Helix (ear)

Last revised by Angela Liao on 4 Jun 2023

The helix of the ear refers to the cartilaginous rim of the auricle.

It can be divided into three parts 1:

  • ascending: beginning from the root at the scalp, extending vertically

  • superior: begins at the end of the ascending portion when the helix curves and ends at the Darwin tubercle, a thickening of the skin at the junction of the upper and middle third

  • descending or posterior: inferior to the Darwin tubercle, ending at the superior edge of the ear lobe, the most inferior end of which may be non-cartilaginous

The ascending portion of the helix receives its blood supply from the superficial temporal artery, whilst the superior and descending helix receives blood from the posterior auricular artery 2, both of which are branches of the external carotid artery.

Venous drainage of the helix follows a similar path to its arterial supply, drained by the superficial temporal vein and posterior auricular vein.

The ascending portion of the helix shares its lymph drainage pathway with the tragus, concha and inferior crus of the antihelix, draining into the pre-auricular lymph node. The superior and descending portion drain to the retroauricular lymph node 3.

The helix is innervated by the auriculotemporal nerve in its ascending portion and the greater auricular nerve in the superior and descending portions 4.

The external ear is developed from six hillocks. The first three auricular hillocks, hillocks 1 to 3 are derived from the first pharyngeal arch and are the embryological origins for the tragus, helix and cymba concha 5.

The helix is a popular area for ear piercings and due to its poor blood supply is often prone to infection leading to keloid scarring, perichondritis and, in severe cases, systemic infection.

Furthermore, the helix is often manipulated to facilitate otoscopy and improve visualization through a tortuous auditory canal.

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