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Clock wise:Preop Pic/Skin incision./Temporalis fascia dissection/
Under perichondral dissection (medial-lateral vision)/
In 1990, Prasad et al. for the first time, described a new surgical approach defined supra-auricular which was based upon the theory that a fistula is, almost always, included in subcutaneous tissues between the temporalis fascia and perichondrium of the helix cartilage. Therefore, these Authors proposed that the elliptical incision of the standard technique be extended higher upward to the pre- and supra-auricular temporal region . This allows better surgical vision without adverse aesthetic consequences. Dissection proceeds identifying the temporalis fascia medially to the sinus area. It is only this fascia that represents a medial and deep limit of dissection that continues in a medium lateral direction until reaching the helix cartilage . At this level, dissection is made below the perichondral layer and, at the point of maximum adherence of the fistula, excision of a small portion of the cartilage is advisable . The surgeon, during dissection, does not follow the fistula but, being aware of the space in which it develops, removes all subcutaneous tissue comprised between thetemporalis fascia and the helix perichondrium . In this tissue, the sinus is certainly present with its ramifications and the eventual cyst.