Reconstruction of the retroauricular fold by 'nonpedicled' superficial mastoid fascia: details of anatomy and surgical technique.

During ear reconstruction, it is often difficult to achieve a good projection of the new ear. This is due to the retraction of retroauricular tissues, and the use of a cartilage wedge and superficial temporal fascia is frequently needed to elevate the ear framework. The aim of this article is to identify, by cadaver dissection, the anatomical structures of the retroauricular and mastoid regions and also to demonstrate the possibility of increasing the size of the superficial mastoid fascia by defibrating and cutting up its structure. The cartilage wedge is then inserted into a three-dimensional fascial environment. This allows reconstruction of the retroauricular fold with 'nonpedicled' fascia and to have a firm, stable ear elevation without sacrificing the temporal fascia. Nine ear reconstructions were performed using this technique and no major complications occurred; however, one procedure was complicated by a limited necrosis of the skin graft. In all cases we obtained a good and persistent elevation of the ear, as well as a well-defined fold, with the possibility of wearing glasses. Symmetry was satisfactory and aesthetic results were pleasant for all treated patients. This simple procedure allows one to obtain a good projection of the ear without involving the use of the superficial temporal fascia, which in addition is very useful in case of eventual complications such as cartilage extrusion.