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Osteoradionecrosis of tympanic bone: reconstruction of outer ear canal with pedicled skin flap, combined with hyperbaric oxygen therapy, in five patients

Published online by Cambridge University Press:  16 July 2009

M Metselaar ,
A G Dumans ,
M P C van der Huls ,
W Sterk  and
L Feenstra
M Metselaar*
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
A G Dumans
Affiliation:
Department of Oral and Maxillofacial Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
M P C van der Huls
Affiliation:
Institute for Hyperbaric Medicine, Hoogeveen, The Netherlands
W Sterk
Affiliation:
Institute for Hyperbaric Medicine, Hoogeveen, The Netherlands
L Feenstra
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
*
Address for correspondence: Dr Mick Metselaar, Erasmus MC, Dept of Otolaryngology, Head and Neck Surgery, ’s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands. E-mail: [email protected]
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Abstract

Objective:

To evaluate the results of one-stage surgical repair of the meatal skin defect in patients with long-lasting osteoradionecrosis of the outer ear canal, using a postauricular, inferiorly pedicled skin flap. All patients were also treated with hyperbaric oxygen both pre- and post-operatively.

Methods:

A prospective study evaluating the results of a one-stage surgical procedure to repair the meatal skin defect in five patients with osteoradionecrosis of the outer ear canal. All patients were treated with hyperbaric oxygen both pre- and post-operatively.

Results:

In four of the five patients, intact canal skin was achieved after surgery and hyperbaric oxygen therapy. One patient needed a second operation to cover a small remaining area of bare bone. In one patient, wound healing was unsatisfactory and an area of bare bone remained.

Conclusion:

In cases of osteoradionecrosis of the outer ear canal, the skin defect can be repaired with an inferiorly pedicled skin flap. Although not yet scientifically proven, the peri-operative application of hyperbaric oxygen may be of additional value to improve wound healing in areas of compromised tissue.

Keywords

External Ear CanalOsteoradionecrosisHyperbaric OxygenationOtologic Surgical Procedures
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 10 , October 2009 , pp. 1114 - 1119
Copyright
Copyright © JLO (1984) Limited 2009

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References

1Schuknecht, HF, Karmody, CS. Radionecrosis of the temporal bone. Laryngoscope 1966;76:1416–28CrossRefGoogle ScholarPubMed
2Ramsden, R. Osteoradionecrosis of the temporal bone. J Laryngol Otol 1975;89:941–55CrossRefGoogle ScholarPubMed
3Wang, CC, Doppke, K. Osteoradionecrosis of the temporal bone – consideration of nominal standard dose. Int J Radiat Oncol Biol Phys 1976;1:881–3CrossRefGoogle ScholarPubMed
4Hill, DS, Gaze, MN, Grant, HR. A simple reconstructive procedure for radiation-induced necrosis of the external auditory canal. J Laryngol Otol 1998;112:1142–6CrossRefGoogle ScholarPubMed
5Curi, MM, Dib, LL, Kowalski, LP. Management of refractory osteoradionecrosis of the jaws with surgery and adjunctive hyperbaric oxygen. Int J Oral Maxillofac Surg 2000;29:430–4CrossRefGoogle ScholarPubMed
6Mansfield, M, Sanders, D, Heimbach, R, Marx, RE. Hyperbaric oxygen as an adjunct in the treatment of osteoradionecrosis of the mandible. J Oral Maxillofac Surg 1981;39:585–9Google Scholar
7Peleg, M, Lopez, EA. The treatment of osteoradionecrosis of the mandible: the case for hyperbaric oxygen and bone graft reconstruction. J Oral Maxillofac Surg 2006;64:956–60Google Scholar
8Dhooge, IHM, Vermeersch, HFE. The use of two pedicled skin flaps in the surgical treatment of acquired atresia of the outer ear canal. Clin Otolaryngol 1999;24:58–60CrossRefGoogle ScholarPubMed
9Jensen, JA, Goodson, WH, Hopf, HW, Hunt, TK. Cigarette smoking decreases tissue oxygen. Arch Surg 1991;126:1131–4CrossRefGoogle ScholarPubMed
10Morecraft, R, Blair, WF, Brown, TD, Gable, RH. Acute effects of smoking on digital artery blood flow in humans. J Hand Surg 1994;19:1–7CrossRefGoogle ScholarPubMed
11Spear, SL, Ducic, I, Cuoco, F, Hannan, C. The effect of smoking on flap and donor-site complications in pedicled TRAM breast reconstruction. Plast Reconstr Surg 2005;116:1873–80CrossRefGoogle ScholarPubMed
12Marx, RE. A new concept in the treatment of osteoradionecrosis. J Oral Maxillofac Surg 1983;41:351–7CrossRefGoogle ScholarPubMed
13Bennett, MH, Feldmeier, J, Hampson, N, Smee, R, Milross, C. Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database Syst Rev 2005;(20):CD005005Google Scholar
14Leach, RM, Rees, PF, Wilmshurst, P. Hyperbaric oxygen therapy. BMJ 1998;317:1140–3Google Scholar
15Neovius, EB, Lind, MG, Lind, FG. Hyperbaric oxygen therapy for wound complications after surgery in the irradiated head and neck: a review of the literature and a report of 15 consecutive patients. Head Neck 1997;19:315–223.0.CO;2-8>CrossRefGoogle Scholar
16Annane, D, Depondt, J, Aubert, P, Villart, M, Géhanno, P, Gajdos, P et al. Hyperbaric oxygen therapy for radionecrosis of the jaw: a randomized, placebo-controlled double-blind trial from the ORN96 study group. J Clin Oncol 2004;22:4893–900Google Scholar
17Feldmeier, JJ, Hampson, NB. A systematic review of the literature reporting the application of hyperbaric oxygen prevention and treatment of delayed radiation injuries: an evidence based approach. Undersea Hyperb Med 2002;29:4–30Google ScholarPubMed
18Laden, G. Hyperbaric oxygen therapy for radionecrosis: clear advice from confusing data. J Clin Oncol 2005;23:4465Google Scholar
19van Merkesteyn, R, Bakker, DJ. Comment on “Hyperbaric oxygen therapy for radionecrosis of the jaw: a randomized, placebo-controlled double-blind trial from the ORN96 study group”. J Clin Oncol 2005;23:4465–6Google Scholar
20Moon, RE, McGraw, TA, Blakey, G. Hyperbaric oxygen therapy for radiation of the jaw: comments on a randomized study. Undersea Hyperb Med 2005;32:146–7Google ScholarPubMed
21Feldmeier, JJ. In response to the negative randomized controlled hyperbaric trial by Annane et al. in the treatment of mandibular ORN. Undersea Hyperb Med 2005;32:141–3Google Scholar
22Friedman, HI, Fitzmaurice, M, Lefaivre, JF, Vecchiolla, T, Clarke, D. An evidence-based appraisal of the use of hyperbaric oxygen on flaps and grafts. Plast Reconstr Surg 2006;117(suppl 7):175–90SGoogle Scholar