Superficial mastoid fascia as an accessible donor for various augmentations in Asian rhinoplasty

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Summary

This study was designed to assess the anatomic characteristics and clinical versatility of superficial mastoid fascia as a soft-tissue donor for augmentation in Asian rhinoplasty.

Dissections were performed on four fresh cadavers (eight ears) for histologic study. A 3 × 10 mm2-sized full layer of skin and underlying soft tissue was harvested from the postauricular area, transversely and longitudinally (cephalic and caudal directions), 5 mm apart from the midpoint of the auriculocephalic sulcus. The average fascial thickness and nerve distribution were assessed using digital microscopic images after haematoxylin and eosin (H&E) staining. In the histologic study, the average measured thickness of the superficial mastoid fascia was between 3.8 and 4.5 mm in various directions.

Clinically, 33 subjects who underwent rhinoplasty using superficial mastoid fascia were assessed prospectively. When soft tissue was needed in various types of augmentations, a longitudinal incision was made on the posterior auriculocephalic sulcus and the maximum thickness of superficial mastoid fascia was harvested. The sizes of the superficial mastoid fascia used in the 33 subjects ranged from 0.4 × 2.5 cm2 to 1.2 × 4.2 cm2. The superficial mastoid fascia was grafted regionally for the nasion, tip and nasal dorsum. In two cases, hypertrophic scars developed at the donor site. Four subjects experienced transient dysaesthesia and hypoaesthesia at the donor area postoperatively.

Superficial mastoid fascia may be a useful resource in rhinoplasty as a donor for various types of augmentations, allowing easy access without prominent scarring or permanent sensory nerve damage when a low-to-moderate volume of soft tissue is required.

Section snippets

Histologic study using fresh cadaver

The histologic study of SMF from the retroauricular area was performed using four fresh cadavers. Three specimens of different direction were harvested from eight different postauricular areas. First, we determined the central point 5 mm from the midpoint of the auriculocephalic sulcus, and then the full layer of tissue (from skin to periosteum), measuring about 3 × 10 mm2 sized transversely, was harvested. For the longitudinal section, the same-sized full layer of tissue was harvested from the

Histologic study

Although the fascial layer was difficult to identify with certainty, we measured the average thickness between the subdermis and posterior auricular muscle. The average measured thickness of the SMF was 3.82 ± 0.42 mm in the transverse section, 4.44 ± 0.68 mm in the cephalic vertical section and 4.58 ± 0.80 mm in the caudal vertical section (Table 1). The posterior auricular nerve was atypically distributed around the posterior auricular muscle and was not located above the posterior auricular

Discussion

In Asian rhinoplasty, autologous grafts are indispensable for better nasal profiles. Regional augmentation is frequently needed at the nasion, bony dorsum, middle vault, supratip area, tip, lobule and, sometimes, the perialar area. Even after reconstructing the main nasal framework, minor fine grafts are needed at the end of the procedures, but most Asian surgeons are limited in supply of autologous tissues for these augmentations. For smoother and more natural tips, soft tissues such as

Conclusion

Although SMF is not large enough to fill an entire dorsum from nasion to tip, as compared with a dermo-fat graft from the trunk, it may provide an appropriate amount of soft tissue for regional augmentation. When unplanned soft tissue is needed intra-operatively, this may be the most convenient donor site. In our clinical study, SMF offered sufficient volume for a nasal root, and part of a nasal dorsum and tip-lobule augmentation, leaving a concealed donor-site scar.

Conflict of interest

None.

Funding

None.

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