Wattles, more appropriately 
termed cartilaginous choristomas,
are pedunculated unilateral 
or bilateral masses.  

Their cartilaginous center 
may extend to the platysma muscle, 
or there may be fibrous bands 
attached to the sternocleidomastoid 
muscle or pharyngeal wall.  

The sex distribution appears 
to be equal and a family history 
of similar branchial anomalies 
is positive in ten percent of cases.

The embryologic origin of the
wattle is controversial.
Some authors feel the wattle is
derived from the branchial arch.  
This is mainly due to the location
on the neck, the rare association 
with adjacent branchial sinuses, 
and the occasional finding 
of associated epithelial nests.  

Others, however, propose that 
wattles are of ectopic auricular
origin since they are composed 
of elastic cartilage rather than 
the hyaline cartilage of the 
branchial arch.  

This latter concept is supported 
by our case which did stain with 
Verhoeff-van Gieson as elastic
The treatment of choice is excision.  

It is important, however, to 
remember that wattles 
may communicate with deeper 
structures or be associated with 
a congenital sinus tract.  

Surgery, hence, should be 
performed by an experienced 
pediatric surgeon or otolaryngologist.

(Some additional questions) 1. What is the derivation of the word wattle? Answer: A wattle is a rare congenital anomaly whose term originates from the dewlap of birds. It has also been used to define the pendulous skin tags found occasionally in pigs, sheep and goats. In mammals, a wattle is a fleshy appendage beneath the throat consisting of skin, subcutaneous fat, and a strip of cartilage. There may also be a skeletal muscle component. 2. How does a wattle differ from an accessory tragus? Answer: The main feature that differentiates the wattle from an accessory tragus is the location. The wattle is located on the neck and the accessory tragus is located preauricularly.

Special thanks to
Dr. Emese Suranyi
for contributing this case
along with the discussion,
replies to additional questions
and references.
Emese is a third year resident
in Dermatology at Geisinger.

She and attending staff pediatric
dermatologist, Dr. Howard Pride,
presented this case in poster form
along with another example
at the 1999 meeting of the
Pediatric Dermatology Society.

Links to Pub Med for References

Wattle: No abstract
Congenital anomalies of head and neck: Review article


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