Diagonal ear lobe crease and atherosclerosis: A review of the medical literature and dental implications

Ah Friedlande,J López-López,E Velasco-Ortega

doi:10.4317/medoral.17390

Abstract

In Spain a significant number of individuals die from atherosclerotic disease of the coronary and carotid arteries without having classic risk factors and prodromal symptoms. The diagonal ear lobe crease (DELC) has been characterized in the medical literature as a surrogate marker which can identify high risk patients having occult atherosclerosis. This topic however has not been examined in either the medical or dental literature emanating from Spain. The majority of clinical, angiography and postmortem reports support the premise that DELC is a valuable extravascular physical sign able to distinguish some patients at risk of succumbing to atherosclerosis of the coronary arteries. A minority of studies have however failed to support this hypothesis. More recently reports using B mode ultrasound have also linked DELC to atherosclerosis of the carotid artery and another report has related DELC to the presence of calcified carotid artery atheromas on panoramic radiographs. DELC is readily visible during head and neck cancer screening examinations. In conjunction with the patient’s medical history, vital signs, and panoramic radiograph, the DELC may assist in atherosclerotic risk assessment. Key words: Diagonal ear lobe crease, atherosclerosis disease, calcified carotid artery, atheromas, panoramic radiographs.

Highlights

Atherosclerosis is a major source of disability and death in Spain
In 2002, coronary artery atherosclerosis (CAA) resulted in 45,000 Spanish citizens suffering a fatal myocardial infarction and carotid artery atherosclerosis resulted in the stroke associated death of an additional 34,000 persons [1]
Preliminary uncontrolled observations by a pulmonologist that a “positive ear-lobe sign”, is associated with the development of premature atherosclerosis of the coronary arteries were heralded in a communication as long ago as 1973 [4]

Summary

Introduction

Atherosclerosis is a major source of disability and death in Spain. In 2002, coronary artery atherosclerosis (CAA) resulted in 45,000 Spanish citizens suffering a fatal myocardial infarction and carotid artery atherosclerosis resulted in the stroke associated death of an additional 34,000 persons [1]. Evidence Supporting Relationship between DELC and Coronary Artery Atherosclerosis Frank’s report was quickly followed in 1974 by the publication of the first controlled clinical study in which DELC (unilateral or bilateral) was shown to be significantly more common (47%) among all age groups of patients (N=531) hospitalized in a USA coronary-care unit after an acute myocardial infarction than among age-matched control subjects (30%) with no clinical evidence of CAA [6].

Results

Conclusion