare. It is usually single but Her baseline investigations were within normal
1-3
may be multiple. The incidence of unilateral and limits. Excision biopsy was performed which
bilateral lesions has been reported as 1.7:1000 and confirmed cervical auricle on histopathology with
4
9-10:100,000 respectively with a male to female findings of hyaline cartilage covered with skin (Fig
ratio of 2:1. Cervical auricle is a congenital 2).
cartilaginous rest of the neck that presents as a firm
nodule in the lower anterior neck near the insertions Fig 2. Hyaline cartilage covered with skin.
of the sternocliedomastoid muscle. Cervical auricle
is also known as wattle, cervical tab, Meckel's
cartilaginous remnant, and elastic cartilage
5,6
choristoma. Cervical auricles have been reported
in lower animals on same anatomical site with
similar morphology as reported in humans.
Hereditary history was noted in animals with
1,2
cervical auricle. We report a recent case of cervical
auricle referred to our hospital.

CASE PRESENTATION
A one year old girl presented with a history of left
sided polypoidal neck lesion present since birth. On
examination, the lesion was painless pedunculated,
elongated, about 1x1.5cm in size; non tender,
normothermic and freely mobile. It was located in
the anterior triangle of neck on left side over middle
3rd of sternocliedomastoid muscle (Fig 1).
Fig 1. Lesion in neck.
DISCUSSION
Neck swelling in a child is a common problem;
hence knowledge of differential diagnosis and their
management is essential for a clinician. Although
most of the neck swellings in children are caused by
local infection (lymphadenopathy) or congenital
anomalies, a significant number of malignancies
can present as neck masses. If diagnosis is uncertain,
excision and histological diagnosis is essential. In
case of congenital swellings, a thorough
understanding of the embryological development of

104 Rawal Medical Journal: Vol. 35. No. 1, Jan-June 2010

 Cervical aurical:A rare congenital anomaly in a one year old girl

the head and neck is mandatory in order to plan that its presence warrant thorough evaluation to
appropriate management. asses any associated developmental defects.

The suspicion of any congenital anomaly warrants
thorough investigation for other associated
anomalies and counseling with parents should be
essential as familial preponderance of cervical
auricle has been reported.6 All suspicious lesions
should ideally be reported by attending
obstetrician/pediatrician so that a thorough
exanimation should be carried by a team of experts.
In our part of world, it is usual tendency to neglect
such examination with the results that even innocent
congenital lesion lead to drastic social problem for
the patient in his/her adult life.
Cervical auricle, although rarely, may be associated
with congenital malformations involving the first
and second branchial arches.2,4,6 In present case, the 5. Vaughan
location of cervical auricle on the middle third of the
sternocleidomastoid is contrary to its usual situation 6. Atlan G, Egerszegi EP, Brochu P, Caouette Laberge L,
near its insertion1,2 and is unique and has not been
described previously. It is, therefore, recommended
Correspondence: Dr. Syed Asad Ali, F.C.P.S
Assistant Professor, Department of Surgery,
Liaqaut University of Medical & Health Sciences.
Jamshoro. sasadalishah@gmail.com. Tel:0301-3630330.
Received: October 1, 2009 Accepted: February 2, 2010
REFERENCES
1. Bendet E. A wattle (cervical accessory tragus) Otolaryn
Head Neck Surg 1999; 121:4508-9.
2. Kuldeep T, Cooper PH. Familial occurrence of accessory
tragus. J Pediatr Surg 1981;16:725-26.
3. Miller TD, Metry DM. Multiple accessory tragi as a clue
to the diagnosis of the oculo-auriculo-vertebral
(Goldenhar) Syndrome. J Am Acad Dermatol
2004;50:11-13.
4. Jensen T, Romiti R, Altmeyer P. Accessory Tragus;
report of two cases and review of the literature. Pediatr
Dermatol 2000;17:391-94.
K, Sperling LC. Diagnosis and surgical
treatment of congenital cartilaginous rests of the neck.
Arch Dermatol 1991;127:1309 - 1310
Bortoluzzii P. Cervical chondrocutaneous branchial
remnants. Plastic Reconstr Surg 1997;100: 32-39.

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