Discussion:
An asymmetrical mass in the oropharynx of a young patient typically
raises the possibility of malignancy and benign neoplasms,
lymphovascular lesions, and inflammatory or infection
etiologies.4 The age of our patient, imaging features
and presentation suggested a benign etiology, but the discovery of an
accessory tragus was still an unexpected rare finding. The
histopathological characteristics of hair follicles, numerous fat
lobules, and cartilage were features that helped determine that the
excised lesion was an accessory tragus.5 Previous
studies on the origins of congenital ear malformations reveal a complex
interplay between environmental and genetic factors.6The rare developmental anomaly of an accessory tragus in the oropharynx
highlights the intricacies of embryological development in the head and
neck region.
The first pharyngeal arch plays a crucial role in development, giving
rise to the maxilla, mandible, malleus, and incus, and the muscles of
mastication.1,7 Anomalies in the development of this
arch can result in a spectrum of presentations, from minor deformities
to significant congenital syndromes such as Treacher Collins and Pierre
Robin syndromes.8,9 While an accessory tragus is
commonly an isolated deformity, it is also found in association with
congenital syndromes such as Goldenhar syndrome.9
In addition to the rare finding of an oropharyngeal accessory tragus,
the patient’s hearing conductive loss was attributed to a congenital
ossicular discontinuity where middle ear exploration revealed anomalies
in the incus and stapes capitulum. A general correlation between the
severity of auricle and middle ear malformations with resultant
conductive hearing loss has been noted and highlighted by conditions
such as congenital aural artesia.6 Specific to this
case, it is curious that the incus and tragus are both derivatives of
the same first pharyngeal arch and thus, both are likely manifestations
of a singular malformation.
As far as we are aware, there is only one other reported case of a
nasopharyngeal accessory tragus, which presented in a 9-year-old with
expected nasal breathing issues.3