Also known as accessory auricle or preauricular tag, accessory tragus is due to an associated developmental anomaly of the first and second branchial arches. It manifests as single or multiple papules, usually anterior to the tragus. Accessory tragi are bilateral in a minority of cases. In some cases, vellus hairs grow from these skin lesions.

In most cases, there are no associated underlying developmental or syndromic findings; however, cleft lip or cleft palate may occasionally be seen. Syndromic associations include Goldenhar syndrome, Townes-Brocks syndrome, Treacher-Collins syndrome, VACTERL association (vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, and limb abnormalities), Wolf-Hirschhorn syndrome, and Wildervanck syndrome.

Some studies have suggested an association between accessory tragus and hearing deficits, but a previously reported association of underlying renal abnormalities has not been confirmed in larger, more recent studies.