Preauricular Retaining Ligament to Anterior Helix of the Ear: Is it a Constant Structure?

Objective: The term ‘retaining ligament’ was first given by Dr. Mar McGregor for the ‘area of fibrous attachment’. A thorough knowledge of the layers, planes, and structures of facial anatomy is critical when performing aesthetic surgery. The retaining ligaments of the face are important in understanding concepts of facial aging and rejuvenation. In this article, the ligamentous structure found in the pre-auricular region anterior to helix of ear encountered during standard pre-auricular approach to the temporomandibular joint has been discussed. Methods: A total of eight cases of the standard pre-auricular approach to the temporomandibular joint were studied, and an anatomically constant cutaneous ligament to anterior helix of the ear was observed. Results: Amongst the cases studied, a constant cutaneous ligament to the anterior helix of the ear was observed. It was also noted that the above-mentioned retaining ligament was useful in separating the sub- and supra-zygomatic compartments, thereby helping to direct the beginning of pre-tragal dissection. Conclusion: As the pre-auricular approach is common in maxillofacial surgeries, thorough knowledge about the various cutaneous ligamentous structures is crucial. The described cutaneous ligament can serve as important landmark in standard pre-auricular approach, and reorientation of this structure is also important to resuspend the pre-auricular skin after surgery.