Posterior Auricular Artery Research Articles

Extended posterior auricular artery flap for coverage of a large temporo-parietal defect

We present a case with a large 5×8 cm full-thickness defect in the temporo-parietal region, which was managed with an extended posterior auricular artery-based flap in one stage. The flap was shaped like a 'gandasa' (an axe-like agricultural implement used in Punjab, India). This allowed ample movement of the flap and also permitted a V-Y closure of the donor site. The flap also received additional blood supply from the ipsilateral superior auricular artery.

New insights in the vascular supply of the human parotid gland—Consequences for parotid gland‐sparing irradiation

Xerostomia is caused by irradiation for head and neck cancer, depending on the dose to the parotid gland. To investigate which part of the parotid gland has to be spared with radiotherapy, detailed information about the vascular supply of the parotid gland is necessary. Arterial vessels of the head of a human cadaver were colored. A 3-dimensional reconstruction of the parotid gland and the arterial vessels was made and analyzed. Five arterial vessels were responsible for the vascular supply of the parotid gland: the posterior auricular artery, 2 branches so far unnamed, the superficial temporal artery, and the transverse facial artery. All arteries were branches off the external carotid artery, and supplied different parts of the parotid gland. This study describes the detailed vascular supply of the human parotid gland. These results may contribute to improve parotid sparing radiotherapy, thus reducing complications such as xerostomia in the future.

Arterial vascularization of occipital scalp: mapping of vascular cutaneous territories and surgical applications

Although the vascular supply of the occipital region of the scalp is usually considered as depending on the occipital arteries, in our clinical experience the importance of the posterior auricular arteries seems to have been underestimated. Most of the authors consider that the occipital artery is the main artery to the vascular supply of this region. The role of the posterior auricular artery has not been clearly investigated. In order to describe the cutaneous territories of these two arteries, 20 occipital areas have been dissected after bilateral injection of coloured latex (40 occipital and 40 posterior auricular arteries studied), and 4 occipital areas have been dissected after selective injection of china ink in the occipital and posterior auricular arteries (4 occipital and 4 posterior auricular arteries injected). The occipital artery was deep from its origin to the arch constituted by the insertions of the trapezius and sternocleidomastoid muscles. Then the occipital artery was becoming superficial while ascending to the vertex. The cutaneous territory of the occipital arteries was paramedian and median (38% of the occipital area). The posterior auricular artery was superficial in the auriculomastoid sulcus and divided into three branches: auricular and mastoid as usually described and also a third terminal branch that we called "transverse nuchal artery". The posterior auricular arteries supplied the major part of the occipital area of the scalp (62%).

Use of Wide Bipedicled Pericranial Flap in Anterior Scalp Reconstruction

Pericranial flap is a composite flap involving the periosteum of the skull with its overlying loose areolar tissue termed subgaleal fascia. The multiple blood supply of the pericranial tissue enables this versatility, with a rich, anastomosing arterial supply from the supraorbital, supratrochlear, superficial temporal, posterior auricular, and occipital vessels. Thus, the shape, size, and location of the pericranial flap could be altered as long as a sufficient pedicle width could be fashioned to maintain a blood supply. In our study, we have performed wide bipedicled pericranial flap in scalp reconstruction in 2 cases. After tumor excision was completed, a pericranial flap was planned on the caudal side of the defect. A bipedicle-based pericranial flap was outlined with the use of a sharp dissection; this flap was elevated in a submusculoaponeurotic plane. The bipedicled pericranial flap, whose arterial supply was from the superficial and posterior auricular arteries, was transposed to the frontal defect.We preferred a bipedicled flap, whose arterial supply is from the superficial temporal and posterior auricular arteries to augment vascular supply. If a large, long pericranial flap is required, making the flap pedicled ensures stable blood supply.

Ear Necrosis Resulting from the Endovascular Onyx‐18 Embolization of a Dural Arteriovenous Fistula Fed by the Posterior Auricular Artery

The treatment of a dural arteriovenous fistula (DAVF) can involve surgery, radiosurgery, or endovascular embolization. New embolization techniques and agents have expanded the role of endovascular treatment. We report the endovascular embolization with Onyx-18 of a DAVF fed by the posterior auricular artery. The DAVF was successfully embolized; however, the patient's ear developed ischemic necrosis of the superolateral pinna. Onyx-18 can provide high rates of success in the treatment of DAVFs in well-selected patients. Risks of end organ ischemia must be considered during endovascular embolization and when counseling patients regarding procedural risk.

Dangerous Extracranial–Intracranial Anastomoses and Supply to the Cranial Nerves: Vessels the Neurointerventionalist Needs to Know

Transarterial embolization in the external carotid artery (ECA) territory has a major role in the endovascular management of epistaxis, skull base tumors, and dural arteriovenous fistulas. Knowledge of the potential anastomotic routes, identification of the cranial nerve supply from the ECA, and the proper choice of embolic material are crucial to help the interventionalist avoid neurologic complications during the procedure. Three regions along the skull base constitute potential anastomotic routes between the extracranial and intracranial arteries: the orbital, the petrocavernous, and the upper cervical regions. Branches of the internal maxillary artery have anastomoses with the ophthalmic artery and petrocavernous internal carotid artery (ICA), whereas the branches of the ascending pharyngeal artery are connected to the petrocavernous ICA. Branches of both the ascending pharyngeal artery and the occipital artery have anastomoses with the vertebral artery. To avoid cranial nerve palsy, one must have knowledge of the supply to the lower cranial nerves: The petrous branch of the middle meningeal artery and the stylomastoid branch of the posterior auricular artery form the facial arcade as the major supply to the facial nerve, and the neuromeningeal trunk of the ascending pharyngeal artery supplies the lower cranial nerves (CN IX-XII).

A study of the vascularization of the auricle by dissection and diaphanization

The vascularization of the auricle is poorly documented, despite the developments in auriculotherapy and reconstructive surgery. The aim of this study was to describe its arterial distribution using two techniques: diaphanization and anatomical dissection. The study was conducted after intravascular injection of eight diaphanized auricles and ten that were dissected. Dissection showed that the auricle is vascularized by an anterior flow arising in the superficial temporal artery and also by a posterior flow arising in the posterior auricular artery in eight cases out of ten, and in the occipital artery in the remaining two. Diaphanization revealed the three-dimensional arterial distribution of preserved specimens. This technique has a didactic use to complement to standard anatomical dissection.

Dural Arteriovenous Fistula at the Anterior Condylar Confluence

We reviewed the records of eight patients with a dural arteriovenous fistula (DAVF) close to the hypoglossal canal and determined the angioarchitecture of the clinical entity at the anterior condylar confluence. Eight patients with DAVF received endovascular treatment at our institute over the past five years. Imaging with selective three-dimensional angiography and thin-slice computed tomography were used to identify the fistula and evaluate the drainage pattern. Based on the angiographic findings, the ascending pharyngeal artery was the main feeder in all cases, and the occipital, middle meningeal, posterior auricular, and posterior meningeal arteries also supplied the DAVF to varying degrees. Contralateral contribution was found in five patients. The main drainage route was the external vertebral plexus via the lateral condylar veins in four patients, the inferior petrosal sinus in three patients, and the internal jugular vein via the connecting emissary veins in one patient. Selective angiography identified the shunt point at the anterior condylar confluence close to the anterior condylar vein. Shunt occlusion with transvenous coil packing was performed in all cases; transarterial feeder embolization was also used in three patients. Two patients treated with tight packing of the anterior condylar vein developed temporary or prolonged hypoglossal palsy. Based on our results, the main confluence of the shunt is located at the anterior condylar confluence connecting the anterior condylar vein and multiple channels leading to the extracranial venous systems. To avoid postoperative nerve palsy, the side of the anterior condylar vein in the hypoglossal canal should not be densely packed with coils. Evaluating the angioarchitecture using the selective three-dimensional angiography and tomographic imaging greatly helps to determine the target and strategy of endovascular treatment for these DAVF.

Thermal screening of facial skin arterial hot spots using non-contact infrared radiometry

Non-contact infrared thermometry of facial skin offers advantages over less accessible internal body sites, especially when considering mass screening for febrile infectious disease. The forehead offers an obvious site, but does not present an isothermic surface, as various small arteries passing close to the surface create ‘hot-spots’. The aim of this study is to use non-contact infrared (IR) thermometry to determine the link between the temperature at specific facial skin sites and clinical body temperature. A sample of 169 asymptomatic adults (age range 18–54 years) was screened with IR thermometers (Braun Thermoscan proLT for auditory meatus (AM) temperature representing clinical body temperature, and a Raytek, Raynger MX for skin surface temperature). Peak IR skin temperature was measured over the course of each posterior auricular artery (PAA) and each superficial temporal artery (STA). In a sub-group (n = 54) the peak skin temperature of the forehead's metopic region (MR) was also recorded. There were no differences (P > 0.05) between the PAA and STA at 34.2 ± 0.9 °C and 34.2 ± 0.7 °C, respectively, which were 2.5 °C cooler than the AM temperature (36.7 ± 0.5 °C, p < 0.001). Although there was no correlation between AM and PAA or STA there was a correlation (r2 = 0.63, p < 0.001) between PAA and STA. There were no asymmetric temperature differences between the left and right sides and males had warmer skin over the MR (F, 33.6 ± 0.7 °C versus M, 34.4 ± 0.6 °C, p < 0.001). Although a lack of correlation between either PAA or STA and AM was apparent in asymptomatics, further research in symptomatics is required to determine the usefulness of these measurements in mass screening of conditions such as fever.

Multislice spiral computed tomography in a neonate with symptomatic non-involuting congenital hemangioma

A full-term female was delivered with a 4×6-cm soft, hemispheric and blue-colored tumor on the right temporal scalp behind the ear. The present patient developed tachypnea and feeding difficulty soon after birth. Ultrasound examination revealed typical findings of congenital hemanigoma. Multislice spiral computed tomography (MSCT) was performed prior to endovascular coil embolization. MSCT showed that the tumor consisted of tortuous and irregular vessels with feeding arteries including the right occipital artery, the right superficial temporal artery and the right posterior auricular artery. At 12 months of age, the hemangioma remained unchaned, which was consistent with non-involuting congenital hemangioma. We consider that MSCT is a useful and non-invasive imaging tool to depict the precise vascular structure of congenital hemangioma even in a neonate. We present herewith a case of a neonate with non-involuting congenital hemangioma (NICH) who had symptoms related to arteriovenous shunts. Transcatheter coil embolization or surgical resection is occasionally performed in a symptomatic patient with NICH [3]. We studied multislice spiral computed tomography (MSCT) prior to transcathter coil embolization to evaluate the vascular structure in a symptomatic neonate with NICH. MSCT is one of useful imaging tools to depict vascular structures of congenital hemanigoma.

Anatomical and Technical Aspects of Harvesting the Auricle as a Neurovascular Facial Subunit Transplant in Humans

Auricular transplants from cadaveric sources may be a viable alternative for difficult auricular reconstruction once immunologic problems are largely solved. The authors report on the neurovascular anatomy and technical details of harvesting the auricle as a single facial subunit. Nine auricles were studied in latex-injected (n = 5) and fresh cadaveric heads (n = 4). In latex-injected heads, dissection in the neck and auricular region and microdissection within the substance of the auricle were performed under loupe magnification. The arterial network was exposed and measurements were taken, including the size, length, and diameters of vessels. The number of branches supplying the entire auricle was noted. Methylene blue dye was injected into fresh cadaveric heads through the posterior auricular (n = 2) or superficial temporal arteries (n = 2) to assess the territory supplied by each arterial system. Dye injected into the superficial temporal artery stained the upper two-thirds of the anterior and posterior auricular regions; all anterior cartilaginous eminences, except the antitragus, were homogenously stained. Dye injected into the posterior auricular artery stained the lobule, posterior auricular skin, and the depressed anterior auricular regions, including the cavum conchae, scapha, and triangular fossa. Neither the superficial temporal nor the posterior auricular arteries could adequately nourish the entire auricle as single pedicles. The auriculotemporal and great auricular nerves can be included in the transplant for sensation. The temporoparietal scalp can also be reliably included to meet reconstructive requirements. The auricle can be reliably elevated as a transplant when nourished by both the superficial temporal and posterior auricular arterial systems. The external jugular vein and external carotid artery can therefore be used as the vascular pedicle for auricular transplantation.

An Anatomical Study of the Temporal Fascia and Related Temporal Pads of Fat

Numerous reports have discussed the use of the temporal fascia in reconstructive surgery, an issue mandating a detailed study of the anatomy of this structure and its vasculature. The material of the present study consisted of 44 specimens, obtained from two stillbirths and 20 embalmed cadavers after injecting the external carotid artery with lead oxide solution. The superficial temporal fascia was visualized by means of radiography to delineate its vasculature. The superficial temporal fascia split into two laminae: superficial and deep, the former being thicker over the lower third of the temporalis muscle resplit into two further layers. Its arterial supply was derived mainly from the superficial temporal artery, describing a proximal tortuous course in 13.6 percent of specimens supplemented by the zygomaticotemporal, zygomaticofacial, and posterior auricular arteries; the musculocutaneous perforators; and the zygomaticoorbital artery in 9.1 percent of specimens. The superficial temporal vein provided the venous drainage. The deep temporal fascia was thicker over the lower half of the temporalis where it split into superficial and deep layers. The fascial branch of the middle temporal artery provided its arterial supply and the muscular branch joined the loose areolar arterial network. Three temporal pads of fat (superficial, intermediate, and deep) were demonstrated. A temporal venous sinus was embedded within the deep and intermediate temporal pads of fat. The superficial temporal artery provides an extra length for raising superficial temporal artery-based flaps. Caution should be exercised whenever the temporalis myofascial flap is raised, to avoid injuring the temporal venous sinus.

耳介ａｒｔｅｒｉｏｖｅｎｏｕｓ ｍａｌｆｏｒｍａｔｉｏｎ例

A 49-year-old male had visited a nearby doctor with a complaint of massive bleeding from the left auricle. Angiography was performed, and arteriovenous malformation of the auricle was diagnosed. The main feeding arteries were the posterior auricular artery and the occipital artery, as demonstrated by angiography via the left external carotid artery; however, bleeding recurred because a collateral blood supply developed. Between 2001 and 2003, embolization was carried out 3 times, but the treatment was not effective. On July, 2003, he was referred to our clinic for treatment. A papula was detected at the left concha auricle, but pulsation was not palpated. On the other hand, an increase of blood supply was detected by Doppler echography. On August 20, 2003, ligation of several import arteries and extraction of the nidus were performed under general anesthesia. AVM was completely resected with little hemorrhage. The post-operative course was good and there has been no recurrence 8 months after surgery.

Arteriovenous malformation and Color Doppler: posterior auricular artery.

Arterio-venous malformations (AVM) are rare in head and neck region and are generally arise from intracranial vessels. We present a case of spontaneous AV malformation in the post auricular region with posterior auricular artery as the feeding vessel that was diagnosed by Color Doppler sonography.

Peninsular Conchal Axial Flap to Reconstruct the Upper or Middle Third of the Auricle

The reconstruction of partial amputations of the auricle is a continuous subject of publications, in particular, the techniques of ear reconstruction with postauricular flaps. To present in detail the surgical procedure of a new peninsular conchal transposition flap. This new conchal transposition flap has been used since 1998 to reconstruct seven partial amputations of the upper or middle third of the auricle. If we compare the flap to a tennis racket, the head corresponds to a skin-cartilage-skin flap harvested from the concha and the shaft to a post- and supra-auricular cutaneous and subcutaneous pedicle based around the posterior auricular artery and the superior auricular branch of the superficial temporal artery. The blood supply is reliable because the superior branch of the posterior auricular artery anastomoses with the superior auricular branch of the superficial temporal artery. There have been no significant complications, except one case of partial rim necrosis, which responded well to wound healing by secondary intention. Our peninsular flap could be an alternative to more complex procedures involving costal cartilage harvesting, provided that auricle amputations are confined to the upper or middle third of the peripheral structures and spare the concha.

Posterior Auricular Artery Sensate Flap for Finger Pulp Reconstruction

Fingertip injuries constitute a large portion of the traumatic injuries sustained in the hand and are frequently associated with significant disability for the patient. Many techniques have been proposed for finger pulp reconstruction; however, results often involve the morbidities of poor sensibility, numbness, joint stiffness, and poor cosmesis. These authors proposed a free posterior auricular artery sensate flap for reconstruction of finger pulp injury with bone exposure. The posterior auricular artery sensate flap was based on the posterior auricular artery and vein, and innervated by the greater auricular nerve, which is a good choice for fingertip reconstruction. The flap provided wound coverage, good aesthetic results, and the donor site can be closed primarily without morbidity. The recovery of sensation in these cases was excellent. The free posterior auricular artery sensory flap has been utilized in 8 constructive index finger pulp injuries. All the flaps survived well with excellent sensory recovery. Microscopic evaluation of sensory return was presented.

Spontaneous arteriovenous malformation of the external auditory meatus

Arteriovenous malformations (AVM) of the head and neck are rare. They usually occur intracranially and derive their vascular supply from the intracranial vessels. In the English literature there has not been any documented case of AVMs in and around the external auditory meatus (EAM). The authors present the first case, a spontaneous AVM deriving its vascular supply from the posterior auricular artery. The diagnostic difficulties and management strategies of spontaneous AVMs are discussed.

Arteriovenous malformation of the scalp: Case report and review of the literature

Background Arteriovenous malformations (AVMs) of the scalp are relatively rare, and their precise natural course remains to be elucidated. We encountered a patient with a scalp AVM that progressively enlarged over the course of 3 years by capturing feeders from intracranial arteries. To our knowledge, ours is the first serial angiographic depiction of the growth of a scalp AVM and the development of a de novo aneurysm in the superior temporal artery (STA) that performed as a feeder. Case description This 21-year-old female consulted us in 1998 complaining of right tinnitus and a pulsating mass in the retroauricular region. The initial angiogram revealed an AVM in the right temporo-parietal subcutaneous space with feeders from the STA, an occipital artery, a posterior auricular artery, and a middle meningeal artery (MMA). Three years later, she complained of enlargement of the lesion, increased tinnitus, and alopecia. Repeat angiographic study revealed the presence of a nidus and the appearance of new feeders from a contralateral MMA and an ipsilateral middle cerebral artery; there was a de novo saccular aneurysm in the right STA. On the day preceding surgery, the left MMA was embolized to control intraoperative bleeding. The AVM was removed totally without any dermal complications. Conclusion This case suggests that scalp AVMs can become enlarged by capturing subcutaneous or intracranial feeders, and that the consequent hemodynamic stress may induce de novo aneurysms in scalp AVMs. Capillary endothelial cells were strongly immunostained for vascular endothelial growth factor.

Vascular supply of the subcutaneous pedicle of Nagata's method in microtia reconstruction

Nagata's method is a two-stage method for total ear reconstruction in patients with microtia. In the first stage of this procedure, mastoid flap and posterior lobule flap are elevated with a subcutaneous pedicle. However, contribution to the vascular supply by this pedicle has been controversial. We investigated the presence or absence of apparent vessels in the subcutaneous pedicle in 14 primary cases of microtia in the first stage operation. In all cases some vessels were included in the pedicle. In lobular and small concha type microtia, the vessels originated from the parotid fascia or aponeurotic tissue behind the remnant cartilage. In concha type microtia, apparent vessels could be preserved by including the perichondrium of the conchal cartilage. These findings suggest that the mastoid and posterior lobule flaps or W-shaped flap in Nagata's first stage operation are actually the perforator-based flaps. The source vessel of the perforators seemed to be the posterior auricular artery because of its location although further dissection was not performed in order not to damage the vascular supply. The presence of the vessels can augment the blood supply of not only W-shaped flaps but also the skin flap cephalad to them. By confirming the preservation of the perforators in the subcutaneous pedicle the surgeon may be able to trim the covering skin more safely.

Perforator-Preserving Chondrocutaneous Rotation Flap Reconstruction of Auricular Defects

A technique of chondrocutaneous flap reconstruction of the ear that preserves the perforating branches of the posterior auricular artery is described. Preservation of the perforators offers improved safety in high-risk patients because it maintains the blood supply to the anterior surface of the ear. This perforator-preserving technique also emphasizes simplicity of flap design, concealment of scars, and preservation of ear shape. It is best suited for reconstructing defects of the scapha, antihelix, or triangular fossa up to approximately 2 cm in diameter. A variety of chondrocutaneous rotation flaps have been developed for reconstructing helical and nonhelical defects. These flaps have been designed on the basis of the size and location of the surgical defect. Although previously described techniques are usually reliable, extensive dissection and mobilization can injure perforators, leading to vascular compromise. When flap reconstruction is used in high-risk patients, it is necessary to protect the blood supply, and perforator-preserving flap reconstruction offers improved safety. The perforator-preserving technique was used in six consecutive high-risk patients during a 2-year period. Good results were obtained in all cases, including in patients who smoked cigarettes or had extensive medical problems.