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Dr. Supreet Singh Nayyar, AFMC 2011
www.nayyarENT.com1
Meatoplasty in CWD (for more topics, visitwww.nayyarENT.com)
Final stage of CWD Ensures sufficient enlargement of external
auditory meatus Mobilizes upper part of pinna
Endaural Approach
Korners flapo Endaural approacho Heerman B incisiono Radial
incisions in canal at 6 & 12 O clock
position
o Circumferential incision joining the twonear TM
o Divides the flap into medialtympanomeatal flap & a lateral
flap
which is called Korners flap
o Flap is pushed posteriorly into cavityo Held in place by
ribbon gauze in oint
(BIPP)
o Superiorly, anterosuperior flap coversattic & tegmen
o Inferiorly tympanomeatal flap coveraditus & antrum
Surdille flapo Circumfrential incision is lateral leaving a
larger
TM flap & smaller lateral flap called surdilles
flap
o Rest same as mentioned in Korners
Stacke meatoplastyo Inferiorly based & consists of posterior
canal skino Radial incision at 12 O clock positiono Medial
circumfrential incision 2-3 mm lat to TMo Lateral circumfrential
incision thru conchal skin
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Dr. Supreet Singh Nayyar, AFMC 2011
www.nayyarENT.com2
o Strip of conchal cartilage cuto Flap covers entire facial
ridge & inferior part of cavity
Farrior meatoplastyo Creates a conchal ear canal skin flapo
Enlarged by incorporating a subcutaneous tissue flapo Encourages
epithelialization of cavity from posterior edge of cavityo
Medially, medial wall of cavity covered with surdille flap raised
in farrier incision
Fleury meatoplastyo Fleury incision with superior vascular
strip
o Large surdile flap created (radial incisions at 12 O clock,
lateral flap is surdile)
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Dr. Supreet Singh Nayyar, AFMC 2011
www.nayyarENT.com3
o Covers facial ridge & lower part of thecavity
o First, vertical skin is sutured pullsupper part of pinna
upwards
o Conchal skin elevated strip of conchalcartilage exposed
o Conchal cartilage resected leavingperichondrium
o Two incisions are made thru conchal skin&
perichondrium
o Folded skin is now fixed with sutures tocover remaining
exposed cartilage
Post aural approaches
Korners techniqueo Radial incisions at 6 & 12 O clocko
Relatively medially placed circumfrential
incisions
o Flap elevated & held with retractor duringCWD
mastoidectomy
o 6 & 12 O clock incisions elongated tillconchal
cartilage
o Conchal cartilage is exposedo 1 cm strip of cartilage is
excised & separated
from perichondrium
o Flap is pulled posteriorly & sutured tosubcutaneous tissue
at posterior edge of
cavity
o Medially, meatal skin flaps are replacedposteriorly partly
covering facial nerve, lat
SCC, medial wall of attic & tegmen tympani
superiorly
o Cavity filled with gel foam in BIPP Stackes meatoplasty
o Inferiorly based & consists of posterior canal skin &
a strip of conchal cartilageo Radial incision at 12 O clock
positiono Medial circumfrential incision 2-3 mm lat to TMo Lateral
circumfrential incision thru conchal cartilageo Conchal cartilage
cut
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Dr. Supreet Singh Nayyar, AFMC 2011
www.nayyarENT.com4
o Flap covers entire facial ridge & inferior part of cavity
Portmans small 3 flap meatoplasty
o 3 flaps lateral, superior &inferior
o No removal of conchal cartilageo For small cavitieso Lateral
circumferential incision
from 12 to 6 O clock position
made 10 mm lateral to upper TM
o Upper lateral radial incision fromupper part of
circumferential
incision to spine of Henle
o Similar lower incision frominferior edge of
circumferential
incision towards conchao CWD mastoidectomyo A finger placed thru
the canal
exposing lateral flap
o Flap thinned outo When this is completed, edge of
conchal cartilage will be visible
o Flap is turned around the cartilageand fixed to posterior
aspect of cartilage This flap will form lateral covering of
cavity covers facial ridge
o Ear canal skin now divided at nine O clock position down to
drum creates asuperior ( covers superior part of cavity) &
inferior (covers facial ridge) flap
o These both flaps have to be thinned out Portmanns large 5 flap
meatoplasty with removal of cartilage
o Ear canal skin divided at 9 O clock position
o Latreally at conchal cartilage One incision turns infero
anteriorly Other incsion turns superoanteriorly
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Dr. Supreet Singh Nayyar, AFMC 2011
www.nayyarENT.com5
o Results in lateral, superior &inferior flap
o Superior & inferior flaps arefurther divided later
o Conchal skin of lateral flap elevated from cartilageo
Triangular piece of cartilage removedo Similarly skin from other
two conchomeatal flaps also elevatedo To facilitate mobility of
these two flaps , a triangle of skin removed from their tipso
Therefore, a total of 5 flaps are createdo Flaps thinned sutured to
posterior aspect of concha with single sutureo Cavity packed with
gel foam in BIPP
Sheehy meatoplastyo Vertical intercartilagenous incision at 12
O
clock position running parallel to crus of helix
o An incision made at 5 Oclock position intoconchal
cartilage
o Horizontal incision passess backward at 9 Oclock position
through conchal skin , cartilage
& post auricular soft tissue
oDivides lateral skin flap into superior & inferior
o Through retro auricular approach, conchalcartilage is exposed
& excised
o Superior & inferior flaps are inverted ontoposterior
aspect of remaining conchal cartilage
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Dr. Supreet Singh Nayyar, AFMC 2011
www.nayyarENT.com6
Fisch meatoplastyo One anteroposterior incisiono Elevates skin
flap from concha
before resecting major part of
conchal cartilage
o Two liberated skin flaps areinverted posteriorly around
edge of concha sutured to
posterior aspect of concha
Landolfis modified Fisch techniqueo Anteroposterior incisiono
Elevates skin flap from concha & cartilageo Conchal cartilage
exposedo Using pair of scissors, conchal cartilage is resected
including anterior edge of crus of
helix
o Similar procedure for inferior conchal flapo Resection of
conchal cartilage enlarges access to cavityo Inverted flap of
conchal skin provides epithelial covering of lateral wall of
cavityo In addition, Sanna uses part of ant canal wall skin as
superior flap
Modification of Palva flap & meatoplastyo Palva flap
normally is subcutis muscle flap used for cavity obliterationo Here
modification of palva flap (i.e. obliteration ) & meatoplasty
are done togethero Retroauricular incision skin elevated curved
incision through subcutaneous
tissue & periosteum to elevate large palva flap
o Before actually elevating , another incision is made along
entrance of canal from 6 to12 O clock through subcutaneous tissue,
muscle & periosteum
o After this incision, palva flap loses its anterior attachment
to pinna onlyattatched superiorly & inferiorly
o Meatoplasty performed by turning pinna backwards, making an
intercartilagenousincision at 12 Oclock position & an incision
through conchal cartilage at 5 O clock
position
o Auricle is again pulled forwards and a large strip of conchal
cartilage is excisedo Korners flap is turned around resected concha
& palva flap is elevatedo
Radial incision made at 9 O clock position through canal,
elevating an inferior &superior canal skin flap
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Dr. Supreet Singh Nayyar, AFMC 2011
www.nayyarENT.com7
o CWD mastoidectomyo Modified palva flap now placed in
cavity attached superoanteriorly and
inferoanteriorly
o Mainly obliterates posterior part ofcavity & sinodural
angle
(for more topics, visitwww.nayyarENT.com)
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