LT Ethan McGann, MD
CDR Erin Hamersley, DO
LT James McLean, MD
Naval Medical Center Portsmouth;
Congenital midline nasal masses are relatively rare with a classically described prevalence of 1 in 20,000-40,000 live births. The differential is broad and may include some atypical diagnostic entities. One such rare entity is an accessory tragus of the nasal cavity. The tragus is a derivative of the first branchial arch and as such is rarely associated with congenital anomalies. Nonetheless, there are numerous reports of anomalous accessory tragi in the preauricular region, and extraneous reports of accessory tragi along the migratory path of the first branchial arch. To our knowledge 4 cases of nasal accessory tragi have been reported arising from varying locations, with the nasal vestibule being the most common. We describe a novel case of a newborn male found to have an accessory tragus originating from the nasal septum.
A full-term male, delivered via urgent Cesarian section was noted to have respiratory distress immediately following delivery. On initial exam he was found to have a right sided nasal mass obstructing the right nasal passage. Subsequent examination, and workup, including nasal endoscopy and imaging studies showed a mass originating from the nasal septum. The mass was surgically excised and histological analysis was consistent with an accessory tragus. We share the patient’s clinical presentation, otolaryngologic management to include surgical intervention and follow-up, as well as a review of literature to discuss.
Congenital nasal masses, while uncommon, are important diagnostic considerations due to the potential for respiratory distress. While uncommon, an accessory nasal tragus is a diagnostic entity with which the otolaryngologist should be familiar.