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Great Auricular Nerve Injury, the “Subauricular Band” Phenomenon, and the Periauricular Adipose Compartments

Rohrich, Rod J. M.D.; Taylor, Nathan S. M.D.; Ahmad, Jamil M.D.; Lu, An; Pessa, Joel E. M.D.

Plastic and Reconstructive Surgery: February 2011 - Volume 127 - Issue 2 - p 835-843
doi: 10.1097/PRS.0b013e318200aa5a
Cosmetic: Original Articles
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Background: Experience with anatomical dissection has suggested that two potential complications of rhytidectomy are related to the anatomy of the periauricular adipose compartments: great auricular nerve injury and the “subauricular band” phenomenon. This study describes this anatomy and its relationship to these potential complications.

Methods: The results of 24 fresh hemifacial cadaver dissections were included in this study. Injections included the use of methylene blue and fixable dye injected into specific regions around the ear. The study incorporated digital macro photography, time-lapse photography, and three-dimensional cross-sections in multiple planes (coronal, sagittal, and axial planes) to identify structural relationships.

Results: This study defined five periauricular adipose compartments. The main branch of the great auricular nerve always ran within the subauricular membrane. The subauricular membrane was located between the subauricular and inferior adipose compartments. Inadequate dissection of the lateral neck and postauricular area along with failure to release this membrane completely results in banding of the lateral neck, a stigma of face lift surgery. McKinney's point was consistently found to lie where the great auricular nerve travels deep to the inferior border of Lore's fascia and the tail of the parotid. Below this point, the great auricular nerve is closer to the skin surface and more susceptible to potential injury.

Conclusion: Two possible complications of rhytidectomy, great auricular nerve injury and the “subauricular band” phenomenon, are avoidable by understanding the anatomy of the periauricular adipose compartments.

SUPPLEMENTAL DIGITAL CONTENT IS AVAILABLE IN THE TEXT.

Dallas, Texas; and Mississauga, Ontario, Canada

From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, and The Plastic Surgery Clinic.

Received for publication December 25, 2009; accepted June 28, 2010.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

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Joel E. Pessa, M.D., Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Avenue, Dallas, Texas 75390, joel.pessa@utsouthwestern.edu

©2011American Society of Plastic Surgeons