Surgery for congenital aural atresia using a superficial temporal artery flap

Abstract

Congenital aural atresia is often associated with microtia. Although surgery for microtia is generally performed, surgery for congenital aural atresia has not been performed as frequently. The results of surgery for congenital aural atresia are not good because of postoperative necrosis of the flap and lateralization of the tympanic membrane. To improve the results of surgery of congenital aural atresia, we performed an operation divided into two steps. In the first operation, a thick and shallow ear canal was created with a superficial temporal artery flap. We then elevated a free skin flap from the inguinal region. The free skin flap was used to develop the deep ear canal and tympanic membrane. By dividing this procedure into two steps, the blood flow of the flap was able to be stabilized, thereby preventing skin necrosis and lateralization of the tympanic membrane. We operated on 12 cases (13 ears). In the first six ears, we used autologous temporal bone as collumera. Given that hearing improvement was not satisfactory in those six ears, the remaining seven were treated using PORP^® for ossicular reconstruction. The average hearing level at 6 months after surgery was 56.4 dB in the autologous bone group and 38.8 dB in the PORP^® group. The postoperative hearing level remains unsatisfactory. We intend to explore new ways to improve poor hearing, and carry out long-term observations of the narrowing of the ear canal. In addition, further studies to clarify the reasons why the ear canal tends to become shallow will be necessary.