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. 2019 May 7;4(3):359-364.
doi: 10.1002/lio2.271. eCollection 2019 Jun.

The surgical anatomy of soft tissue layers in the mastoid region

Takahiro Hongo  1 , Noritaka Komune  1 , Ryo Shimamoto  2 , Takashi Nakagawa  1
Affiliations

The surgical anatomy of soft tissue layers in the mastoid region

Takahiro Hongo et al. Laryngoscope Investig Otolaryngol. .

Abstract

Background: An understanding of the soft tissue layers in the mastoid region has become important for otologic reconstructive surgery. The objective of this study was to clarify the surgical anatomy of the soft tissue layers in the mastoid region and reveal its clinical significance.

Methods: Cadaveric study.

Results: Our dissections showed the soft tissue layers consisting of skin, subcutaneous layer, superficial and deep mastoid fasciae, and periosteum. The superficial mastoid fascia was continuous with the temporoparietal fascia cranially and the superficial cervical fascia caudally. The deep mastoid fascia could be clearly separated from the superficial mastoid fascia and has continuity to the loose alveolar layer in the temporoparietal region. However, it caudally fused with the fascia and ligament of the sternocleidomastoid.

Conclusions: A comprehensive understanding of soft tissue layers would improve otologic reconstructive surgery.

Level of evidence: NA.

Keywords: Temporal bone surgery; cadaveric study; fascia; otology; surgical anatomy.

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Figures

Figure 1
Figure 1
Gross anatomy of the mastoid region. (A) View after the removal of the dermis and subcutaneous tissue around the auricle. (B) Enlarged view of the mastoid region of (A). (C) The course of the posterior auricular artery in the mastoid region. A. = artery; M. = muscle; N. = nerve; SCM = sternocleidomastoid.
Figure 2
Figure 2
The cadaveric dissection shows each soft tissue layer in the mastoid region. (A) View after elevation of the dermis. (B) View after elevation of the subcutaneous tissue. (C) The elevated superficial mastoid fascia is continuous with the superficial cervical fascia in the portion anterior to the attachment of the posterior auricular muscle to the periosteum. (D) The elevated deep mastoid fascia is continuous with the fascia and ligament of the sternocleidomastoid. (E) The elevation of the deep mastoid fascia exposes the periosteum of the mastoid region between the temporal line (blue dotted line) and superior nuchal line (red dotted line). M. = muscle; N. = nerve; SCM = sternocleidomastoid.
Figure 3
Figure 3
The double pedicled flaps, arising from the mastoid fasciae, were used for otologic reconstructive surgery after canal wall down mastoidectomy. PAA = posterior auricular artery; SCM = sternocleidomastoid muscle.
Figure 4
Figure 4
Comparison of the postoperative course of two different procedures of otologic reconstructive surgery after canal wall down mastoidectomy on the same patients.
See this image and copyright information in PMC

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