Meatoplasty - Vula - University of Cape Town

OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD &NECK OPERATIVE SURGERYMEATOPLASTYMeatoplasty is an operative technique towiden the lateral cartilaginous part of theexternal auditory canal. Cartilage displacedanteriorly from the cavum conchae of thepinna, as well as bulky underlying softtissue can cause narrowing of the lateralpart of the ear canal. 1 The aim of ameatoplasty is to enlarge the lumen of theentrance of the ear canal by removing theobstructing cartilage of cavum conchae aswell as the underlying soft tissue.Indications for surgeryThere are 2 clinical scenarios where ameatoplasty may be required i.e. as anintegral part of another otologicalprocedure, or where there is lateral stenosisof the external ear canalAs integral part of other otologicalproceduresOpen mastoidoepitympanectomy(MET): Meatoplasty is an essentialroutine step at the end of an open METto provide easy access for cleaning andto assist with ventilation of the mastoidcavity. Failure to do an adequatemeatoplasty will result in a lifelongproblem of a chronic draining ear. Thistype of meatoplasty is discussed in thechapter Mastoidectomy andEpitympanectomyTympanoplasty, canalplasty, removalof exostosis (bony canal wall intact): Inthese procedures it may be mandatoryto perform a meatoplasty to improveintraoperative surgical exposure.For lateral stenosis of the external earcanal: Meatoplasty becomes necessarywhen wax impaction as a result of canalstenosis causes recurrent otitis externa orhearing loss and requires frequent visits toan otolaryngologist.Tashneem Harris & Thomas LinderCanal stenosis may be a result of:Congenital stenosisOtitis externaIatrogenic following surgery orirradiationTraumaM-Meatoplasty (See Meatoplasty video)The authors favour the M-Meatoplastytechnique first described by Mirck in1966. 2AnaesthesiaAntibiotic prophylaxis is not requiredIt is performed under local anaesthesiaas an outpatient procedureThe retroauricular skin behind theconchal cartilage and the underlyingsoft tissue are infiltrated with 1%lidocaine and 1: 100 0000 adrenalineThe skin and subperichondrial layer ofthe conchal bowl as well as theposterior ear canal wall are infiltratedwith the same solutionCreating the skin flapsAn assistant retracts the tragus using amicrohook to improve exposure(Figure 1)Figure 1: Microhook retracting tragus

Excision of obstructing cavum cartilageand underlying soft tissueA circle of about 1cm diameter is cutout of the cavum cartilage (Figure 7)Figure 9Figure 7: Circle cut out of cavum cartilageThe underlying subcutaneous tissue isoften bulky and is also excised (Figure8)Figure 10Figure 8: Subcutaneous tissue is excised6/0 Nylon sutures are used to suture theskin flaps as follows:Sutures are placed between the pointedends of the two intrameatal skin flapsand either side of the base of thecentral triangular skin flap (Figures 11& 12)V-Y plastyA fourth 1cm transverse incision ismade in the posterior canal wall, thuscreating two intrameatal skin flaps(Figures 9 & 10)Figure 11: Sutures placed between ends ofthe intrameatal skin flaps3

Figure 12: Sutures placed between ends ofthe intrameatal skin flapsFigure 14A suture is placed at the beginning ofthe intrameatal skin incision and theapex of the middle triangular skin flap.This step widens the entrance of theexternal ear canal (Figure 13)Figure 15Figure 13: Suture placed at beginning ofthe intrameatal skin incision and apex ofmiddle triangular skin flapThe two redundant triangular skin flapsare excised and sutures are placedbetween the remaining edges of skin ofthe cavum concha and the intrameatalskin flaps. (Figure 14,15,16)Figure 16This results in a scar shaped like an“M” (Figure 17)4

AuthorTashneem Harris MBChB, FCORL,MMED (Otol), Fisch InstrumentMicrosurgical FellowENT SpecialistDivision of OtolaryngologyUniversity of Cape TownCape Town, South Africaharristasneem@yahoo.comFigure 17A Terracortril (ointment containing asteroid and antiseptic agent) gauze isplaced in the external ear canal for 5daysSutures are removed after 1 weekReferences1. Fisch U, May J, Linder T. Tympanoplasty,Mastoidectomy, and StapesSurgery. New York: Thieme; 2008.2. Mirck PG. The M-meatoplasty of theexternal auditory canal. Laryngoscope.1996; 106(3):367-69.Senior AuthorProf Thomas Linder, M.D.Chairman and Head of Department ofOtorhinolaryngology,Head, Neck and Facial Plastic SurgeryLucerne Canton Hospital, Switzerlandthomas.linder@ksl.chEditorJohan Fagan MBChB, FCORL, MMedProfessor and ChairmanDivision of OtolaryngologyUniversity of Cape TownCape TownSouth Africajohannes.fagan@uct.ac.zaDownload meatoplasty videohttps://vula.uct.ac.za/access/content/group/9c29ba04-b1ee-49b9-8c85-9a468b556ce2/Johan%20Fagan%20Surgery%20Atlas/M%20-%20Meatoplasty.aviTHE OPEN ACCESS ATLAS OFOTOLARYNGOLOGY, HEAD &NECK OPERATIVE SURGERYwww.entdev.uct.ac.zaThe Open Access Atlas of Otolaryngology,Head & Neck Operative Surgery by JohanFagan (Editor) johannes.fagan@uct.ac.zais licensed under a Creative CommonsAttribution - Non-Commercial 3.0Unported License5