The antihelix of the ear refers to the Y-shaped cartilage within the external ear, it lies next to the scapha of the ear, the ridge separating the helix from the antihelix.

Gross anatomy

The antihelix can be divided into two parts bifurcating around the triangular fossa¹:

• superior crus: upper cartilaginous ridge running above the triangular fossa, with a less angled path than the inferior crus

• inferior crus: running below the triangular fossa, the inferior crus separates it from the concha, ending beneath the ascending portion of the helix

Blood supply

The antihelix is predominantly supplied by perforating branches of the posterior auricular artery ², a branch of the external carotid artery. Similarly, the venous drainage of the antihelix is via the posterior auricular vein.

Lymphatic drainage

The external ear including the antihelix drains into three main lymph nodes: the pre-auricular, infra-auricular and retro-auricular nodes ³.

Innervation

The antihelix is predominantly innervated by the great auricularnerve but may also be innervated by the auriculotemporal nerve at the superior crus ⁴.

Variant anatomy

Common anatomical variants of the antihelix include ¹:

• supernumerary crus (Stahl ear), in which there is an additional ridge or crus to the superior and inferior crus

• angled antihelix where a steep angle is observed typically at the level of the antitragus instead of a smooth gentle curve

• prominent superior or inferior crus

• underdeveloped superior or inferior crus

• serpiginous antihelix, a posterior curving of the antihelix such that is obscures some of the conchal bowl

• absent antihelix

Development

The external ear is developed from six auricular hillocks arising from the first and second pharyngeal arches. The first pharyngeal arch giving rise to hillocks 1 to 3 and second forming auricular hillocks 4 to 6, the antihelix, antitragus and concha are derived from the latter ⁵.

Clinical importance

The antihelix has been growing in popularity in years as a site for ear piercings.