Clin Exp Otorhinolaryngol.  2009 Dec;2(4):164-168. 10.3342/ceo.2009.2.4.164.

A Novel Meatoplasty Method in Canal Wall Down Tympanomastoidectomy: A Perichondrial Posterior Fixation Technique

• Choi IJ
• Song JJ
• Jang JH
• Chang SO

• KMID: 1466492
• DOI: http://doi.org/10.3342/ceo.2009.2.4.164

Abstract

OBJECTIVES
Although it is well recognized that a small meatus after canal wall down (CWD) tympanomastoidectomy can cause a lifetime problem, unsatisfactory results are frequently encountered. We herein introduce a novel technique, perichondrial posterior fixation (PPF), to maintain a wide external auditory canal (EAC), to minimize postoperative wound infection due to the smaller dead space and to improve the posterior auricular cosmetic outcome. METHODS: A total of 73 patients who underwent CWD tympanomastoidectomy were included. Interventions are CWD tympanomastoidectomy with the PPF technique. Review of the medical records and evaluation of the postoperative size of the meatus and the extent of the cavum conchal cartilage buried within the mastoid cavity by taking digital photographs. RESULTS: Thirty males and 43 females were included and the mean age was 44.1 yr (range, 6 to 66 yr). The mean follow-up duration was 26 months (range, 12 to 56 months). All ears maintained a clean and large external meatus. The posterior auricular cavum conchal cartilage was successfully prevented from being buried into the mastoid cavity in all ears. The extent of cartilage buried into the mastoid cavity was much reduced compared to the conventional technique. CONCLUSION: The PPF technique, which is a novel meatoplasty technique in CWD tympanomastoidectomy, seems to be effective in maintaining a large external meatus and improving the cosmetic outcome with minimal risk of complications.

Keyword

Chronic otitis media; Meatoplasty; Tympanomastoideotomy

MeSH Terms

Cartilage
Cosmetics
Ear
Ear Canal
Female
Follow-Up Studies
Humans
Male
Mastoid
Medical Records
Surgical Wound Infection
Cosmetics

Figure

• 

  Fig. 1 A surgical outcome by conventional meatoplasty. (A) Lateral view. Narrowing of the external auditory canal due to sliding of the conchal cartilage (arrowhead) from the posterior wall. (B) Posterior view. The cavum conchal cartilage (arrowhead) is buried in the mastoid cavity (arrow).

• 

  Fig. 2 The surgical technique of a novel meatoplasty in canal wall down tympanomastoidectomy using perichondrial posterior fixation. (A) Partial excision of the cavum cochal cartilage. (B) A wedge incision is made in the Ko_rner flap. (C) Suturing the anterior edge (arrowhead) of the conchal cartilage to the periosteum of the mastoid bone (arrow) with 3-0 vicryl. (D) Final result after finishing our novel meatoplasty.

• 

  Fig. 3 Axial cross-section diagram at the level of the external auditory canal (EAC) of the right ear. (A) Narrowed EAC opening (a) by conventional meatoplasty and reduced height of the external auricle by boring into the mastoid cavity (B) Cutting the excessive anterior edge (b) of the conchal cartilage. (C) Suturing the anterior margin of the conchal cartilage posteriorly to the periosteum of the mastoid bone (c), widened EAC opening (d) by prevention of conchal cartilage sliding.

• 

  Fig. 4 A surgical outcome by perichondrial posterior fixation. (A) Lateral view. Widening of the external auditory canal (arrowhead) by fixation of the conchal cartilage to the posterior wall. (B) Posterior view. Elevation of the cavum conchal cartilage (arrowhead) on the posterior mastoid wall (arrow).

Reference

1. Roulleau P. Development of the surgery of chronic otitis. Rev Laryngol Otol Rhinol (Bord). 1993; 114(2):87–91. PMID: 8284561.

2. Fisch U, Chang P, Linder T. Meatoplasty for lateral stenosis of the external auditory canal. Laryngoscope. 2002; 7. 112(7 Pt 1):1310–1314. PMID: 12169919.

3. Paparella MM, Kurkjian JM. Surgical treatment for chronic stenosing external otitis (Including finding of unusual canal tumor). Laryngoscope. 1966; 2. 76(2):232–245. PMID: 5324121.

4. Soliman T, Fatt-Hi A, Abdel Kadir M. A simplified technique for the management of acquired stenosis of the external auditory canal. J Laryngol Otol. 1980; 5. 94(5):549–552. PMID: 7400681.

5. Hunsaker DH. Conchomeatoplasty for chronic otitis externa. Arch Otolaryngol Head Neck Surg. 1988; 4. 114(4):395–398. PMID: 3348895.

6. Mirck PG. The M-meatoplasty of the external auditory canal. Laryngoscope. 1996; 3. 106(3 Pt 1):367–369. PMID: 8614206.

7. Eisenman DJ, Parisier SC. Meatoplasty: the cartilage of the floor of the ear canal. Laryngoscope. 1999; 5. 109(5):840–842. PMID: 10334243.

8. Suskind DL, Bigelow CD, Knox GW. Y modification of the Fisch meatoplasty. Otolaryngol Head Neck Surg. 1999; 7. 121(1):126–127. PMID: 10388893.

9. Raut W, Rutka JA. The Toronto meatoplasty: enhancing one's results in canal wall down procedures. Laryngoscope. 2002; 11. 112(11):2093–2095. PMID: 12439187.

10. Garap JP, Dubey SP. Canal-down mastoidectomy: experience in 81 cases. Otol Neurotol. 2001; 7. 22(4):451–456. PMID: 11449098.

11. Kos MI, Castrillon R, Montandon P, Guyot JP. Anatomic and functional long-term results of canal wall-down mastoidectomy. Ann Otol Rhinol Laryngol. 2004; 11. 113(11):872–876. PMID: 15562896.