Hair Follicle Nevus Located on the Neck: Comparison with Accessory Tragus, Cervical Chondrocutaneous Branchial Remnants and Trichofolliculoma

Hair follicle nevus (HFN) is a rare, benign, follicular hamartoma that most frequently presents as a congenital nodule on the face. We experienced a rare case of HFN on the neck of a 14-year-old boy and performed a pilot immunohistochemical study with cytokeratin 19 (CK19) to compare the staining pattern of hair follicles in HFN and its differential diagnoses, accessory tragus, cervical chondrocutaneous branchial remnants (CCBR) and trichofolliculoma. With hematoxylin and eosin stain, HFN showed numerous tiny hair follicles in the dermis with several sebaceous and eccrine glands, and perifollicular fibrous thickening. With CK19 stain, some hair follicles in HFN and CCBR showed positive expression, a few hair follicles in accessory tragus showed weak expression, and no hair follicles in trichofolliculoma showed expression. The present report supports the view that HFN, accessory tragus and CCBR are within the same spectrum of hamartomas.

Accessory auricle: Classification according to location, protrusion pattern and body shape

BACKGROUND: Accessory auricles (AAs) are common congenital anomalies. We present a new classification according to location and shape, and propose a system for coding the classifications. METHODS: This study was conducted by reviewing the records of 502 patients who underwent surgery for AA. AAs were classified into three anatomical types: intraauricular, preauricular, and buccal. Intraauricular AAs were divided into three subtypes: intracrural, intratragal, and intralobal. Preauricular AAs were divided into five subtypes: precrural, superior pretragal, middle pretragal, inferior pretragal, and prelobal. Buccal AAs were divided into two subtypes: anterior buccal and posterior buccal. AAs were also classified according to their protrusion pattern above the surrounding surface: pedunculated, sessile, areolar, remnant, and depressed.Pedunculated and sessile AAs were subclassified as spherical, ovoid, lobed, and nodular, according to their body shape. Cartilage root presence and family history of AA were reviewed. A coding system for these classifications was also proposed. RESULTS: The total number of AAs in the 502 patients was 1,003. Among the locations, the superior pretragal subtype (27.6%) was the most common. Among the protrusion patterns and shapes, pedunculated ovoid AAs were the most common in the preauricular (27.8%) and buccal areas (28.0%), and sessile lobed AAs were the most common in the intraauricular area (48.7%). The proportion of AAs with a cartilage root was 78.4%, and 11% of patients had a family history. The most common type of preauricular AA was the superior pretragal pedunculated ovoid AA (13.2%) with a cartilage root. CONCLUSIONS: This new system will serve as a guideline for classifying and coding AAs.

A Case Report of Cervical Chondrocutaneous Branchial Remnants / 대한피부과학회지

No abstract available.

A Dermal Turnover Flap for Treating the Accessory Tragus

PURPOSE: Accessory tragus is a fairly common congenital malformation and usually located at pretragal area. Surgical removal is a common treatment of accessory tragus irrespective of location and morphology. Most accessory tragi do not have depression site around them, but some do. So in those cases, simple surgical excision was not enough to promote the aesthetic facial appearance. For depression site remodeling, the excess amount of skin and cartilage need to be remained partially instead of total excision. This method can achieve the symmetric contour of pretragal area. The authors excised the epidermis and cartilaginous tissue totally and remained the dermis for reconstruction of the depression site around accessory tragus. The depression site is filled with dermal turnover flap. The purpose of this report is to present new idea to promote cosmetic result in treatment of accessory tragus containing the depression site. METHODS: Two patients had a pair of accessory tragi at pretragal area. One was a common featured accessory tragus, but the other was different. Depression site was found around accessory tragus. After epidermis and cartilaginous tissue were removed from it, dermis component was used as turnover flap for reconstruction of depression site. RESULTS: After accessory tragus was removed and depression site was reconstructed, facial contour and cosmetic result was achieved. Complication such as flap necrosis and wound dehiscence was not observed. CONCLUSION: The accessory tragus has variant morphology and degree of invasive depth. And some has a depression site around them. In those cases, simple surgical removal results in morphological distorsion and do not promote facial symmetry. The authors suggest dermal turnover flap as reconstruction method of the depression site. This method improves both surgical outcome and cosmetic result.

Reconstruction of Atypical Tragus in Patients with Accessory Tragus or Macrotragus

PURPOSE: Tragus is one of the key structure of the normal shape of auricle. We experienced several cases of hypoplastic tragus with preauricular appendage. This article describes the methods of reconstruction of atypical tragus using accessory tragus or macrotragus to make better aesthetic results rather than simple excision. METHODS: From April, 2004 to March, 2009, 21 patients got operations by our method. Seven patients had bilateral deformity of tragus. Mean age was 12.7 years. For 17 cases of accessory tragus, simple excision, z-plasty and interpolation flap was performed. For 11 cases of macrotragus, debulking and z-plasty was performed. Mean follow-up period was 9.4 months. RESULTS: Reconstructed tragus looked symmetric with the opposite side in contour, size, direction and partial coverage of auditory meatus. There was no enlargement of remnant appendage for the follow up period and there was no complication such as hematoma, infection and chondritis. CONCLUSION: In cases of small and deformed tragus, preauricular tissue such as accessory tragus and macrotragus could be a good source of tragal reconstruction.

A Case of Accessory Tragus on the Nasal Vestibule

We present a case of accessory tragus (AT) which developed at an unusual site, the nasal vestibule, of a 1-day-old girl. To our knowledge, this is the first report of an accessory tragus that appears on the nasal vestibule.

A Case of Accessory Tragus on the Posterior Neck / 대한피부과학회지

Cervical accessory tragus is a rare congenital malformation presenting at birth as a firm nodule on the neck along the anterior edge of the sternocleidomastoid muscle. It has also been reported under different names, such as elastic cartilage choristoma of the neck, Meckel's cartilaginous remnant, cervical tab, cervical auricle, and wattle. Histologically, cervical accessory tragus is composed of numerous hair follicles, and a prominent connective tissue framework in the subcutaneous fat and central core of cartilage. We report a case of an 8-year-old female who presented with a solitary flesh colored papule on the posterior neck that was histopathologically diagnosed as cervical accessory tragus.

A Case of Accessory Tragus on the Posterior Neck / 대한피부과학회지

Cervical accessory tragus is a rare congenital malformation presenting at birth as a firm nodule on the neck along the anterior edge of the sternocleidomastoid muscle. It has also been reported under different names, such as elastic cartilage choristoma of the neck, Meckel's cartilaginous remnant, cervical tab, cervical auricle, and wattle. Histologically, cervical accessory tragus is composed of numerous hair follicles, and a prominent connective tissue framework in the subcutaneous fat and central core of cartilage. We report a case of an 8-year-old female who presented with a solitary flesh colored papule on the posterior neck that was histopathologically diagnosed as cervical accessory tragus.

A Case of Oculo-auriculo-vertebral (OAV) Syndrome / 대한피부과학회지

We present a patient with various features of oculo-auriculo-vertebral syndrome (OAVS), also known as Goldenhar's syndrome. In general, multiple accessory tragi in a linear distribution from the preauricular skin to the mandible or to the lateral neck suggest a diagnosis of OAVS. However, in most cases, an accessory tragus is an isolated developmental defect without an associated congenital syndrome. A female infant presented with a solitary, skin colored, sessile papule on the right lower cheek, microtia, and ear deformity since birth. A biopsy specimen showed numerous irregularly spaced hair follicles with a prominent connective tissue framework in the subcutaneous fat, but without central cartilage. Multiple congenital anomalies, including ocular lipodermoid, sensorineural hearing loss, and vertebral deformity, were found on further evaluation.

A Case of Accessory Tragus on the Neck / 대한이비인후과학회지

Accessory tragus is an embryologic developmental anomaly of the external ear. It is usually presented as congenital, firm papules located anterior to tragus; but rarely, it apprears along an imaginary line drawn between the pretragal and the angle of the mouth, or on the neck along the anterior edge of the sternocleidomastoid muscle and the sternoclavicular region. Histologically, there are numerous follicles, prominent connective tissue framework in the subcutaneous fat and central core of cartilage. The diagnosis is made by the age of onset, site of localization, and affirmative histopathology. We herein report a unique case of cervical accessory tragus on the suprasternoclavicular region in an 8 year-old-boy along with a study of embryological review and differential diagnosis.

Familial Isolated Accessory Tragi / 대한피부과학회지

Accessory tragi are an unusual congenital disorder, which are derived from a developmental abnormality of the first branchial arch. They appear at birth as soft or firm skin-colored papules or nodules, usually located in front of the auricle. There was no report of familial accessory tragi in Korean literature. Herein, we present two cases of familial accessory tragi occurring in a brother and a sister.

A Case of Cervical Accessory Tragus / 대한피부과학회지

Accessory tragus is an uncommon congenital malformation of the external ear. It is derived from the dorsal part of the first branchial arch. Usually it appears as a small skin-colored tag or nodule arising near the tragus, along an imaginary line drawn between the tragus and the corner of the mouth, or rarely on the neck along the anterior edge of the sternocleidomastoid muscle. To our knowledge there have been only one case report of cervical accessory tragus in Korean literature. We herein report a typical case of cervical accessory tragus on the left lateral side of midline of the neck in 4-year-old boy adding embryological review and differential diagnosis with hair follicle nevus.

A Case of Hair Follicle Nevus Associated with Accessory Tragus / 대한피부과학회지

Hair follicle nevus is a rare hamartoma that has numerous tiny but mature hair follicles with thick fibrous root sheaths. It occurs on the face at or after birth. It must be differentiated from accessory tragus by clinical and histological findings. We herein report a unique case of a hair follicle nevus that may be associated with an accessory tragus on the face of a neonate.

A Case of Accessory Tragus on Neck / 대한피부과학회지

Accessory tragus is a rare congenital malformation of the external ear. It is usually presented as congenital, firm papules located anterior to tragus commonly. Other less common sites include the cheek and lateral neck anterior to the sternocleidomastoid muscle. Though the possibility of occurrence on the neck, there was no reported case. We present herein a typical case of accessory tragus on the right lateral neck in 24-year-old female.

Three Cases of Accessory Tragus / 대한피부과학회지

Accessory tragi are rare congenital malformations of the external ear. They are present from birth and appear as solitary or multiple papules located between the pretragal and sternoclavicular regions. Accessory tragi may be multiple but are almost always unilateral and rarely bilateral. We report two cases of bilateral accessory tragus and a typical case of unilat,eral accessory tragus manifesting as skin-colored papules on the preauricular area.