Cholesteatoma in concha-type microtia

Concha-type microtia with congenital aural stenosis carries a risk of external auditory canal cholesteatoma, which may cause infection and lead to the loss of costal cartilage grafts during auricular reconstruction. However, awareness of this risk among plastic surgeons remains limited. We aimed to review cases of cholesteatoma in concha-type microtia and discuss optimal management strategies.

We conducted a single-center retrospective review of patients with concha-type or small concha-type microtia and congenital aural stenosis who underwent auricular reconstruction with costal cartilage grafting between January 2018 and December 2021. We identified patients who developed external auditory canal cholesteatoma and analyzed the timing of occurrence, treatment, postoperative complications, graft preservation or removal, and postoperative course (including recurrence).

Among 278 patients with microtia (90 auricles), 83 had concha-type or small concha-type microtia. The mean age at surgery was 11.8 years (range 10 to 24 years; median 11 years), and the cohort comprised 53 males and 30 females. Congenital aural stenosis (<4 mm) was present in 60 auricles, with cholesteatoma occurring in 4 (6.7%). One cholesteatoma was diagnosed preoperatively, two were diagnosed shortly after reconstruction (one required graft removal), and two were diagnosed after reconstruction. All patients underwent cholesteatoma excision and canalplasty. During ≥2 years of follow-up, mild restenosis but no recurrence were observed.

Concha-type microtia with congenital aural stenosis carries a risk of cholesteatoma. Preoperative screening is essential, and excision should precede auricular reconstruction. Vigilance during and after reconstruction, and close collaboration with otolaryngologists, are essential to prevent complications.