Meatoplasty with intraoperative topical mitomycin C application: technique and outcome

ABSTRACT

The present study was designed to evaluate the outcome of meatoplasty using Z-shaped incision with application of mitomycin C as trial to enlarge the external auditory meatus of patients undergoing modified radical mastoidectomy in comparison to classic meatoplasty with application of mitomycin C. The study included 40 patients; 25 males and 15 females with mean age of 38.7 +/- 8.4 years. All patients underwent Jull history taking, complete otorhinolaryngological examination and CT scanning and then were randomly allocated into two equal groups [n=20] according to the procedure assigned Classic meatoplasty [C group] and Z-shaped meatoplasty [Z group] using Z-shaped skin incision made along the posterior and inferior conchal borders and extended along the posterior ear canal meatus. In both groups, mitomycin C, 0.4 mg/ml solution was applied on a sponge to the edge of the remnants of conchal cartilage for 5 minutes. Patients were examined bi-weekly till the ear was fully healed. Meatoplasty was assessed as regards the feasibility of easy examination and debridement with the use of simple otologic tools and an operating microscope. Both groups were compared as regards age, sex, operative time and amount of intraoperative bleeding. All cases passed smooth intraoperative course with non-significantly longer operative time and non-significantly more bleeding during Z-meatoplasty compared to classic meatoplasty. All Z flaps healed completely with good take without sloughing or change in color and the meatus was so enlarged to allow inspection of mastoid cavity and easy debridement with simple tools and allowed frequent otoscopic examination for cavity inspection. Only one ear, in Z group, developed hypertrophic scar that did not impose significant narrowing of the meatus. On contrary; 3 ears had classic meatoplasty developed keloid formation and significant narrowing of the meatus that hampered cavity examination and debridement. Another ear, in C group, developed postoperative perichondritis that resolved with local care and oral antibiotics, but unfortunately developed meatal stenosis. Thus, Z-meatoplasty showed a success rate of 95% which is significantly higher compared to classic meatoplasty [80%]. It could be concluded that application of mitomycin C in conjunction with Z-meatoplasty is an effective modality for reduction of possibility for hypertrophic meatal scar with its subsequent problems. Also, classic meatoplasty with mitomycin C application provided acceptable frequency of hypertrophic meatal scar and is recommended wherever Z-meatoplasty was technically difficult