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.