The role of the antitragicus muscle in plical folding of the pinna

The antitragicus is one of six intrinsic muscles of the external ear. This study examined the anatomical variations of the muscle and its association with prominent ears. Twenty-seven consecutive patients presenting for correction of prominent ears were recruited into the study. In each case, the antihelical fold was assessed preoperatively by a single investigator. A standard anterior cartilage scoring otoplasty was performed, and the presence and quality of the antitragicus muscle were assessed by a second investigator. For statistical analysis, the qualitative assessment of the fold and the muscle was given a numerical value. It was then possible to plot the qualitative assessment of the fold against the muscle, and correlations between muscle and fold were calculated. The presence of the muscle was associated with an absent antihelical fold, whereas a well-defined antihelical fold was associated with an absent muscle (p < 0.0001). The authors propose that the presence of a well-formed antitragicus muscle, which exerts an anterior pull on the cauda helicis, contributes to the poor development of the antihelical fold.