Postauricular Twin Flap for Canal Wall Reconstruction after Canal Wall Down in Chronic Otitis Media with Small Canal

Abstract

Objective: Propose the postauricular twin flap consisting of an anteriorly based periosteal flap and soft tissue flap for reconstruction of the canal wall in patients with chronic otitis media and small ear canal in which a canal down procedure is required. Method: A retrospective review was performed in patients undergoing canal wall reconstruction with postauricular twin flap and type I tympanoplasty after canal wall down from 2009 to 2010. Shape of the canal after reconstruction, pre- and postoperative audiogram, and postoperative complications such as infection, delayed healing, and dehiscence of the wall were evaluated. Results: Seven ears of 7 patients underwent the canal wall reconstruction procedure after canal down and type I tympanoplasty. The ages of the patients ranged from 19 to 63 years. The mean duration of follow-up was 13.3 months with a range of 9 to 18 months. The shape of the canal was maintained in all ears, and no dehiscence of the canal wall was found in all seven ears. Postoperative hearing was variable depending on the hearing of preoperation, but no worsening was observed. Mean improvement of postoperative air conduction was 21.8 dB, and that of postoperative air-bone gap was 16.4 dB. Conclusion: The postauricular twin flap is thin and flexible enough to support the posterior surface of the canal skin and to fill the space remaining after surgery. The twin flap procedure for the reconstruction of the external ear canal showed a high success rate.