A, The incision sweeps widely around the posterior margin of the ear so that a retrosigmoid, presigmoid, and far-lateral exposure can be obtained behind the ear, and a subtemporal, infratemporal, pterygopalatine, and orbital exposure can be obtained in front of the ear. B, The scalp flap has been reflected forward, the external canal transected, and the parotid gland and superficial branches of the facial nerve exposed. C, The sternocleidomastoid muscle has been reflected. The neck dissection exposes the internal jugular vein, C1 transverse process, and the glossopharyngeal, vagus, accessory, and hypoglossal nerves. The accessory nerve is retracted forward. D, The parotid gland has been removed to expose the temporofacial and cervicofacial trunks of the facial nerve and the temporomandibular joint. The splenius capitis muscle has been reflected downward to expose the superior and inferior oblique muscles, which insert on the transverse process of C1 and border the suboccipital triangle in which the vertebral artery courses. (Images courtesy of AL Rhoton, Jr.)