Accessory tragus: an usual aspect with uncommon location

To the Editor, Accessory tragus (AT) is a fairly common congenital malformation of the external ear. It is a moderately rare congenital condition reported in 1858 by Birkett for the first time [1]. AT is generally presented as a congenital skin-colored papule or nodule located anterior to the tragus, along an imaginary line drawn from the tragus to the angle of the mouth, or, uncommonly, along the anterior margin of the sternocleidomastoid muscle. These sites can, to some extent, be comprehended through the embryological progression of the outer ear, which initiates with the emergence of six hillocks situated on the first and second pharyngeal arches. These initially manifest during the second month of pregnancy around the anticipated angle of the mouth, later migrating backwards along the cheek before amalgamating to shape the external ear. Consequently, the presence of AT on the cheek and in the preauricular region has been elucidated as a consequence of an unfinished, halted migration of these hillocks [2,3]. AT could be an isolated malformation or be a sign of associated congenital syndromes. It is commonly linked with oculoauriculovertebral (syndrome (Goldenhar syndrome), an autosomal recessive disorder characterized by the simultaneous presence of epibulbar dermoid cysts and vertebral column defects alongside AT. Additionally, albeit less frequently, AT is associated with other autosomal dominant conditions, including mandibulofacial dysostosis (Treacher-Collins syndrome), Townes–Brocks syndrome, VACTERL syndrome, and Wolf–Hirschhorn syndrome. Treacher–Collins syndrome manifests with ocular, aural, maxillary, and mandibular anomalies, potentially impacting dental health. Townes–Brocks and VACTREL syndromes are marked by anal, aural, and renal congenital abnormalities. Wolf–Hirschhorn syndrome, is characterized by a partial deletion of chromosome 4 [4]. Surgical excision is the treatment of choice. Its histological features include a thin layer of stratum corneum with a rugated epidermis, the presence of eccrine glands, and irregular spatial positioning of vellus hair follicles accompanied by sebaceous glands [5]. Here we report a case of a newborn boy, with no history, who has had a flesh-colored lesion since birth. The examination found a pedunculated nodule traversed by telangiectasias of fibrous consistency located at the level of the right cheek (Fig. 1). The rest of the clinical examination was without abnormalities. He underwent excision and the histological results of which showed polypoid-looking skin tissue lined on the surface by a regular squamous epithelium. The dermis is fibrous with a few adipose lobules with a cartilaginous tissue in the center related to a supernumerary tragus (Fig. 2). The evolution has been marked by good clinical control with no recurrence observed after a 1-year follow-up (Fig. 3).Figure 1: Pedunculated nodule of the right cheek.Figure 2: Histological image showing a fibrous dermis with a few adipose lobules and a cartilaginous tissue in the center (HES*400).Figure 3: Control image after excision.Our case illustrates an atypical aspect of the AT by its noncartilaginous fibrous consistency and its unusual location. Acknowledgments Declaration of patient consent: The authors certify that they have obtained all appropriate patient consent forms. In the form, the parent has given consent for images and other clinical information to be reported in the journal. The patient understands that names and initials will not be published and due efforts will be made to conceal patient identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.