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