A Comparative Study Using CT Imaging and Cadaveric Dissection in the Evaluation of the Posterior Auricular Vein as an Alternative Recipient Vein for Facial and Scalp Reconstructions

Objective: To determine the diameter and anatomical location of the posterior auricular vein (PAV) and evaluate its suitability as an alternative recipient vein to the superficial temporal vein in microvascular facial and scalp reconstruction. Materials and Methods: A retrospective study was conducted using 50 contrast-enhanced cranial CT scans (100 sides) and anatomical dissections on 10 fresh cadaveric heads (20 sides) between 2015 and 2019 at Siriraj Hospital, Mahidol University. Measurements of PAV diameter and its distance from the vertical tragus line were recorded at the trunk, tragus, and helix levels. Descriptive statistics and side-to-side comparisons were analyzed using appropriate analytical tools. Results: CT scans showed mean PAV diameters of 1.74 mm (trunk), 1.67 mm (tragus), and 1.33 mm (helix). Corresponding measurements from cadaveric dissections were 1.47 mm, 1.39 mm, and 1.16 mm, respectively. The 95% confidence intervals confirmed anatomical consistency and bilateral symmetry. The harvestable length of the PAV reached up to 65 mm on CT) and 61 mm on cadaveric dissection, comparable to the superficial temporal vein. No significant differences in positional measurements (distance from the tragus) were found between methods or sides (p > 0.05). Conclusion: The posterior auricular vein demonstrates consistent anatomical parameters and a diameter comparable to the superficial temporal vein. These findings support its feasibility as a reliable alternative for venous anastomosis in facial and scalp microvascular reconstruction, especially in vessel-depleted cases.