[Meatoplasty by intra-aural approach]

The object of this communication was to discuss our experience with a new type of endaural meatoplasty. Auricular meatoplasty was described by Viennese otologists in the late nineteenth century. A hundred years later the procedure still is necessary for every open mastoidectomy. Most surgeons prefer to perform meatoplasty following traditional guidelines via a retroauricular incision. However, we have developed a new meatoplasty method using an endaural approach, similar to that described by Osborne Farrior and Fleury but performed at the beginning of the operation. The advantage of the procedure is that the size and shape of the cartilage to be removed are easily calculated. Therefore, the width of the future external canal can be predicted. Using this meatoplasty, the tragal cartilage can be removed as a whole piece with its perichondrium. This is important for middle-ear reconstruction.

Two hundred twenty-seven meatoplasties via an endaural approach were performed in the last 6 years, most as a step in open mastoidectomy. The procedure is described in detail for the cases in which it was used.

Two parameters were considered in the evaluation of results: permanence of a dry and stable mastoid cavity and an intact eardrum. Only 3 (1.4%) ears out of 223 remained unstable after 3 years and 5 (2.24%) continued with a perforated eardrum.

Meatoplasty via an endaural approach allowed us to design precisely the size and shape of the conchal cartilage to be removed and to calculate the volume of the future external canal. This approach can be used to remove a cartilaginous conchal fragment with its perichondrium. This piece is useful for the reconstruction of the middle ear or mastoid. Realization of this meatoplasty at the beginning of the procedure produces a broad exposure of the mastoid.