Temporal Region, Anatomy Of The Mastoid Area And Reconstructive Surgery Application In The Ear

Objective:Auricular reconstruction is one of the most challenging procedures in plastic surgery. The regions involved in the surgery include temporal region and mastoid region. The objective of this research is to clarify the layers of temporal and mastoid regions and distribution characteristics of the nerves and vessels. And also discuss the application of the anatomical results in auricular reconstruction.Methods:Four embalmed cadaver heads (eight sides) of adults were dissected with general method.1. Dissect the anatomical layers of temporal and mastoid regions.2. Dissect and observe the distribution of the nerves of temporal and the mastoid regions.3. Dissect the muscles around the auricle and observe the blood supply of the auricularis posterior muscle.4. Dissect the superficial temporal artery and the posterior auricular artery, as well as their branches. Observe the amount and distribution characteristics of the transverse branches within the retroauricular fascial flap.5. Measure the thickness and range of the retroauricular fascial flap.Result:1. The order of anatomical layers of the temporal region is skin, subcutaneous tissue, superficial temporal fascia, subgaleatic connective tissue, deep temporal fascia, temporal muscle and pericranium. For the mastoid region, the order is skin, subcutaneous tissue, superficial mastoid fascia, subgaleatic connective tissue, deep fascia and pericranium.2. The nerves of temporal region include auriculotemporal nerve and temporal branch of facial nerve. The innervation of mastoid region includes great auricular nerve and lesser occipital nerve.3. Superficial temporal fascia and retroauricular fascia are richly vascular and supplied by the superficial temporal artery and the posterior auricular artery respectively. One or two thick transverse branches of posterior auricular artery are distributed on the surface of the retroauricular fascia, the range of which is around8.8cm×5.95cm.4. The auricularis posterior muscle is supplied by a single branch of the posterior auricular artery. 5. The thickness of top, middle and bottom part of the retroauricular fascial flap is1.24±0.11mm、2.86±0.25mm and3.80±0.23mm respectively.Conclusion:The operation of auricular reconstruction should strictly follow the anatomical layers and keep continuity of the layers when dissecting the fascial flap. The retroauricular fascial flap is used for draping the posterior surface of the cartilage framework, which possess advantages of easily harvested, invisible incision, clear auriculocephalic sulcus and keep the integrity of the superficial temporal fascia at the same time. During the process of dissecting the retroauricular fascial flap, it is possible to remain a thin layer of subcutaneous tissue, which ensures the blood supply of the fascial flap. In addition, at the bottom part of the fascial flap, it can be separated between the surface of sternocleidomastoid muscle and the back side of the fascial flap. The auricularis posterior muscle can also be removed during the process in order to minimize the thickness of the fascial flap.