Surgical modification for redo mastoidectomy in the presence of a large postauricular keloid: a case report and literature review

Alex Z. J. Ho; Ardhi Abdullah; Nadia S. Naseruddin; Suhaili Zazali; Atikah Rozhan

doi:10.18203/issn.2454-5929.ijohns20263395

Authors

Alex Z. J. Ho Department of Otorhinolaryngology, Head and Neck Surgery, Sultan Ahmad Shah Medical Centre, International Islamic University, Malaysia
Ardhi Abdullah Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Tengku Ampuan Afzan, Malaysia https://orcid.org/0000-0001-7088-0574
Nadia S. Naseruddin Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Tengku Ampuan Afzan, Malaysia https://orcid.org/0000-0002-2639-295X
Suhaili Zazali Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Tengku Ampuan Afzan, Malaysia https://orcid.org/0000-0002-0150-4687
Atikah Rozhan Department of Otorhinolaryngology, Head and Neck Surgery, Sultan Ahmad Shah Medical Centre, International Islamic University, Malaysia https://orcid.org/0000-0003-0443-7595

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20263395

Keywords:

Cholesteatoma, Mastoidectomy, Keloid, Postoperative complications

Abstract

Postauricular keloids may complicate mastoid surgery by obscuring landmarks, restricting flap mobility, and increasing recurrence risk. Their presence demands surgical modifications to ensure both safe disease clearance and stable wound healing. A 19-year-old male from a Malaysian indigenous tribe presented with recurrent cholesteatoma and a large postauricular keloid (8×3 cm) following prior mastoidectomy. The keloid limited access and distorted anatomy. Steroid injections were ineffective. A single-stage redo modified radical mastoidectomy with type IV tympanoplasty, meatoplasty, and keloid excision was performed. Elliptical incision, wide undermining, meticulous hemostasis, layered closure, and mastoid bandaging achieved tension-free healing. At six months, the ear remained dry without recurrence of cholesteatoma or keloid. Single stage mastoidectomy with keloid excision is feasible. Careful surgical technique with simple measures such as wide undermining and compression bandaging may obviate the need for adjuvant therapy in selected patients.

References

Viera MH, Vivas AC, Berman B. Update on Keloid Management: Clinical and Basic Science Advances. Adv Wound Care. 2012;1(5):200-6.

Piromchai P, Wijewickrema S, Smeds H, Kennedy G, O'Leary S. Correlations of External Landmarks With Internal Structures of the Temporal Bone. Otol Neurotol. 2015;36(8):1366-73.

Asadi LK, Tarantino IS, Beroukhim K, Goldberg LH. The Use of Z-Plasty for Reconstructing Posterior Ear Defects. Dermatol Surg. 2022;48(5):579-81.

Roh J-L. The retroauricular hairline incision (RAHI) approach for head and neck surgery. Oper Tech Otolaryngol - Head Neck Surg. 2007;18(4):310-4.

Komatsu S, Azumi S, Hayashi Y, Morito T, Kimata Y. S-shaped Wound Closure Technique for Dumbbell-shaped Keloids. Plast Reconstr Surg Glob Open. 2017;5(3):e1278.

Gong Y, Huang J, Liu J, Lin J, Wu W. Benefits of Reducing Incision Tension in Hard-To-Close Keloid Surgery. Dermatol Surg. 2023;49(5s):S56-7.

Wang W, Zhou B, Xia L, Chen Z, Liu W, Gao Z, et al. An Innovative Single-Stage Approach of High-Tension Keloid Excision and Reconstruction Using Acellular Dermal Matrix and Epidermal Skin Grafting. 2024;2024(1):7551111.

Raposio E, Nordström RE, Santi PL. Undermining of the scalp: quantitative effects. Plast Reconstr Surg. 1998;101(5):1218-22.

Klaassen MF, Brown E, Behan F. Elliptical Excision and Sliding Flap Repair. In: Klaassen MF, Brown E, Behan F, editors. Simply Local Flaps. Cham: Springer International Publishing; 2018;33-44.

Ouldamer L, Caille A, Giraudeau B, Body G. Quilting Suture of Mastectomy Dead Space Compared with Conventional Closure with Drain. Ann Surg Oncol. 2015;22(13):4233-40.

Wu XL, Gao Z, Song N, Liu W. Clinical study of auricular keloid treatment with both surgical excision and intralesional injection of low-dose 5-fluorouracil and corticosteroids. Zhonghua Yi Xue Za Zhi. 2009;89(16):1102-5.

Li Y, Zhang D, Hang B, Wang H. The Efficacy of Combination Therapy Involving Excision Followed by Intralesional 5-Fluorouracil and Betamethasone, and Radiotherapy in the Treatment of Keloids: A Randomized Controlled Trial. Clin Cosmet Investig Dermatol. 2022;15:2845-54.

Dash PC, Islam MMT, Khondoker MS, Khundkar SH. Earlobe Keloid Management- A RCT of Intra-Lesional Excision With Intra- & Post-Operative Steroids Versus Intra-Lesional Excision With Post-Operative Steroids. BDJPS. 2010;1(1):24-8.

Yigit B, Yazar M, Alyanak A, Guven E. A custom-made silicon mold for pressure therapy to ear keloids. Aesthetic Plast Surg. 2009;33(6):849-51.