Postauricular advancement fascio-cutaneo-periosteal flap for closure of mastoid cutaneous fistula.

BACKGROUND Postauricular cutaneous mastoid fistula (PCMF) is a rare complication of chronic suppurative otitis media, may also complicate ear surgery and, very rarely, has been reported to complicate congenital cholesteatoma. Few authors have given descriptions of techniques of closure, with majority agreeing on the difficulty in managing such fistula due to the necrotic nature of the margin. SETTING A tertiary care urban referral hospital in a developing economy. METHODOLOGY A new technique of closure of PCMF is described. This technique utilizes the postauricular fascio-cutaneo-periosteal advancement flap with Burow's triangles following excision of the fistula margin. Details of this technique are described. RESULTS Two women with cholesteatoma, aged 33 and 41 years, were successfully managed using this technique. The first case was diagnosed with right ear cholesteatoma with automastoidectomy and persistent discharging cutaneous mastoid fistula and had completion of canal wall-down mastoidectomy with postoperative cleaning of the mastoid cavity. The mastoid cutaneous fistula persisted postoperative despite conservative treatment and was treated using this technique 14 months postsurgery with successful outcome. The second case with left attic cholesteatoma extending to the mastoid antrum had canal wall-up mastoidectomy with limited atticotomy, but developed persistent mastoid cutaneous fistula 4 months postoperative and was treated with this technique. She had delayed wound healing but the fistula eventually closed. Both cases have been followed up for 24 and 18 months respectively with no recurrence. CONCLUSION Postauricular advancement flap is effective for closure of persistent cutaneous mastoid fistula.