Reconstruction of external auditory canal with a laterocervical twisted (snail) flap

There are several different causes of the deformities of the external auditory canal requiring reconstruction such as tumors, burns, trauma, and malformations. Many surgical approaches with varying success for the reconstruction of the external auditory canal (EAC) have been favored, including secondary healing, skin grafting, and a variety of local skin flaps. Unfortunately, the major drawback of the previously defined techniques is the resulting stenosis of the EAC. A 73-year-old white man was admitted to our clinic because of an unhealing ulcerated lesion at the superior and posterior one third of the left external auditory canal, involving the most internal part of the concha. Preserving the superior one third of the helix, left auricle and the EAC was surgically removed en bloc. To reconstruct the surgical defect, a snail flap was designed on the ipsilateral cervical region and based posteriorly on the left mastoid region. Twisting the flap on its main axis, as mentioned, created a final shape resembling a snail and a tube with epithelium-lined canal inside. At the postoperative first-year visit, the patient's endoscopic examination showed no sign of recurrence, tympanoplasty graft was intact, and the EAC was patent without signs of stenosis. Our experience with the laterocervical flap supports the fact that this flap does not cause stenosis, hearing loss, and therefore should be concerned as one of the first choices of treatment for the reconstruction of EAC.