Reconstructing Ear Defects Using the Revolving Door Island Flap: A Case Series

BACKGROUND AND OBJECTIVES

Defects of the anterior region of the pinna pose a reconstruction challenge owing to the complex topography and difficult access. We report our experience using the revolving door island flap (RDIF) to reconstruct pinna defects and present the surgical results.

MATERIAL AND METHODS

Retrospective descriptive study of patients undergoing ear reconstruction using RDIF at different sites of the anterior region after resection of malignant tumors.

RESULTS

Seventeen patients underwent surgery between 2011 and 2019 for squamous cell carcinoma (n=7) and basal cell carcinoma (n=10). Conventional histology showed disease-free surgical margins in all the resected tissue specimens. The mean follow-up period was 40 months. One local recurrence of squamous cell carcinoma was observed, which responded well to radiation therapy; all patients were free of disease at the end of follow-up. Only 3 patients presented minor complications (depression of the flap surface in 1 case and retraction of the ear toward the mastoid process in 2 cases). Subjective rating scales were used to evaluate cosmetic and functional outcomes as assessed by both the dermatologist and the patient. The normal contour of the pinna was conserved in all patients and no patients required additional corrective surgery.

CONCLUSIONS

Reconstruction of the pinna using RDIF allowed for satisfactory repair following complete resection of the tumors, while conserving structure and functionality. RDIF has been reported to be a very good option for reconstruction of the pinna. It is a simple technique that makes it possible to repair large defects with minimal risk of necrosis. In our series, the cosmetic results were excellent and recurrence rates were very low. RDIF provided optimal results in repairing lesions in the concha and in other regions, such as the antihelix, triangular fossa, and scapha.

Malignant myoepithelioma of the external auditory canal - a rare case report with literature review and clinical importance of foramen of Huschke

BACKGROUND

A malignant myoepithelioma is a rare tumor, mostly arising from the salivary glands. Myoepitheliomas of the ear have rarely been reported. The manuscript reports myoepithelial carcinoma of the external auditory canal (EAC) spreading to the infratemporal fossa. A clinician must be aware of anatomical variation of the bony EAC wall, such as the foramen of Huschke. This rare defect may be a pathway for spreading pathologies between these two anatomical regions.

CASE REPORT

We present a case of osteoma-like stenosis of the EAC, which turned out to be an extremely rare malignant tumor. The preoperative MRI and PET/CT revealed that two parts of the tumor communicated through a defect in the antero-inferior portion of the bony ear canal. No distant metastases were detected. Subsequently, the tumor was resected from the ear canal and the infratemporal fossa en bloc. Perioperatively the defect in the EAC wall was suspected of the foramen of Huschke. After the surgery, the older scans of the patient from the past showed no presence of a congenital EAC wall defect. Therefore, the authors concluded that the tumor aggressively grew through the bone due to its biological nature.

CONCLUSION

Malignant myoepithelioma of the external auditory canal is an extremely rare condition and could be misdiagnosed as other benign lesions. In cases of suspicious lesions, it is advisable to do a probatory biopsy from the EAC. Surgery is the treatment of choice in malignant myoepitheliomas, and regular follow-ups are essential to monitor for recurrence or metastatic disease. Any mass located at the antero-inferior portion of the EAC wall warrants close evaluation due to its potential for expansion from the EAC.

Reconstruction of the external auditory canal using full-thickness rolled-up skin graft after lateral temporal bone resection for T1 and T2 external auditory canal cancer

OBJECTIVE

To present our results of the external auditory canal (EAC) reconstruction procedure using rolled-up full-thickness skin graft with tympanoplasty after lateral temporal bone resection (LTBR) for early-stage EAC carcinoma.

PATIENTS AND METHODS

A retrospective review of 15 patients who had undergone LTBR with reconstruction of the EAC for T1 and T2 EAC cancer between 2016 and 2020.

RESULTS

Postoperative mean air-bone gap was 30.7 decibel hearing level. Although a few patients experienced chronic granulation, persistent otorrhea, and/or laterization of the tympanic membrane, most patients showed no serious complications related to the EAC reconstruction.

CONCLUSION

EAC reconstruction using a full-thickness skin graft in combination with tympanoplasty is useful for minimizing the hearing loss, maintaining the cosmetic appearance, and facilitating the observation into the ear cavity.

En Bloc Subtotal Temporal Bone Resection in a Case of Advanced Ear Cancer: 2-Dimensional Operative Video

Temporal bone cancer is extremely rare; thus, the optimal surgical strategy for advanced tumors, en bloc vs piecemeal resection, remain controversial. Some authors have favored piecemeal resection and reported comparable outcomes.1 Other authors recommend the use of en bloc subtotal temporal bone resection (STBR) for advanced tumors and reported better outcomes, although long-term cancer control remains uncertain.2 Because of the technical difficulty and the lack of demonstrative surgical videos, STBR has not been sufficiently distributed. This video demonstrates en bloc STBR in a stepwise manner with particular focus on the neurosurgeon's role and aims to improve its safety, feasibility, and distribution. This video conforms to the description of Osawa et al3 in the designations for each segment of the petrous ICA. A 67-yr-old man suffered from consistent otorrhea and underwent tympanoplasty at an outside hospital 1 yr earlier. Following a histopathological diagnosis of squamous cell carcinoma in the specimen, he underwent chemoradiotherapy (cisplatin + 70 Gy). However, a current imaging revealed a recurrent tumor and he was admitted to our hospital for radical resection. Computed tomography revealed a disrupted external auditory canal and magnetic resonance imaging indicated a carcinoma equivalent to Pittsburg stage T3. The patient underwent radical STBR without complications. His postoperative course was uneventful. At 2 yr postoperative, his modified Rankin scale score was 1, no recurrence was noted, and his facial nerve function was restored to House-Brackmann Grade IV. This video was reproduced with informed consent from the patient.

Expression of EGFR and p16 in Squamous Cell Carcinoma of External Auditory Canal

The expression of EGFR and p16 in the external auditory canal squamous cell carcinoma (EACSCC) and their impacts on oncological outcomes were not well studied. Seventeen-one consecutive patients who were treated for EACSCC at Kobe University Hospital from 1995 to 2018 were enrolled in this study. The expression of EGFR, and p16 were evaluated and their impacts on oncological outcomes were statistically analyzed. Positive expression of EGFR was observed in 62 patients (87%). Strong positive expression of p16 were observed in 18 patients (32.4%), and weakly positive expression in 30 patients (42.3%), respectively. While the number of the patients with negative EGFR expression were limited, all the surgically treated patients with negative EGFR expression have been alive without disease. In the patients with T3 & T4a EACSCC, prognosis of the patients with positive p16 expression EACSCC tended to be better than those with negative p16 expression. These results suggest the clinical significance of EGFR and p16 expressions in the patients with advanced EACSCC to predict oncological outcomes.