Lateral Ear Canal Resection and Ear Canal Ablation

It is beyond the scope of this chapter to describe lateral ear canal resection and ear canal ablation fully; the reader is referred to a general surgery text. Lateral ear canal resection is indicated in cases where the management of chronic otitis externa has failed or the size and number of the masses within the auricular canal prevent their adequate removal with laser-assisted video otoscopy.

Complete ear canal ablation and bulla osteotomy are indicated in cases where a malignant tumor has been diagnosed within the ear canal or tympanic cavity. It may also be performed as a salvage procedure in cases of refractory otitis externa (Figure 19-24).

The incisions and dissection required for these procedures are greatly enhanced by the use of the CO₂ laser. The hemostasis that can be achieved greatly increases the surgeon’s visualization of vital structures, which in turn minimizes iatrogenic complications (Figure 19-25). In cases of chronic otitis externa, the ear canal is

Figure 19-24

Preoperative total ear canal resection and bulla osteotomy.

Intraoperative ear canal ablation.

Figure 19-26

Postoperative total ear canal resection and bulla osteotomy.

markedly thickened and can be calcified and surrounded by a significant amount of fibrous tissue. The facial nerve can become entrapped in this tissue. Meticulous dissection is required to preserve this structure and its function. Facial nerve paraly­sis results if this nerve is damaged or severed. The use of the CO₂ laser for this procedure markedly increases postoperative comfort and seems to lead to a more rapid recovery (Figure 19-26).²³