The Role of the Parotid-Mastoid Fascia in Identification of the Facial Nerve Trunk During Parotidectomy.

OBJECTIVE: We aim to describe the parotid fascia as a landmark that can help identify the immediately underlying facial nerve trunk. METHODS: Dissection of the parotid fascia and identification of the facial nerve trunk were carried out on 8 fresh cadaveric parotid glands. The attachments and arrangement of the parotid gland and its fascia were evaluated and histologically assessed, with special attention to the fascia overlying the facial nerve trunk. RESULTS: The parotid fascia envelops the posterior aspect of the parotid gland in an open-book fashion. Posteriorly, it connects to the anterior and medial aspect of the mastoid tip. Posterosuperiorly, it attaches to the inferior aspect of the tragal pointer. Directly medial to the fascia lies the facial nerve trunk. CONCLUSION: The parotid fascia, particularly the parotid-mastoid segment overlying the facial nerve trunk, can be utilized as an additional landmark of depth to help identify the facial nerve trunk during a parotidectomy in conjunction with other commonly used standard anatomic landmarks. The parotid fascia sling spans from the mastoid and tragal pointer to the parotid gland and can be easily palpated intraoperatively. Once the fascia is removed, the facial nerve trunk is identified.

Interpositional Flap Reconstruction of Temporomandibular Joint Using a Novel Anterior-Based Mastoid Flap Technique.

In this report, it was aimed to use the anterior-based mastoid fascia flap as an interpositional graft in TMJ surgery. This technical report, along with this characteristic, is the first in the literature.

The use of mastoid fascia for dorsal nasal augmentation.

BACKGROUND AND AIM: Dorsal augmentation of the nose is needed after trauma, rhinoplasty or for ethnic reasons. Alloplastic or autogenous materials may be used. In this paper, postauricular mastoid fascia was used for dorsal nasal augmentation. METHODS: This study included ten patients who underwent dorsal nasal augmentation. Fascia over mastoid area was taken in all cases and was fixed with Steri-Strips and external nasal splints. RESULTS: All patients were female except one case. Five patients had the operation because of ethnic causes and five patients did the operation due to post traumatic deformity. Donor sites healed uneventfully. Digital photography was taken to assess the grafts and follow up was extended up to 9 months. CONCLUSIONS: Mastoid fascia is a reliable method and its donor site is hidden. In addition, it can be a potential site for conchal graft if needed.

Mastoid fascia kite flap for cryptotia correction.

OBJECTIVE: Cryptotia is one of the most common malformations of the upper auricle with aesthetic and functional consequences, however there is no standard treatment. We present the surgical technique and results of a kite flap procedure which can be used in the different cryptotia subtypes. METHODS: We reviewed all patients treated in our department from 2010 to 2015, using a mastoid fascia kite flap technique. The incision of this local flap follows the retro-auricular sulcus along the rim of the helix superiorly and drawing a skin paddle inferiorly. The mastoid fascia is exposed and a superiorly and posteriorly based flap is drawn and detached from the skull. Finally, the skin paddle is rotated and sutured between the superior helix and temporal skin creating the superior sulcus. The retro-auricular incision is closed directly inferiorly. RESULTS: Six patients (mean age 12) and seven ears were studied. One patient had bilateral cryptotia and only two had a normal contralateral ear. Mean follow-up was of 45 months. There was no skin necrosis, no complications reported and no revision surgery. CONCLUSIONS: We describe a reliable flap with a simple design and improved aesthetic result, as the thickness of the flap projects the helix well, the scar is entirely hidden in the retro-auricular sulcus and the direct suture induces a harmonious medialization of the inferior part of the ear and earlobe.