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Z‐meatoplasty of the external auditory canal

1998; Wiley; Volume: 108; Issue: 9 Linguagem: Inglês

10.1097/00005537-199809000-00033

1531-4995

Paul Fagan, Mohammad Ajal,

Reconstructive Facial Surgery Techniques

An integral part of intact canal wall mastoidectomy (ICWM) is an adequate canalplasty.1 Extensive soft tissue mobilization can result in stenosis of the membranous canal, so that no matter how effective a bony canal widening procedure has been, an easily inspected self-cleaning ear will not be obtained. When standard adequate meatoplasty techniques23 are employed in conjunction with ICWM, there is a significant risk of creating a mastoid-cutaneous fistula. Z-meatoplasty4 allows for adequate cartilage resection with the creation of a wide meatus as well as providing soft tissue and skin cover to the posterior canal wall, obviating the risk of fistula. The procedure is usually carried out under general anesthesia as part of the ICWM, but in an existing stenosis the surgery can be done under local anesthesia, as an outpatient procedure. Left ear: surgeon's view. An incision runs along the roof of the external auditory canal (EAC) beginning laterally at the inter-tragal notch (a-d). A second incision (b-c), parallel to the first, begins at the junction of the floor of the EAC and the conchal cartilage. A third incision (a-b) runs along or just behind the free edge of the conchal cartilage. Elevation of flaps d,a,b and c,b,d exposes a wide area of conchal cartilage (shaded area), which is then resected. The flaps are then transposed and sutured with 4 × 0 Dexon. An end-aural incision (A–D) is carried into the roof of the external auditory canal (EAC) (Fig. 1). A second parallel incision begins near the floor of the EAC at the conchal junction and extends upward and backward (B–C). The third incision runs along or just behind the conchal free margin to connect points A and B (Fig. 2). Elevation of flap A,B,C gives access to the area of the conchal cartilage to be resected. Soft tissue deep to the cartilage can be resected as required. Flap D,A,B is also elevated, then the flaps are transposed and fixed with 4 × 0 interrupted Vicril sutures (Fig. 3). The EAC is then packed in the usual fashion. View of Z-meatoplasty at conclusion of procedure. Closure of the skin in a broken line (the Z line) prevents retraction and reduces the stenosis of the meatus. Stenosis secondary to wound disruption has not occurred in our experience. Although many methods of meatoplasty have been published,5-7 the authors are not aware of any description of the Z-meatoplasty. The maneuver is simple and quick to perform and represents an effective treatment and prevention of lateral canal stenosis in intact canal wall surgery.