Premium
Novel Method of External Auditory Canal Atresia/Stenosis Repair
Author(s) -
Bedwell Joshua,
Roy Sudeep,
Kim Ana,
Linstrom Christopher,
Parisier Simon
Publication year - 2010
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.21255
Subject(s) - citation , medicine , art history , art , library science , computer science
14 patients (mean age 14.8 years) underwent the described procedure from 2007-2009. After an average followup of 13.8 months, 2 required revision surgery for re-stenosis of the external canal, a rate of 14%. The average time to revision was 6 months. Notably, 3 of the 14 patients represented revision cases, none of which have re-stenosed to date. This revision rate represents a dramatic improvement from a series of 13 patients operated from 2001-2006 (mean age 26.3 years), using a split-thickness skin graft cut into multiple strips, and placed without silastic reinforcement. Of those 13 patients (followed for an average of 41 months), 6 required re-operation for external canal restenosis, a rate of 46%. In this group, the average time to revision was 4.8 months. Repair of aural atresia is a technically demanding operation. Post-operative external auditory canal stenosis is one of the most common complications. We describe a useful technique for handling the split thickness skin graft used to line the EAC, and review our experience in a series of 27 patients. As the technique of atresiaplasty has evolved over time, so has the method for providing an epithelial lining for the newly created external auditory canal. Postoperative canal stenosis has dramatically decreased from initial series using fullthickness skin grafts, but remains a common complication. Similar to our series, De la Cruz reported a decrease in external canal stenoses with the adoption of new techniques (13.9 to 3.8%), including using a thinner split thickness graft, lining the EAC with silastic after graft placement, and using Merocel wicks in the EAC5. We feel the technique of fixing the silastic to the graft prior to placement in the EAC renders the graft easier to manipulate and precisely position. Furthermore, it allows the skin to be placed smoothly along the bony canal, without bunching and wrinkling.Although the followup of our newer cases is shorter than the older group, it is likely that the decreased incidence of stenosis will remain stable over time, as the average time to revision for both groups is less than 6 months. The literature bears this out, with most series reporting no cases of re-stenosis beyond 1-2 years. 27 patients underwent repair of either congenital aural atresia or external canal stenosis at the New York Eye and Ear Infirmary between 2001 and 2007. The charts of these patients were reviewed and information regarding the surgical technique was obtained. Patients were classified as “new” if the split-thickness skin grafting technique described below was used, and “old” if another technique was used. The development of post-operative EAC stenosis requiring revision, and the timing of revision surgery was noted.