Diagonal Ear Lobe Crease and Atherosclerosis: A Review of the Medical Literature and Oral and Maxillofacial Implications

BackgroundA significant number of individuals die from atherosclerotic disease of the coronary and carotid arteries without having classic risk factors and prodromal symptoms. A diagonal ear lobe crease (DELC) has been characterized in the medical literature as a marker that can identify high-risk patients having occult atherosclerosis. The oral and maxillofacial surgery literature, however, offers very little information on the subject.Materials and MethodsThe authors conducted a MEDLINE search using the key terms “earlobe crease,” “ear lobe crease,” “atherosclerosis,” “cardiovascular disease,” and “cerebrovascular disease.” They selected articles published in peer-review journals and gave preference to articles reporting randomized controlled trials.ResultsA majority of clinical, angiographic, 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. Of particular interest to oral and maxillofacial surgeons is the reported association between individuals with DELC and the development of morbid cardiovascular events associated with the administration of general anesthesia. 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. A minority of studies have, however, failed to support the association between DELC and atherosclerosis.ConclusionsDELC is readily visible during presurgical/preanesthetic physical examination and, in conjunction with the patient's medical history, vital signs, and panoramic radiograph, may assist in risk assessment and the identification of individuals needing further evaluation.