Reevaluation of the arterial blood supply of the auricle

Abstract

The anatomical basis for auricular flaps used in multiple aesthetic and reconstructive procedures is currently based on a random distribution of the underlying arterial network. However, recent findings reveal a systematic pattern as opposed to the present concepts. Therefore, we designed this study to assess the arterial vascular pattern of the auricle in order to provide reliable data about the vascular map required for surgical interventions. Sixteen human auricles from eight body donors (five females/three males, 84.33 ± 9.0 years) were investigated using the unique 'Spalteholz' method. After arterial injection of silicone, a complete transparency of the tissue was achieved and the auricular arteries and branches were visible. Qualitative and quantitative evaluation of the arterial vascular pattern was performed. The superior and the inferior anterior auricular artery provided the vascular supply to the helical rim, forming an arcade, i.e. helical rim arcade. On the superior third of the helical rim another arcade was confirmed between the superior anterior auricular artery and the posterior auricular artery (PAA), i.e. the helical arcade. The perforators of the PAA were identified lying in a vertical line 1 cm posterior to the tragus, supplying the concha, inferior crus, triangular fossa, antihelix and the earlobe. The results of this study confirmed the constant presence of the helical rim arcade (Zilinsky-Cotofana), consistent perforating branches of the PAA, and the helical arcade (Erdman), and will help and guide physicians performing auricular surgeries toward fast and simple procedures with optimal patient satisfaction.

Concerning Auricular Vagal Nerve Stimulation: Occult Neural Networks

“…Hence, arteries-as well as perivascular sympathetic and cholinergic innervation-should be considered when determining the sham/placebo zones in the human ear. The concha zone, which corresponds with the perforating auricular artery (Figure 2C), as been demonstrated in two independent anatomical studies (Park and Roh, 2002;Zilinsky et al, 2017), is also postulated as the most effective zone in the context of fMRI activations. The confounding factor of the perforating artery in this zone of the ear is also underestimated and is not mentioned in the study report (Yakunina et al, 2017).…”

“…The perforating arteries also distribute to the auricular skin areas that include the AVNS zones (Figure 2C), including the zone in the cymba concha where most AVNS studies place their active electrodes. It has also been reported that the perforator at the root of the helix consistently supplies the cymba and cavum of the concha as well as the posterior wall of the external auditory meatus, which fits perfectly with the AVNS zone (Park and Roh, 2002;Zilinsky et al, 2017). Hence, arteries-as well as perivascular sympathetic and cholinergic innervation-should be considered when determining the sham/placebo zones in the human ear.…”

“…In addition to the inhomogeneous distribution of the sympathetic nerves in the human ear , perforating auricular arteries are also worth considering when placing electrodes in sham/control groups. Two independent group studies demonstrated that the posterior auricular artery-i.e., the periarterial sympathetic and cholinergic nerves-perforates the auricular cartilage in up to five locations (Figure 2C) to emerge from the posterior auricular surface at the anterior auricular surface, where they anastomose with branches of the superior temporal artery (Park and Roh, 2002;Zilinsky et al, 2017); four of the five perforated zones are reported in both of these studies (the perforating artery location in the triangular fossa was documented in only of the studies; Park and Roh, 2002;Zilinsky et al, 2017).…”

“…In contrast, this distribution complicates interpretations of the AVNS because the sympathetic nerves also contribute to the perivascular innervation of the auricular arteries , and these auricular arteries have perforating branches that pierce the posterior aspect of the auricular cartilage (Figures 2C,D). These pass through to the internal aspect of the auricula and auricular skin, including the concha area where AVNS is performed (Park and Roh, 2002;Zilinsky et al, 2017;Cakmak et al, 2018). This perforating pathway provides not only a route for the sympathetic nerves to pass from the posterior surface of the ear to its anterior/interior surface but also a path for the parasympathetic axons from which the ABVN may originate.…”

Surgical management of skin cancer and trauma involving the middle third of the auricle

“…The arterial supply of the auricle from branches of the posterior auricular artery (PAA) and the superficial temporal artery is the anatomical basis for auricular reconstructive procedures . The presence of several vascular anastomoses, such as the helical arcade (Erdman) and the arterial helical rim arcade (Zilinksi‐Cotofana), connecting the superior and inferior branch of the superficial temporal artery, allow the preparation of a wide variety of auricular flaps .…”