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In this correspondence we would like to describe a modification using the posterior auricular muscle.
The posterior auricular muscle is one of the three extrinsic muscles of the external ear. It has been previously demonstrated that the muscle influences the position of the auricle relative to the cranial surface. One study has suggested that the posterior auricular muscle is significant in the pathogenesis of prominent ears,
The findings of this study strongly support transposition of the posterior auricular muscle insertion site on the scapha. We regularly adopt this technique, especially for patients with valgus of the concha.
The posterior auricular muscle can be clinically delineated by valgus traction on the ear. It is clearly seen, forming a ridge of the overlying skin, in the sulcus of the posterior auricular region (Fig. 1) . A standard dumbell shaped incision is used and postauricular skin is excised. Dissection is carried out posteriorly, till the posterior auricular muscle is seen. The muscle attachment to the scapha is dissected, transfixed with a 5/0 Monocryl stitch and detached completely (Fig. 2) . Further dissection is down to the mastoid fascia. This is followed by three to five conchomastoid sutures using 5/0 Monocryl.
Multiple conchomastoid sutures facilitates total conchal setback. The posterior auricular muscle is then transposed on an anterior location on the scapha. Anterior scoring or Mustarde type of mattress sutures can be used after anterior dissection, if necessary.
Fig. 1Posterior auricular muscle seen on clinical examination.
The effect of transposition is to create a posterior muscular strut, which adds to conchal setback. We feel that transposition of the posterior auricular muscle has a useful role as an adjunct to otoplasty, especially in valgus of the concha and use this technique whenever a posterior auricular dissection is carried out.
References
Guyuron B.
DeLuca L.
Ear projection and the posterior auricular muscle insertion.
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