Comparison between classic 'Fisch' and 'corner-tag' meatoplasty techniques after canal wall down tympanomastoidectomy.

PURPOSE: To compare outcomes of two different methods of meatoplasty following Canal Wall-Down tympanomastoidectomy. METHODS: A retrospective case review study of 48 patients with non-complicated unsafe chronic suppurative otitis media candidate for post-auricular canal wall-down tympanomastoidectomy via a post-auricular approach at Otolaryngology department, Benha university hospitals from January 2021 to January 2023, all were operated for the first time, and divided into 2 groups each of 24 patients. Group A submitted for classic 'Fisch', and group B 'Corner-Tag' meatoplasty. RESULTS: The mean age was 28.88 ± 13.26 years in group A and 33.33 ± 16.04 years in group B. Only one patient (4.2 %) in each group developed wound infection and none in both groups developed perichondritis. Two patients (8.3 %) in group B compared to only one patient (4.2 %) in group A had granulations on the meatal incision. One patient (4.2 % of group A) needed revision meatoplasty. Group B needed more time for epithelization (mean 7.33 ± 0.96 weeks) than group A (mean 6.5 ± 0.88 weeks; P = 0.003*) also resulted in wider mean new meatus in group B (mean 10.50 ± 1.02 mm) than in group A (mean 9.63 ± 1.41 mm; P = 0.02*). CONCLUSION: Both techniques had comparable post-operative complications. 'Corner-Tag' technique needed more time for healing and epithelization but gave a wider new meatal diameter than 'Fisch' meatoplasty after one year of follow-up.

The MO-meatocanalplasty: long-term results in the narrow external auditory canal with recurrent otitis externa or the inability to wear a hearing aid.

OBJECTIVE: The MO-meatocanalplasty is the oblique modification of the M-meatoplasty. The MO-meatocanalplasty was designed to address the superior quadrants of the meatus and the bony canal without the need for a retro-auricular incision. This retrospective analysis was performed to evaluate the long-term results of the MO-meatocanalplasty in patients with a narrow external auditory canal (EAC) with recurrent otitis externa or in patients unable to wear a hearing aid. METHODS: Twenty-two ears in twenty consecutive patients who received a MO-meatocanalplasty for a narrow EAC with recurrent otitis externa or the inability to wear a hearing aid were analysed retrospectively. There were no patients included with any type of previous or planned second stage tympanoplasty procedures. A follow-up period of 3 years was analysed for postoperative recurrent narrowing, the self-cleaning capacity of the EAC, the recurrence of otitis externa, the inability to wear a hearing aid, change in hearing level and for all types of aesthetical complaints. RESULTS: The MO-meatocanalplasty procedure was effective in 82% (n = 18). Postoperative recurrent narrowing was detected in 9% (n = 2). Insufficient self-cleaning capacity of the EAC was 9.1% (n = 2). The ability to wear a hearing aid was restored in all patients with the need for a hearing aid. No aesthetical complaints were reported. CONCLUSION: The MO-meatocanalplasty is an effective, safe and aesthetical accepted procedure to address the narrow meatus and external auditory canal. With this procedure, there is no need for a retro-auricular incision in order to create a well aerated, dry and self-cleaning EAC in patients with a narrow EAC with recurrent otitis externa or in patient with the inability to wear a hearing aid.

[Meatoplasty - an effective method for surgical treatment of patients with nasolacrimal duct ostium stenosis]. / Meatoplastika - éffektivnyi sposob khirurgicheskogo lecheniia patsientov so stenozom ust'ia nososleznogo protoka.

The authors proposed a novel approach to the surgical correction of distal nasolacrimal duct stenosis - the meatoplasty of the nasolacrimal duct. AIM: To evaluate the effectiveness of the developed surgical technique in cases of nasolacrimal duct ostium stenosis. METHODS: 78 patients (90 cases) with nasolacrimal duct stenosis at the level of it's ostium were included and divided into three comparable groups depending on the type of performed surgery: - the meatoplasty of the nasolacrimal duct in group 1, the meatoplasty with concomitant recanalization and bicanalicular silicone intubation of nasolacrimal duct by Ritleng in group 2 and recanalization with bicanalicular silicone intubation of nasolacrimal duct by Ritleng in group 3. A comparative analysis of the surgical treatment effectiveness of the patients of three groups was carried out. RESULTS: The best effectiveness of treatment was noted in group 2 (positive outcomes in 90.0% of cases). The positive outcomes were obtained in 76.7% of cases in group 1 and in 66.7% of cases in group 3. CONCLUSION: The developed surgical technique of meatoplasty with concomitant recanalization and bicanalicular silicone intubation of nasolacrimal duct is a highly-efficient and safe minimally invasive method for treatment of nasolacrimal duct ostium stenosis and it can be recommended in a wide clinical practice.

The MO-meatocanalplasty: a modification of the M-meatoplasty to address the superior quadrants and the bony canal.

The meatoplasty of the external auditory canal is a frequently performed otologic procedure in recurrent otitis externa, eczema or frequent accumulation of cerumen due to a narrow meatus of the external ear canal. Numerous surgical techniques have been described. The M-meatoplasty described by Mirck for addressing the external meatus is widely used. However, this technique does not sufficiently enlarge the external ear canal in all cases. Specifically in patients where the ear canal narrowing is most prominent in the postero- and/or anterosuperior quadrants of the lateral meatus the technique needs some modifications. In these cases, an oblique conversion of the M-meatoplasty, the MO-meatocanalplasty, is useful. In cases where the bony canal is also narrow this modification allows for a bony canalplasty while avoiding a retro-auricular approach. The MO-meatocanalplasty can be used in combination with myringoplasty and tympanoplasty.

Meatal Surgery at the Time of Circumcision for Lichen Sclerosus (LS/BXO) Does Not Reduce the Need for Later Meatal Intervention: A Retrospective Cohort Study.

PURPOSE: We describe meatal outcomes for boys undergoing circumcision to treat Lichen Sclerosus (LS/BXO) with a focus on those who underwent meatotomy/meatoplasty at circumcision and factors associated with post-circumcision meatal intervention. METHODS: Retrospective review of patients undergoing circumcision for histologically confirmed LS between 2011 and 2020. Statistical testing was by Chi2 and multivariate analysis. RESULTS: 382 patients underwent circumcision at a mean of 9.1 years (SD 2.9). At circumcision, LS on the glans was documented in 213/365 (58%). Meatal involvement was documented in 74/382 (19%); 25/382 (6.5%) had a meatotomy, 94/382 (25%) had meatal calibration/dilatation and 234/367 (64%) were prescribed post-operative topical steroids. Patients with LS glans or meatal involvement were more likely to have a meatotomy (p = 0.0013) and to receive post-operative steroids (OR 5, p = 0.0001). Post circumcision, 40/382 (10%) required a median of 1 subsequent procedure (range 1-5), 10 (2.6%) underwent dilatation, 30 (7.4%) had a meatotomy. Patients undergoing meatotomy at circumcision had an odds ratio (OR) of 1.2 for subsequent meatotomy (p = 0.027). Analysis based on requirement for any subsequent procedure identified an OR of 3.1 for having had a meatotomy at circumcision (p = 0.022) and an OR of 6.0 of receiving post-operative steroids (p=<0.001). CONCLUSIONS: Meatal stenosis following circumcision for LS requiring meatal intervention affected 10% of boys. Meatotomy at circumcision increased the likelihood of subsequent meatal intervention and is therefore not recommended. LEVEL OF EVIDENCE: Level III.

Penile Carcinoma Secondary to Balanitis Xerotica Obliterans and Its Compounding Resultant Pathologies: A Case Report.

A 57-year-old African-American male presented with urinary retention secondary to a history of balanitis xerotica obliterans (BXO) concurrent with penile carcinoma. BXO, characterized by chronic, sclerosing inflammation of the male external genitalia, presents significant clinical challenges due to its progressive nature and potential for complications. The patient experienced recurrent episodes of urinary retention, leading to multiple hospital visits and disease progression, prompting a comprehensive evaluation and intervention. The patient's medical history revealed a complex array of comorbidities, including penile carcinoma secondary to BXO, urethral strictures, and meatal stenosis. Clinical assessment, including bedside bladder ultrasound and laboratory investigations, confirmed urinary retention secondary to urethral stricture, necessitating urological consultation. Management strategies involved Foley catheter placement, urethral dilation, and pharmacological interventions for pain management. Subsequent follow-up and imaging evaluations identified an increased risk of carcinoma development, highlighting the importance of surveillance and early intervention in patients with BXO. This case report highlights the intricate clinical manifestations and therapeutic considerations encountered in managing BXO and its associated pathologies.

Objective and subjective sexual outcomes in adult patients after hypospadias repair performed in childhood.

PURPOSE: We evaluated sexual function and psychosexual adjustment in adults who underwent hypospadias repair in childhood. MATERIALS AND METHODS: After receiving institutional review board approval, 119 of 449 adult patients (26.6%) who underwent hypospadias repair between 1978 and 1993 responded to questionnaires on penile appearance and sexual life. Patients were divided into 3 groups according to primary meatal location in childhood, including group 1-45 (37.8%) with glanular hypospadias, group 2-56 (48.2%) with distal hypospadias and group 3-18 (14%) with proximal hypospadias. RESULTS: All group 1 and 2 patients, and 11% in group 3 were satisfied with the penile appearance. Of group 1 patients 8.9% reported mild erectile dysfunction, as did 50% and 72.2% in groups 2 and 3, respectively. A total of 99 patients (83.2%) complained of premature ejaculation. All group 1 and 2 patients reported excellent self-esteem and relationship on the Self-Esteem and Relationship questionnaire. Most group 3 patients were satisfied with their relationship and only 1 (5.6%) was not satisfied. Two-thirds of the patients in groups 1 and 2 reported that sexual quality of life was excellent and the others described it as good. In group 3 sexual quality of life was somewhat decreased in all patients and 1 (5.6%) had poor sexual quality of life. Physical and mental component summaries were satisfactory in all patients reviewed. CONCLUSIONS: Our data show that the high incidence of mild erectile dysfunction and premature ejaculation should not be disregarded and requires appropriate counseling before surgery.

A novel technique C-conchoplasty in canal wall down tympnomastoidectomy.

BACKGROUND: Numerous methods for meatoplasty and conchoplasty have been introduced, but no clear V/S(the meatal cavity volume to the cross-sectional) was given and many patients have complained about poor cosmesis on follow-up. AIMS: To explore the proper size, and cosmetic shape of the external auditory meatus and auditory canal for canal wall-down tympnomastoidectomy (CWD). MATERIAL AND METHODS: In this observational case series study 36 patients undergone CWD with C-conchoplasty that uses a C-shape skin incision on the concha were reviewed. S and V/S of the preoperative, postoperative and contralateral normal ears were observed. We analyzed the relationship between the epithelialization time and postoperative V/S. Long-term efficacy observation and the shape of the meatus after the operation were observed. RESULTS: C-conchoplasty could effectively enlarge S and reduce V/S. The postoperative V/S were closer to the normal ear than that if we didn't do C-conchoplasty. The greater difference of V/S between the post-operative ears and the contralateral normal ears, the longer the epithelialization time will be. C-conchoplasty produced an excellent cosmetic result. No other complications were noted. CONCLUSIONS AND SIGNIFICANCE: The C-conchoplasty, which is a novel and easy technique in CWD, offers good functional and excellent cosmetic results with minimal risk of complications.

Causes of Failure of Canal Wall down Mastoidectomy.

AIMS: To identify the causes of failure of the canal wall down mastoidectomy and evaluate the causes for discharging mastoid cavity and to address the causes of failure of previous surgery to minimize the Revision surgery. MATERIALS AND METHODS: This was a prospective and retrospective observational study conducted at a tertiary care hospital from May 2019 to December 2021. Total 20 Patients (11 male & 9 female) with age group (0-60 years) who previously underwent canal wall down mastoidectomy and presented with complaints of persistent ear discharge were included. All patients underwent otoscopic, oto-endoscopic and microscopic examination. RESULTS: Out of 20 cases,13 cases had residual/recurrent cholesteatoma, 11 cases had narrow meatoplasty and 9 cases had high facial ridge.Other causes for failure are graft defect, incomplete removal of anterior and posterior buttress. CONCLUSION: Recurrent/residual cholesteatoma and Narrow meatoplasty are most common cause for failure of previous surgery. Persistent granulation at un-exenterated area was the most common cause for suppuration. Regular follow up and cleaning of the debris from cavity enhances the epithelialization and healing of the cavity.

Acquired Stenosis of the External Ear Canal.

Acquired stenosis of the external ear canal (ASEEC) is a relatively uncommon condition. Stenosis or narrowing of the external ear canal (EEC) occurs lateral to the tympanic membrane resulting in a skin lined blind canal. Recurrent otorrhea, and conductive hearing loss are typical clinical features. Although ASEEC can be due to different etiologies, a common pathogenesis, namely an inflammatory cascade, has been implicated. Clinical evaluation, audiogram, and Computed tomography (CT scan) form the mainstay of diagnosis. Surgery is the primary modality for treatment. Restenosis is the most common postsurgical complication.

Total penile glans amputation following circumcision: A case report of a dramatic complication.

Circumcision is one of the most commonly performed surgical procedures. As traditional ritual circumcisions are still practiced in the community, in Senegal the majority of circumcisions are performed in hospitals. We report the case of a 9-year-old boy who underwent a total amputation of the glans after a circumcision in a pharmacy by an unqualified agent. A meatoplasty was performed and the postoperative course were uneventful.

[Genital surgical procedures for feminization in gender dysphoria]. / Genitalchirurgische Maßnahmen zur Feminisierung bei Geschlechtsdysphorie.

The necessity and the benefits of genital approximating surgery in gender dysphoria are established, therefore the indications after careful diagnostics are indisputable. For vaginoplasty, the method of choice is penile inversion, in which the penile skin is inserted as a pedicled flap into the prepared vaginal space. Alternatively, free skin grafts or intestinal segments can be used. Lifelong bougienage of the vagina is obligatory for all methods. The spectrum of complications after vaginoplasty is broad. Of particular note, although rare, is injury to the anterior rectal wall, from which rectovaginal fistulas can result. During the course strictures of the urinary meatus or also the neovagina occur. Corrections must often be surgically undertaken but conservative measures, e.g. intensified bougienage and topical estrogen treatment, can also be successful. Neovaginal infections are treated analogously to infections of a native vagina. A special situation is inflammation of the intestinal neovagina, which must be treated with mesalazine.

Comparison of Different Techniques of Meatoplasty After Canal Wall Down Mastoidectomy.

To compare surgical outcomes with different meatoplasty techniques without removal of a cartilage piece in canal wall down mastoidectomy. Total 61 patients of canal wall down mastoidectomy included in the study where either inferior based flap technique or division in middle technique meatoplasty performed and 2 groups formed. Group A consisted of 33 patients and the inferior based flap technique of meatoplasty used in these patients. Group B consisted of 28 patients and the division in middle technique of meatoplasty used in these patients. Granulations, discharge or stenosis of canal were observed in less than 8% of cases in both the groups. Meatoplasty done without incision or excision of a piece of cartilage from pinna can be achieved with good success rates with either inferiorly based flap technique or division in middle technique.

Role of Pre Auricular Flap in Reconstruction of Acquired Meatal Stenosis Via Endaural Approach.

Acquired meatal stenosis is a difficult entity to treat with a significant recurrence rate. It is normally approached posteriorly via post aural approach and reconstructed using split thickness skin graft. We are presenting a novel method of surgery for acquired meatal stenosis using a pre auricular flap via endaural approach only. The aim was to evaluate the success rate of using a pre auricular flap in acquired atresia of the external auditory canal using the endaural approach. Twenty patients with acquired atresia of the external auditory canal that was surgically treated were retrospectively studied from July 2012 to July 2018. All cases were done using endaural approach only. During the surgery, the atretic tissue was removed, wide canaloplasty done and the stenotic segment widened. Reconstruction of the external auditory canal was done using a pedicled anteriorly based pre auricular flap rotating it into the external auditory canal to cover the bare bone. Of the 20 patrients there were good results in 18 patients with restenosis occurring only in 2 patients. However, a skin tag developed in 2 other patients which was excsiced as OPD procedure and patient was asymptomatic on further follow ups. In all the 20 cases preauricular flap was used for reconstruction along with use of Split thickness skin graft in 10 cases. All 20 cases were operated via endaural route only. Use of a Preauricular flap in surgical treatment of acquired aural stenosis gives good results with a wide dry cavity as the flap is pedicled with its vascular supply and it can be tailor made according to each case and requirement.

Surgical treatment of external auditory canal cholesteatoma in congenital malformation of the ear: A case series.

BACKGROUND: External auditory canal (EAC) cholesteatoma is a lesion lined with stratified squamous epithelium containing proliferative keratin with bony erosion in EAC which can spread to the tympanic cavity, mastoid, and surrounding organ. External cholesteatoma can occur in patients with congenital abnormalities such as congenital aural atresia (CAA). METHOD: This case series was reported using the 2020 PROCESS Guideline. The design of this study used a retrospective study during the 2015-2020 period. RESULT: 3 participants aged 10.67 ± 2.31 years with CAA had other complaints of ear infections. All participants experienced sensorineural hearing loss with an average threshold of 59.33 ± 36.68 dB and suspicious cholesteatoma from a CT scan. Canal wall down, meatoplasty, and/or canaloplasty were performed based on the findings. CONCLUSION: Surgical procedure in CAA with cholesteatoma aimed on preventing further complications and recurrence.

Efficacy of the mini-meatoplasty.

OBJECTIVES: The lateral meatoplasty is a well-described technique for widening the lateral external auditory meatus. After bony canalplasty, the external auditory meatus may need to be enlarged to accommodate an expanded tympanic ring. In this study, we introduce a novel meatoplasty technique for use during canalplasty and describe its efficacy in widening the external auditory meatus. METHODS: Patients undergoing at least 180-degree bony canalplasty and mini-meatoplasty at a tertiary care facility were enrolled. Meatus diameter was measured before and after mini-meatoplasty using Shea aural speculums and Hegar dilators. RESULTS: Nineteen patients were enrolled. Mean preoperative speculum size was 6.1 mm (range 3.5-7.5 mm). All postoperative speculum sizes were 8 mm (P < .0001). Mean preoperative and postoperative Hegar dilator sizes were 10.6 mm (range 7-14 mm) and 16.2 mm (range 13-19 mm), respectively (P < .0001). The mean increase in aural speculum and Hegar dilator sizes were 1.9 mm (range 0.5-3.5 mm) and 5.7 mm (range 3-10 mm), respectively (P < .0001). CONCLUSIONS: The mini-meatoplasty is a novel and effective technique for widening the external auditory meatus after bony canalplasty. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:1294-1298, 2020.

Meatoplasty in Canal wall down Surgery: Our Experience and Literature Review.

INTRODUCTION: Meatoplasty is the final and essential step in performing effective canal wall down surgery for chronic otitis media. In this article we review some previous techniques and discuss our preferred method. MATERIALS AND METHODS: In this observational case series study, we used this technique in 53 patients (28 male and 25 female) between January 2005 and January 2008. Our survey was completed in 31 patients. RESULTS: Twenty-six patients (83.9%) said their ear appeared normal after the procedure, but five patients (16.1%) complained of some minor change in the shape of their ear. Twenty-nine patients (93.5%) had a completely wide ear canal. The ear canal had some degree of stenosis in two patients (6.5%) post-operatively. CONCLUSION: This technique offers good functional and cosmetic results with minimal manipulation and minimal anatomic disruption.

Evaluation of Jordan's meatoplasty for the treatment of fossa navicularis strictures. A retrospective study.

INTRODUCTION: Fossa navicular strictures can be a challenging problem for reconstructive urologists in which there is a need to achieve good cosmetic results along with a consistent stream. Our aim was to retrospectively evaluate the outcome of Jordan meatoplasty in the management of fossa navicularis strictures. MATERIAL AND METHODS: A total of 25 patients who underwent Jordan meatoplasty for the management of fossa navicularis strictures between 2011 and 2016 were retrospectively reviewed. All patients were evaluated with uroflometry. Preoperative retrograde urethrogram was performed in all patients to exclude proximal urethral strictures. The operative details including operative time were analyzed. All patients were evaluated for urinary pattern changes, irritative voiding symptoms and with uroflometry at the end of three months. Hypospadias objective score evaluation (HOSE) was applied at the end of three months for the evaluation of cosmetic outcome. RESULTS: The mean age of patients was 64 years and the mean operative time was 42 minutes. The mean follow up period was 30 months. The mean post-operative peak urine flow rate at three months after removal of the catheter was 18 ml per second. The meatus was slit shaped in 84%. Only 12% of patients complained of splay of urine at the end of three months. 96% of patients were stricture free, with one patient developing a recurrence at 12 months of follow up which was managed by urethral dilatation. CONCLUSIONS: Jordan meatoplasty is a feasible and easily reproducible technique for the management of distal penile strictures.

Our Experience of Treating Wide Spectrum of External Ear Canal Atresia of Different Etiologies in Pediatric Patients.

External auditory canal atresia (EACA) is a common otologic condition. Etiology can vary from congenital to acquired causes. It causes considerable difficulty to the patient. Bilateral ear canal atresia in children can lead to speech delays due to hearing impairment caused by this condition. Though easily diagnosed it is one of the most difficult conditions to treat. Acquired conditions can affect any age group. Restenosis following treatment is very common. This article focuses on the treatment of EACA due to different etiologies and emphasizes on special points of surgical treatment and follow up. Five cases of external auditory canal atresia was treated between 2014 and 2016. Two of them were congenital cases and three were acquired. One congenital atresia patient had pinna abnormalities in the form of one sided anotia and other side microtia. Another patient of congenital ear canal atresia had congenital cholesteatoma. Acquired atresia was due to osteoma, external trauma and surgical trauma following a condylectomy surgery. All the patients were treated surgically. A wide meatoplasty with split thickness skin graft lining the canal/cavity was done to avoid restenosis. Merocel wicks were used in all cases. Removal of localized granulations on follow up helped keep the canal patent especially in congenital EACA. All patients had significant hearing improvement following surgery. Child with bilateral atresia and pinna anomaly has now achieved normal hearing and speech milestones. She does not use any hearing aid. None of the patients developed restenosis of their reconstructed ear canal. One of the patient developed granulations around the meatoplasty edges which was cauterized using silver nitrate. External auditory canal atresia surgery is a difficult surgery keeping in view the distorted anatomy and the propensity of restenosis of the newly constructed ear canal. Hearing restoration in the operated ear is all the more challenging. Meticulous planning with close discussion with patients and their caregivers regarding multiple surgeries has to be done. Using skin graft, doing a wide meatoplasty, using merocel wicks for ear canal dressing are few important aspects of this surgery which can give satisfactory results in long term.

Long-term result of meatoplasty using inferiorly based retroauricular island pedicle flap for external auditory canal stenosis.

OBJECTIVE: To characterize the long-term outcomes of meatoplasty using our new technique, inferiorly based retroauricular island pedicle flap for external auditory canal (EAC) stenosis. METHODS: A long-term clinical analysis of meatoplasty for nine patients (mean age, 33 years; age range, 8-64 years) with stenotic EAC was performed. The follow-up period after meatoplasty ranged from 5 years to 14 years, with a mean duration of 8.4 years. We compared preoperative and postoperative otoscopic findings, high-resolution computed tomographic (CT) images of the EAC, and hearing levels. RESULTS: Otoscopic examinations demonstrated widened EAC in eight of the nine patients. There was a significant increase in the size of the EAC on postoperative CT examinations when compared with the preoperative state. The hearing outcome in all patients was variable. The postoperative air-bone gap (ABG) was closed to 10dB or less in two cases, while the other seven cases showed ABG ranging from 15.0dB to 57.5dB. CONCLUSIONS: We performed meatoplasty using inferiorly based retroauricular island pedicle flap for nine patients with EAC stenosis and eight of the nine patients demonstrated satisfactory patent EAC during a mean follow-up of 8.4 years.