The Journal of Laryngology and Otology November 1990, Vol. 104, pp. 860-861

Quelprud's Nodule: a post-auricular cartilaginous nodule Km KHANOBTHAMCHAI, M.D., (Toronto, Canada)

BRIAN BINGHAM,

F.R.C.S.,

MICHAEL HAWKE,

M.D., F.R.C.S.(C)

Abstract

A number of minor variations to the configuration of the external ear are well recognized. This paper brings attention to one entity which is characterized by a small cartilaginous nodule or prominence arising from the posterior surface of the pinna and which we have named Quelprud's nodule. A prospective clinical survey of 208 patients attending an ENT clinic revealed that nearly one-third of the population studied possess this nodule. There was an equal sex incidence. The Quelprud's nodule was identified within families in a distribution which suggests an autosomal dominant inheritance with variable expressivity.

Introduction

examined by both inspection and palpation. The ages of the subjects examined ranged from 9 months to 91 years.

The human pinna has a topography which varies with age, with race and often shows familial variations. Darwin's tubercle, a small projection above the level of the inferior crus of the anthelix, is the most well recognized minor variation of the pinna. Darwin's tubercle is considered to have an autosomal dominant inheritance with variable expressivity. A small cartilaginous prominence or nodule can be found on the posterior (medial) surface of the pinna in certain individuals. Such nodules were identified bilaterally on the pinna of the daughter of one of our authors (B.B.). The same author also is the proud possessor of similar nodules. This observation instigated a literature search which revealed that this postauricular nodule had previously been described by Quelprud in 1934 (quoted by Altman 1951). Quelprud considered this nodule to be a rare finding with a male predominance but was unable to establish the mechanism of inheritance. A survey of patients attending a private ENT clinic was undertaken to determine the prevalence, sex incidence, family history and precise location and to identify the clinical significance, if any, of the Quelprud nodule. Method

Two hundred and eight consecutive patients and their relatives attending the office of one of the authors (M.H.) during April and May of 1990 had their ears examined for the presence of a cartilaginous nodule on the posterior aspect of each pinna. A record of the patient was collected which included name, address, age, sex, family history of occurrence and an auricular diagram for pin-pointing the location of the nodule as related to lateral (anterior) aspect of the pinna.

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FIG. 1 A typical Quelprud's nodule can be emphasised retracting the pinna forwards and the nodule is easily identified in this illustration.

Results

The pinnae of 90 men and 118 women (total 208) were

Ear Pathology Research Laboratory, Department of Otolaryngology, University of Toronto. Accepted for publication: 31 August 1990. 860

861

OUELPRUD'S NODULE

There were seven patients of Oriental origin, two of Negroid origin and the remaining 199 were Caucasian. The total number of patients in whom had a Quelprud's nodule, was present, either unilateral or bilateral, was 65 (31 per cent). Thirty-three of these patients were male and 32 were female. Figure 1 demonstrates the typical appearance of a Quelprud's nodule. A Quelprud's nodule was present unilaterally in 37 patients (18 per cent of all patients). Eighteen of these patients were male (20 per cent of the male patients) and 19 were female (16 per cent of the female patients). Bilateral Quelprud's nodules were present in 28 patients (13.5 per cent of all patients). Fifteen of these patients were male (17 per cent of the male patients) and 13 were female (11 per cent of the female patients). The ratio of patients with unilateral nodules to those with bilateral nodules was 1.3 to 1. There were five sets of parent and child in our series which were subdivided into two mother/son, two father/ daughter and one mother/daughter. In these individuals the position and nature (bilateral or unilateral) were always identical between parent and child. There was one pair of identical twins who had a unilateral Quelprud's nodule located at the same position on the same side. The most common site of occurrence of Quelprud's nodule was on the posterior aspect of the pinna at the area which corresponded to the junction between concha cymba and concha cavum. We were unable to identify any clinical associations or syndromes which could be linked to the Quelprud's nodule. Discussion

This study demonstrates that a Quelprud's nodule, of the pinna, is a relatively common finding (31 per cent of our sample population) which is found in most races. The sex incidence is essentially equal. The observations

made in the small number of family members that we examined suggests to us that a Quelprud's nodule is inherited by an autosomal dominant mode probably in a similar manner to Darwin's tubercle. Moreover, the parents and children in our series always demonstrated the same location for their tubercles within the family.

Acknowledgements

This study was supported by the T. W. J. Foundation, Guildford, Surrey, England, the St. Joseph's Health Centre Research Foundation, Toronto, Canada, the Toronto Hong Kong Lions Club, the Saul A. Silverman Family Foundation and the Canadian Otological Study Fund.

Dedication

To Katherine Bingham without whose ears this paper would never have started.

References Quelprud (1934) quoted in Altmann F. (1951) Malformations of the auricle and the external auditory meatus. Archives ofOtolaryngology, 54: 115-139. Quelprud, T. (1934) Zur Erblichkeit des Darwinschen Hockerehens Zeitschrift fur Morphologie und Anthropologie 34: 343-363. Address for correspondence: Dr Michael Hawke, 21 Whitney Avenue, Toronto, Ontario, M4W 2A7 Zeitschrift fur Morphologie und Anthropologie

Quelprud's nodule: a post-auricular cartilaginous nodule.

A number of minor variations to the configuration of the external ear are well recognized. This paper brings attention to one entity which is characte...
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