Long-term result of meatoplasty using inferiorly based retroauricular island pedicle flap for external auditory canal stenosis
Introduction
EAC stenosis is a challenging problem. Stenotic EAC hampers the self-cleaning function of the EAC skin, leading to accumulation of debris, which causes hearing loss and chronic infection. The surgical procedures for patients with stenotic EAC have been skin grafting and/or stent placement [1], [2], [3]. However, revision surgery is often required to address complications associated with the initial procedure, which include restenosis and chronic recurrent otorrhea. In order to solve such problems, a vasculized pedicled skin flap technique has been proposed by several groups of investigators [4], [5], [6], [7], [8]. Our technique is a modification of a technique described by Chole, who utilized postauricular skin used as an island pedicle graft to epithelize the posterior and inferior ear canal as well as the newly constructed tympanic membrane [4]. Stucker and Shaw described a similar method in 1991 [5]. The goal of the present study was to characterize the long-term result of our new technique, inferiorly based retroauricular island pedicle flap for EAC stenosis.
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Subjects
The enrolled subjects were comprised of nine patients with EAC stenosis who underwent surgeries at Tokyo Medical and Dental University Hospital from August 2002 to July 2009. This study was a retrospective chart review and all procedures followed were in accordance with the World Medical Association and the Declaration of Helsinki in 2008. All the subjects gave their written informed consent to receive the surgery.
The patient age at the time of initial surgery ranged from 8 to 64 years, with an
Results
Nine patients underwent meatoplasty, as described above. Demographics and the size of the flap are shown in Table 1. Otoscopic results revealed “improvement” in eight patients and “no change” in one patient (Table 2). There was no disagreement in evaluation between investigators. No patient experienced flap failure.
The preoperative diameter of the EAC ranged from 0.1 to 5.7 mm with an average of 3.1 mm. The postoperative diameter of the EAC ranged from 3.3 to 6.7 mm with an average of 4.9 mm. All
Discussion
The EAC stenosis is either caused by congenital malformation or acquired insult, secondary to persistent otitis externa, trauma, surgery, and irradiation. The EAC stenosis restricts otoscopic examination and toilet. It also affects epithelial migration of the EAC skin, leading to chronic aural disease. Cases of narrow fibrocartilaginous canal can be associated with EAC cholesteatoma [1]. The cholesteatoma occurred in 91% of patients with the age of 12 years and older and the EAC size of 2 mm or
Conclusion
We performed meatoplasty using an inferiorly based retroauricular island pedicle flap for nine patients with EAC stenosis. Eight patients demonstrated satisfactory patent EACs during a mean follow-up of 8.4 years.
Conflict of interest
The authors declare no conflicts of interest in association with this study.
Acknowledgments
This study was supported by Grants-in-Aid for Scientific Research (Nos. 21390459 and 22659305) from the Ministry of Education, Culture, Sports, Science and Technology, Japan and by a grant-in-aid for scientific research from the Ministry of Health, Labor and Welfare of Japan (H23-kankaku-005).
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