The helical arcade: anatomic basis for survival in near-total ear avulsion.

Survival of the ear based on a single vascular pedicle has been previously documented. The anatomic basis for this survival remains incompletely described. In the 3 clinical cases of inferior-to-superior near-total ear avulsion presented herein, the authors have observed that the ear can survive based on a narrow pedicle along the helical root. In an anatomic study to further investigate the relevant vascular anatomy, the common carotid artery system of 6 fresh human cadaver specimens was injected with latex. The superficial temporal artery and its branches located at the helical root were examined. This anatomic study showed that the upper auricular branch of the superficial temporal artery continues into the ear as the helical artery supplies an arterial arcade, which we have termed the helical arcade. This arcade seems to allow for communication between the anterior and posterior arterial systems of the ear and allows the helical artery to provide sufficient arterial supply to the entire ear.