Auricular complication after en bloc temporal bone surgery
The clinical characteristics of 64 patients are listed in Table 1. The
patients included 22 men (34.4%) and 42 women (65.6%), with a median
age of 67 years (range: 33–84 years). We included 57 SCC cases (89.1%)
and 7 ACC cases (10.9%). In 64 cases, 21 cases (32.8%) had a history
of radiotherapy at the locoregional site before surgery. Incision types
(Fig. 3A) around the auricle were as follows: S shape (2 cases), C shape
(17 cases), large shape (24 cases), inferior C shape (13 cases), upper C
(7 cases), and preauricular incision (1 case). The incision around the
EAC orifice varied (Fig. 3B). We used a small circumference incision
around the orifice (Type a) for 58 cases. One case had the circumference
incision crossing the crus helix (Type b). We applied the circumference
incision, including the preauricular skin (Type c) to two cases. We
sacrificed the inferior half of the auricular in three cases (Type d).
Three of 64 cases (4.7%) developed postoperative auricular
complications (Fig. 4) and all cases showed venous congestion (case 26,
27, and 43). We found auricular congestion and started mechanical
bloodletting within 1 hour postoperatively in case 26 and 27. Several
full thickness skin defect wounds (5 mm diameter) were created in the
auricle, without exposing the cartilage, and covered with heparin-soaked
gauze sequentially to maintain active bleeding from the wounds.
Mechanical bloodletting enabled recovery from auricular congestion and
the auricles in both cases were salvaged. However, for case 27, a 1 cm ×
2 cm postauricular skin segment developed necrosis and required
debridement. For case 43, just pin pricking was applied postoperatively
to confirm the auricular congestion, and mechanical bloodletting was not
applied. This resulted in auricular necrosis due to venous congestion.
We performed debridement of necrotic tissue and finally the majority of
the auricle was sacrificed.
To reveal the risk factors associated with auricular complications of
temporal bone resection, we examined its relationship with the
categorical variables, including neck dissection, pre-/infra-auricular
lymph node dissection, parotidectomy, TMJ manipulation, and history of
radiotherapy. We found that pre-/infra-auricular lymph node dissection
was correlated with auricular complications, with statistical
significance.(Table 2) The relationship between the type of
microvascular anastomosis for reconstructing the auricular complication
remains unclear due to an insufficient number of cases for analysis. The
facial artery was used for vascular anastomosis for reconstruction in
three cases, but these cases did not experience auricular complications.