Accessory tragus is a fairly common congenital malformation of the external ear. In the vast majority of cases it is an isolated developmental defect not associated with other abnormalities. 

The accessory tragus can be found along the entire course of embryonic migration. It is usually located unilaterally in the preauricular region.

The lesion may be solitary or multiple, unilateral or bilateral, sessile or pedunculated.

Accessory tragus is a consistent feature of the oculoauriculovertebral syndrome (Goldenhar syndrome).

Gross features:  Clinically presents as a nodule covered by skin.

Histological features : Shows numerous tiny mature hair follicles in various phases, and central cartilage. The presence of cartilage is not essential. Of importance is the prominent connective tissue framework in the subcutaneous fat that seems to be one of the diagnostic criteria for accessory tragi.

When correctly identified, surgical excision of accessory tragus is quite simple and rarely results in any complications.

Definition of malformations of the tragus is important for terminology and treatment. Most common entities are the skin tag, accessory tragus, preauricular sinus, and cyst, whereas macrotragus is an uncommon and unaddressed deformity that should be distinguished from these. In this report, three cases with diagnosis of the macrotragus are presented. The tragus was uniformly large and displaced anteriorly, and external auditory meatus was not obliterated in all cases. For correction, excision of the excess tragal cartilage and skin was performed. In all cases, bilaterally symmetric tragus was achieved. There were no complications in the early postoperative period and there was no enlargement after 6 months of observation. Macrotragus and accessory tragus are different entities that should be distinguished for accurate diagnosis. They have similar histopathological but distinct anatomical characteristics. Although both are treated by a simple excision, in the case of macrotragus, special effort should be taken to leave enough cartilage to restore normal tragal contours.

Accessory tragus: A report of 2 cases.J Dent Child (Chic). 2006 Jan-Apr;73 (1):42-4.

The purpose of this article was to review the embryology of the external ear, as related to the clinical finding of accessory tragus (ear tags). Medical management of the accessory tragus is discussed, as well as differential diagnoses and associated syndromes. A general clinical description of accessory tragus is described, and 2 specific cases in pediatric patients are presented.

Accessory tragus: report of two cases and review of the literature.Pediatr Dermatol. 2000 Sep-Oct;17(5):391-4.

Accessory tragus is a fairly common congenital malformation of the external ear. In the vast majority of cases it is an isolated developmental defect not associated with other abnormalities. However, the remote possibility exists that it could be associated with other abnormalities of the first and second branchial arch. Accessory tragus is a consistent feature of the oculoauriculovertebral syndrome (Goldenhar syndrome). When correctly identified, surgical excision of accessory tragus is quite simple and rarely results in any complications.

Hair follicle nevi and accessory tragi: variable quantity of adipose tissue in connective tissue framework. Pediatr Dermatol. 1997;14(6):433-6

Controversy exists about the histologic differences between hair follicle nevi and accessory tragi. We examined 10 congenital lesions histologically, possible diagnoses of which were hair follicle nevi or accessory tragi. Two specimens out of the 10 had tiny, mature hair follicles surrounded by thick fibrous root sheaths, a few fat cells, and no cartilage. The subcutaneous fat cells of their bases were segmented by a connective tissue framework. They had histologic features of hair follicle nevi. One specimen had cartilage and abundant fat cells with a connective tissue framework in the nodule, as well as a conglomeration of numerous well-differentiated hair follicles. It possessed both elements of a hair follicle nevus and an accessory tragus. Seven specimens had abundant subcutaneous fat and showed a prominent connective tissue framework. These were typical accessory tragi. The present study suggests that the number of fat cells in the nodule or papule differs between these two conditions. All the lesions studied revealed a connective tissue framework in the subcutaneous fat. Histologic features of both hair follicle nevi and accessory tragi can coexist in a single lesion. Hair follicle nevi may represent incomplete accessory tragi with scant fat cells.

Bilateral accessory tragus. Cutis 1993 Mar;51(3):199-200.

Bilateral accessory tragus is a rare congenital malformation of the external ear. An isolated, nonfamilial occurrence of bilateral accessory tragus in a forty-three-year-old man is presented, and the literature is reviewed. Congenital firm, preauricular papules should be recognized as accessory tragi.

Histological diagnostic criteria for accessory tragi. J Cutan Pathol. 1990 Aug;17(4):206-10.

The histological features of accessory tragi from 13 patients were analyzed. All the lesions showed numerous tiny mature hair follicles in various phases, while the presence of cartilage was not essential. Of importance was the prominent connective tissue framework in the subcutaneous fat that seemed to be one of the diagnostic criteria for accessory tragi.

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Bilateral accessory tragi on the suprasternal region. J Dermatol. 1997 Aug;24(8):543-5.

We report a 25-year-old man who had two protruding firm masses on his suprasternal region. These lesions were present at birth without any family history. He had no other subjective symptoms. In a histological specimen, there were numerous unevenly distributed telogen follicles that contained vellus hairs. Beneath a relatively narrow zone of fibrovascular tissue, lobules of fat with a central core of cartilage were seen. The mass was totally excised; during the follow-up period, there was no evidence of recurrence. The tragus derives from the first branchial arch. The accessory tragus can be found along the entire course of embryonic migration. It is usually located unilaterally in the preauricular region. To our knowledge, bilateral development on the suprasternal region has not been previously reported.