ANATOMY OF EXTERNAL

EAR
BY: INDERDEEP SINGH ARORA
 External Ear

 PINNA  EXTERNAL
ACOUSTIC
MEATUS
 DEVELOPMENT OF
EXTERNAL EAR
 At 4-6wks-
 External ear develops from 6 auricular
Hillocks of His
 First 3 Hillocks arise from 1st branchial
arch
 Rest 3 Hillocks arise from 2nd
branchial arch
Contd……………………
 At 8-9 wks Hillocks fuse to form
primordia of auricle
 At 20th wks the pinna achieve adult
shape
 Hillock 1-tragus
 Hillock 2-root of helix
 Hillock 3-crus of helix
 Hillock 4-antihelix
 Hillock 5-antitragus
 Hillock 6-lower helix,lobule
Contd………………………

 The embryonic pinna begins caudal to

the growing mandible and then it is
placed more cephalad and posterior
 By end of 2nd trimester,the pinna
reach adult location at the side of
neck

 External auditory canal-
 Develops from 1st branchial cleft
 1st branchial cleft-ectoderm-dorsal
and ventral portion
 Dorsal persists, ventral disappears
 At 4th week ectoderm invaginates and
lies adjacent to endoderm of 1st
pharyngeal pouch
 At 5th week-mesoderm grows
between ectoderm and endoderm
 By 16th week –meatal plug forms,
which remains solid till 21st wk
 By 21-28 wks medial plate begins to
degenerate
 At birth floor of bony canal is partially
ossified
 The bony canal is ossified by 3-4yrs
 Incomplete ossification in
anteroinferior canal-foramen of
Huschke
Pinna

 SYN:AURICLE
 Bilaterally symmeteric cartilage frame
that helps in focussing and localising
sound
 2 SURFACES-LATERAL AND CRANIAL
 LATERAL-irregularly concave,directed
forwards
Landmarks of pinna

 Helix
 Antihelix
 Darwin’s tubercle
 Fossa triangularis
 Scapha
 Concha-
 Cymba conchae
 Cavum conchae
Contd………………………..

 Tragus
 Anti tragus
 Intertragic notch
 Lobule

 Cranial surface
 Eminentia concha
 Eminentia triangularis
Cartilage of pinna

 Yellow fibroelastic cartilage

 Parts-
Spina helicis
Cauda helicis
Fissura antitragohelicis
Sulcus antihelicis
transversus
Ponticulus
CONTD…………………

 Cartilage is avascular
 Derives its nutrition from
perichondrium
 On lateral side skin is thin and tightly
attached
 On medial side skin loosely attached
with a layer of subdermal adipose
tissue
Muscles of pinna

 2 groups
 Extrinsic muscle
 Intrinsic muscle
 Extrinsic-
 Auricularis anterior
 Auricularis superior
 Auricularis posterior
 Intrinsic muscle
 Helicis major
 Helicis minor
 Antitragus
 Tragicus
 Transverse

auriculi
LIGAMENTS

 Extrinsic Ligaments
 Anterior ligament-It runs from tragus
and spina helicis to root of zygomatic
process
 Posterior ligament-It runs from
eminentia concha to outer surface of
mastoid process
Blood supply

 Branches of external carotid

 Posterior auricular artery-

 Medial surface[except lobule]
 Conch
 Medial and lower portion of helix
 Lower part of antihelix
 Anterior auricular branch of superior
temporal artery
 Upper portion of helix,antihelix
 Triangular fossa
 Tragus
 Lobule
LYMPHATIC DRAINAGE

 From posterior surface –lymph node

at mastoid tip
 From tragus and upper part of
anterior surface-preauricular nodes
 Rest of the auricle-upper deep
cervical nodes
Nerve supply
 Greater auricular [C2,C3]-medial
surface and posterior portion of
lateral surface
 Lesser occipital[C2,C3]-superior
portion of medial surface
 Auricular[Vagus X]-concha,eminentia
concha and antihelix
 Auriculotemporal[Vc mandibular]-
tragus,crus of helix
 Facial VII-small region in the root of
concha
External auditory meatus

 Extension-from the concha to the

tympanic membrane
 Length-approximately 2.4cm
 Volume-2ml
 Diameter-8mm
 Supporting framework-
 Cartilage-lateral 1/3 rd

 Bone-medial 2/3rd
 Shape-’s’ shaped
 Directed inwards ,downwards,
forwards
 Cartilage part is 8mm long
 Medial border of cartilage attached to
body canal by fibrous bands
 Bony canal 16mm long
 Narrower than cartilageneous part
 Medial end of bony canal marked by a
groove,the TYMPANIC SULCUS,which
is absent superiorly
 Most of the bony canal made up of
tympanic bone except roof which is
formed by squamous bone
 2 suture line exist
 Tympanosquamous [anteriorly]
 Tympanomastoid [posteriorly]
 2 constrictions occur

1. At the junction of cartilagenous and

bony portion
2. Isthmus,5mm from the tympanic
membrane
 Skin-keratinised squamous
 There is outward,oblique growth of
epidermis of canal skin
 Normal rate of migration is 0.1mm
per day
 Cartilageneous portion -0.5-
1mmthick,dermisand subcut.layer
contains hair follicle and glands
 Glands-ceruminous [modified
apocrine sweat glands],sebaceous
glands
 Bony canal skin-0.2mm,attached to
periosteum
Blood supply

 Branches of external carotid

 Auricular branch of superficial
temporal-roof and anterior portion
 Deep auricular branch of maxillary
artery-anterior meatal wall
 Auricular branch of posterior auricular
artery-posterior portion
 Veins drain into external jugular
vein,maxillary vein,pterygoid plexus
Relations

 Superiorly-middle cranial fossa

 Posteriorly-mastoid air cells
 Medial-middle ear
 Anterior-temporomandibular joint
 superficial temporal vessel
 auriculotemporal nerve
 parotid gland
 preauricular lymph node
 Inferiorly-jugular bulb
 external carotid
 facial nerve
 styloid process
 parotid
 digastric muscle
Nerve supply

 Anterior wall and roof-

auriculotemporal[V3]
 Posterior wall and floor-auricular
branch of vagus[X]
 Posteriosuperior wall receives sensory
fibers of facial nerve through
auricular branch of vagus
Lymphatic drainage

 Similar to that of pinna i.e

preauricular nodes,upper deep
cervical lymph nodes
 surgical importance
 Pinna as a source of graft material for
reconstruction surgeries of middle ear
 Conchal cartilage can be used to
correct the depressed Nasal Bridge
and Nasal Ala
 Incisura Terminalis-
 This is the area where no cartilage
between tragus and helix
 An incision made in this area will not
cut through cartilage and is used for
Endaural approach in surgery of ear
Contd……………………………

 Syndromes associated with arrested

development of 1st and 2nd brachial
arch deviation leading to
retroverted,malformed and low
set,more anteriorly placed pinna are
Treacher Collins Syndrome,Hemifacial
Microsomia,Nager Synd,Klippel Fleil
Synd
Contd…….
 Disturbances in external ear growth
associated with other systemic
defects-
CHARGE,VATER,VACTERL,Townes
Brocks syn.,Winderwanck S.,Brachio-
oto-renal S.
1st branchial cleft anomalies result in
early disruption of hillock fusion
 Duplicated ext. auditory canal
 Persistent embryonic tract-callaural
fistula
 Cat’s ear- Auricle is folded forward
and downward.
 Wildermuth ear- Antihelix is more
prominent then helix.
 Mozart ear- Enlarged antihelix that is
continuous with the helix.
 Lop ear/bat ear-disrupted cartilage
formation of helix,fold of antihelix is
absent,.angle of projection is more
 Cup ear-disrupted cartilage formation
of concha
 Microtia-associated with Hemifacial
Microsomia,Gondenhar syn.,oculo
auriculo vertebral dysplasia
 Macrotia-associated with Marfan
syn.,Fragile X syn.
 Most exagerrated portion is scaphoid.
 Anotia-complete absence of pinna
 Absent lobule-seckel syndrome
 Auricular cleft-associated with
holoprocencephaly
 Melotia-ear located on cheek
 Synotia-Bow-Tie ear-AGNATHIA
SYNOTIA MICROSTOMIA SYN.
 Auricular appendages-located
infront,behind,within,on the lobule.
 On medial layer of pinna there is
subdermal adipose tissue which
allows dissection during pinnaplasty
surgery.
 Superior auricular artery connects
superficial temporal & post. Auricular
artery. This branch provides reliable
vascular pedicle for retro auricular
flaps.
 By 5-6 yrs of age auricle is 80% of
adult size. This is appropriate time for
surgical management of deformities
of pinna.
 BOXER’S EAR
 Atresia of EAC- Failure of canalisation
of ectodermal core that fills dorsal
part of first branchial cleft.
 Foramen of Huschke- Ant. Inferior
part of bony canal may present
deficiency in children upto age of 4 or
more, permitting infection to and
from the parotid.
 Fissure of Santorini- 2-3 in no. in
cartilaginous portion , through them
the parotid or mastoid infection can
enter EAC or viceversa.
 Tympanomastoid and
tympanosquamous sutures are
landmarks for vascular stripe
incisions.
Thank you