A Novel Procedure for the Removal of Supernumerary or Accessory Tragus on Neonates

The majority of supernumerary or accessory tragus in humans are noted soon after birth, and are generally benign isolated lesions not associated with other genetic abnormalities. When present, these lesions are typically managed by the primary care provider, but occasionally the caretakers opt to refer the patient to a surgeon to have the lesion resected surgically as an outpatient. This practice may place an unnecessary financial burden on the patient’s family, and may pose added difficulty due to the availability of the subspecialist. The current literature lacks other practical and effective methods for dealing with these lesions despite the incidence of up to 1.5% of the population [1]. Traditionally, however, these lesions are managed by pediatricians or the PCP by placing a suture ligature at its base so that the distal portion of the tragus will fall off after the ischemic necrosis has occurred [2]. This approach is the current standard of care, and is the method being taught at most pediatric training programs. When successful, this process can take days if not weeks to run its course. Another approach may be to refer these patients to a Plastic Surgeon or a Pediatric Surgeon for care which may be to have the lesions managed by means of application of surgical clips [3] at their base thus achieving a similar effect as a ligature. Alternatively, the lesions can be permanently surgically excised later when the patient is older. At the University of Florida we have been successfully excising these lesions when devoid of cartilage prior to the patient’s discharge using the Digiclamp® device. We report 7 lesions which were permanently removed using this method; the clamp was placed at their base flush with the skin, and the accessory tragus was excised. This novel minimally invasive procedure does not require suturing, and has proven to be safe and poses minimal risk to the patient when performed correctly. All of these excisions took place prior to the patient’s discharge and uniformly required only minimal care thereafter. Among the advantages of utilizing this procedure are: the time needed to perform the procedure is brief, on average requires only 10 minutes or less to perform; the procedure has consistently been well tolerated by all of the patients; and although all of the excisions took place in the patient’s center of birth prior to their discharge, it can easily be performed in the outpatient setting since it requires minimal time, equipment, and is relatively simple to perform.