What are the types of meatoplasty (meatoplasty) in ear surgeries?

Types of Meatoplasty in Ear Surgery

Meatoplasty techniques for widening the external auditory canal include the M-meatoplasty, MO-meatocanalplasty, conchal flap meatoplasty, and modified meatoplasty with endoaural-conchal incision, with selection based on the location and extent of stenosis.

Primary Meatoplasty Techniques

M-Meatoplasty (Mirck Technique)

• The M-meatoplasty is widely used for addressing external meatus stenosis but has limitations when narrowing is most prominent in the postero- and/or anterosuperior quadrants of the lateral meatus 1
• This technique is frequently performed for recurrent otitis externa, eczema, or frequent cerumen accumulation due to narrow meatus 1

MO-Meatocanalplasty (Modified M-Meatoplasty)

• The MO-meatocanalplasty represents an oblique conversion of the M-meatoplasty specifically designed to address the superior quadrants and bony canal 1
• This modification is particularly useful when ear canal narrowing is most prominent in the postero- and/or anterosuperior quadrants 1
• The technique allows for bony canalplasty while avoiding a retro-auricular approach, making it less invasive 1
• Can be combined with myringoplasty and tympanoplasty procedures 1

Conchal Flap Meatoplasty

• This technique opens the superficial meatus by eliminating the sharp rim at the junction of the conchal bowl and posterior canal wall cartilage 2
• The procedure thins the skin and increases the circumference of the external auditory orifice 2
• Proven successful in treating chronic otitis externa 2

Modified Meatoplasty with Endoaural-Conchal Incision

• This technique achieved a remarkably low restenosis rate of 1.38% in a series of 145 ears, making it one of the most reliable methods 3
• The approach is particularly effective for congenital external auditory canal stenosis 3
• No severe complications occurred in the reported series, including no facial nerve injury, skin flap necrosis, sensorineural hearing loss, or intractable otorrhea 3
• Provides stable, functionally adequate, and cosmetically acceptable results 3

Clinical Indications

Primary Indications for Meatoplasty

• Exostoses, stenosing external otitis, and widening for surgical access are the main indications 4
• Soft tissue stenosis is more common than bony stenosis in clinical practice 4
• Congenital aural stenosis (CAS) responds better to meatoplasty than congenital aural atresia (CAA) 5

Special Considerations for Congenital Cases

• Meatoplasty with canalplasty and tympanoplasty in individuals with congenital aural stenosis yields reliable and lasting positive hearing results with low complication rates 5
• The existence and preoperative condition of the tympanic membrane and external auditory canal skin help improve hearing results and decrease complications 5
• Congenital aural atresia patients have significantly higher complication rates (61.3%) compared to stenosis patients (20%), requiring stricter surgical indications 5

Surgical Technique Considerations

Bone Removal Technique

• Particular attention must be paid to bone removal from the anterior canal wall to achieve adequate widening 4
• The surgical approach should be tailored to whether stenosis is primarily soft tissue or bony in nature 4

Skin Flap Management

• Avoid using middle temporal artery flaps, as restenosis in one series was exclusively associated with this technique (4% restenosis rate, all cases involved this flap) 4
• Proper skin flap design and management is critical to prevent necrosis 3

Complications and Outcomes

Common Complications

• Restenosis rates vary by technique: 4% with traditional canalplasty 4, 1.38% with modified endoaural-conchal approach 3
• Partial, transient, delayed facial palsy occurs in approximately 2% of cases, likely from thermal injury transmitted from the burr 4
• Full spontaneous recovery of facial function typically occurs 4

Complication Prevention

• Careful burr technique prevents thermal injury to the facial nerve 4
• Avoiding middle temporal artery flaps reduces restenosis risk 4
• The modified endoaural-conchal incision technique demonstrates superior safety profile with no severe complications reported 3

Outcome Expectations

Success Rates

• The modified meatoplasty with endoaural-conchal incision provides the most favorable outcomes with 98.62% success rate (no restenosis) 3
• Traditional canalplasty is safe and effective with 96% success rate 4
• Congenital stenosis patients achieve significantly better hearing outcomes and lower complication rates compared to atresia patients 5