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A simple technique for improving access to the conchal bowl

A simple technique for improving access to the conchal bowl
A simple technique for improving access to the conchal bowl
Carcinomas of the external auditory canal and conchal bowl are rare and usually associated with a poor prognosis. Basal cell carcinomas are less common in this area than squamous cell carcinomas.1 So, when these tumours are treated surgically, adequate access is essential to obtain clear margins. However, visibility of this area can often be difficult. Although an assistant can flatten the natural concavity of the conchal bowl by manipulating it from behind the pinna, this does not always help. The use of an angled beaver blade may improve the manoeuvrability of the scalpel in this restricted space.2

There have been few reports of approaches that improve access to this area. Massey and Eliezri3 described an auriculotomy, with an extensive incision from the antihelix to the preauricular area, which mobilised the pinna from its base. Another technique involved a crusotomy, and was useful in superior conchal lesions.4 We describe a simple technique that can be used under local anaesthesia, which may be suitable for tumours that extend towards and into the external auditory meatus.

A preauricular incision is marked from the superior aspect of the tragusextending to the top of the pinna (Fig. 1). A plane is then easily developed along the cartilage of the ear, which can be dissected down on to the external auditory meatus. This facilitates planning of the tumour margin and subsequent resection, particularly the medial margin at the external auditory meatus (Fig. 2). The access incision is closed in two layers. This simple technique adds little time to the procedure, and gives a good aesthetic result.

skin cancer, conchal bowl, access, surgery
0266-4356
427-428
Anand, R.
d9b9c4c5-ddc4-4283-b26d-816340d6e84c
Salib, R.
d6fde1c1-5b5e-43f7-ae1c-42cce6a0c9fc
Mourouzis, C.
7b1e170c-49d3-41ea-b5be-964920229276
Wilbourn, M.
108dc429-2565-4d2f-9e4b-97eec66a0634
Resouly, A.
3a575220-d57f-400d-98ed-ae2d3c9f684a
Brennan, P.A.
0b128e06-601c-4d40-97f8-3b10b3624378
Anand, R.
d9b9c4c5-ddc4-4283-b26d-816340d6e84c
Salib, R.
d6fde1c1-5b5e-43f7-ae1c-42cce6a0c9fc
Mourouzis, C.
7b1e170c-49d3-41ea-b5be-964920229276
Wilbourn, M.
108dc429-2565-4d2f-9e4b-97eec66a0634
Resouly, A.
3a575220-d57f-400d-98ed-ae2d3c9f684a
Brennan, P.A.
0b128e06-601c-4d40-97f8-3b10b3624378

Anand, R., Salib, R., Mourouzis, C., Wilbourn, M., Resouly, A. and Brennan, P.A. (2007) A simple technique for improving access to the conchal bowl. British Journal of Oral and Maxillofacial Surgery, 45 (5), 427-428. (doi:10.1016/j.bjoms.2006.10.005). (PMID:17098340)

Record type: Article

Abstract

Carcinomas of the external auditory canal and conchal bowl are rare and usually associated with a poor prognosis. Basal cell carcinomas are less common in this area than squamous cell carcinomas.1 So, when these tumours are treated surgically, adequate access is essential to obtain clear margins. However, visibility of this area can often be difficult. Although an assistant can flatten the natural concavity of the conchal bowl by manipulating it from behind the pinna, this does not always help. The use of an angled beaver blade may improve the manoeuvrability of the scalpel in this restricted space.2

There have been few reports of approaches that improve access to this area. Massey and Eliezri3 described an auriculotomy, with an extensive incision from the antihelix to the preauricular area, which mobilised the pinna from its base. Another technique involved a crusotomy, and was useful in superior conchal lesions.4 We describe a simple technique that can be used under local anaesthesia, which may be suitable for tumours that extend towards and into the external auditory meatus.

A preauricular incision is marked from the superior aspect of the tragusextending to the top of the pinna (Fig. 1). A plane is then easily developed along the cartilage of the ear, which can be dissected down on to the external auditory meatus. This facilitates planning of the tumour margin and subsequent resection, particularly the medial margin at the external auditory meatus (Fig. 2). The access incision is closed in two layers. This simple technique adds little time to the procedure, and gives a good aesthetic result.

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More information

Published date: July 2007
Keywords: skin cancer, conchal bowl, access, surgery
Organisations: Clinical & Experimental Sciences

Identifiers

Local EPrints ID: 195697
URI: http://eprints.soton.ac.uk/id/eprint/195697
ISSN: 0266-4356
PURE UUID: 7bf68159-20ff-4f67-8496-c5a9e7acae8e
ORCID for R. Salib: ORCID iD orcid.org/0000-0002-6753-7844

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Date deposited: 25 Aug 2011 12:28
Last modified: 15 Mar 2024 03:14

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Contributors

Author: R. Anand
Author: R. Salib ORCID iD
Author: C. Mourouzis
Author: M. Wilbourn
Author: A. Resouly
Author: P.A. Brennan

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