The region of the ear is subject to congenital malformations, deviations, and defects, which include anomalous shapes of the auricle, malpositions of the organ, defects in the cartilaginous structure with resulting deformity, and congenital excesses or redundancies by which there are made to appear supernumerary auricles or portions thereof. These latter have been described by Sutton and treated in his work on Comparative Pathology. They bear relation as well to the branchial clefts, and are of great interest from a phylogenetic point of view. Some of these defects result from absolute arrest or excess of development, others from injury during intra-uterine life; some are accentuated by lack of care during the early months of infancy. The most common deformity of the ear is that by which it is made unduly prominent and deflected outward or forward, the cartilage being thick and abnormally curved. Such overlapping or overprominent ears can be made to assume their proper position on the side of the head by the excision of an elliptical piece, either of skin or of skin and cartilage, at the point of junction of the ear and the scalp. The amount to be removed should be proportionate to the desired effect. The parts may be brought together by sutures, and the auricle should then be bound upon the head.
[Fig. 395] illustrates a common form of defect, inherently of the cartilage and of the overlying skin. This is but one illustration of many, two cases being rarely found exactly alike. Not infrequently these arrests of development include the structures of the middle ear as well. The auditory meatus may be entirely covered and concealed, or may be absent, having failed to develop.
Fig. 395
Developmental defect of external ear. (Broome.)
Supernumerary auricles are usually found as small tags of skin and cartilage in front of or below the ear. They are easily removed and leave no disfiguring scar.
The external ear is also exposed to injury, which it frequently receives in the way of contusions and lacerations. It is occasionally detached. The ordinary wounds of these parts require only the conventional treatment, while it may be possible, by replacement and approximation of a completely detached portion, to see it re-adhere. This happened to the writer after his horse had completely bitten a piece out of the ear of his groom. Here, as with detached finger-tips, cleanliness is necessary, and the parts must be kept warm and protected after dressing. The cartilage of the ear is covered by a perichondrium which corresponds to the periosteum. Beneath it, or beneath the skin alone, blood may be extravasated as the result of contusions. When such collections fail to promptly resorb they should be incised and the contained blood released. Such lesions are referred to as traumatic othematomas.
A peculiar lesion of this general character occurs occasionally in the insane. If due to injury the latter is but trifling. It makes a conspicuous tumor, involving usually the lower end of the auricle, and is known as the othematoma of the insane. It is scarcely amenable to surgery, nor does it often need it, but it constitutes a disfigurement which is not only easily apparent, but diagnostic as to the cerebral or mental condition.
The ear is the site of many neoplasms, both innocent and malignant. Small papillomas are common, while fibrous tumors are likely to develop, especially about the fibrocartilaginous lower end of the auricle, where the ear has been pierced for ear-rings. Keloid tumors, of still more conspicuously fibrous nature, are common about the ear, especially among negroes. All innocent tumors may be excised, through incisions which should be so planned as to leave a minimum of disfigurement. (See [Fig. 397].)
Of the malignant tumors epithelioma is perhaps the most frequent. It pursues a course here similar to that which characterizes it elsewhere, save that the dense structures of the cartilaginous ear yield but slowly to its encroachment. The form known as “rodent ulcer” is slower here than elsewhere. [Fig. 396] illustrates a case under the writer’s care, showing complete destruction of the external ear by a growth of this kind, which had attained a degree and extent that did not permit of successful treatment, and which eventually proved fatal. When growths of this character have not progressed too far they should be radically removed, the question of cosmetic effect being secondary to that of their eradication. By a well-planned plastic operation much can be done to atone for disfigurement resulting from radical operation.