A case study of post-auricular persistent mastoid cutaneous fistula closure by anteriorly based temporalis muscle flap and tempero-mastoid fascio-cutaneous-periosteal flap
Keywords:Mastoid-cutaneous fistula, Fistula closure, Complication of mastoidectomy, Flap, Post-aural fistula
Post-auricular cutaneous mastoid fistula (PAMCF) is a rare complication of chronic otitis media (COM), following complicate mastoid surgery and very rarely following congenital cholesteatoma. The failure rate with simple closure is high due to necrotic skin edges. Therefore several techniques for the closure of this fistula have been described. Post aural fistula after canal wall down (CWD) mastoidectomy can be successfully treated by fistula tract excision and obliterating the mastoid cavity. A 45 year old woman presented with discharging PAMCF, 10 years following radical mastoidectomy surgery. It was due to non-compliance of the patient, as she had not gone for follow up for 10 year following radical mastoidectomy. The temporo-mastoid fascio-cutaneous-periosteal advancement flap is effective for proper closure of the fistula and obliteration of the cavity by conchal cartilage along with anteriorly based vascularised pedicled temporalis muscle flap to ensure the viability of the flap and preventing the necrosis of the skin edges, henceforth the recurrence of the fistula.
Bhat KV, Udayashankar SG, Venkatesha BK, Kumar P. Bilateral attico-antral chronic suppurative otitis media presenting as bilateral cutaneous mastoid fistulas. Ear Nose Throat J. 2009;88(10):1-3.
Choo JC, Shaw Cl, Schong YC. Postauricular cutaneous mastoid fistula. J Laryngol Otol. 2004;118(11):893-4.
Naik SM, Naik SS. Postoperative mastoid fistulas managed by fistulous tract excision and cavity obliteration by epicranial aponeurosis and temporalis fibromuscular flaps. Pakistan J Otolaryngol. 2013;29:59-61.
Franco D, Franco T, Gonsalves LFF, Silva CSC. Galeal flaps for mastoid fistula. Rev Bras Otorrinolaringol. 2001;67(6):852-7.
Wadhwa V, Anand TS, Kumar S. Periosteo-temporofascial flap for cavity obliteration. Ind J Otolaryngol Head and Neck Surg. 2003;55(3):170-4.
Saki N, Araghi S, Abshirini H, Nikakhlagh S. Postauricular advancement flap for closure of persistent mastoid cutaneous fistula. Biomed Pharmacol J. 2015;8:795-7.
Vathulya M, Malhotra M, Varshney S. Extra dimension of fascio-cutaneous flap in the surgical management of postaural fistula, a complication of chronic otitis media-squamous type. Int J Otorhinolaryngol Head Neck Surg. 2017;3(2):419-22.
Olusesi AD, Opaluwah E. Postauricular advancement fascio-cutaneo-periosteal flap for closure of mastoid cutaneous fistula. Otolaryngologia Polska. 2014;68(5):276-80.
Gibb AG, Tan KK, Sim RST. The Singapore swing. J Laryngol Otol. 1997;111(6):527-30.