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Optimal meatoplasty in canal wall down tympanomastoidectomy: a SMAART 2 flap technique
Published online by Cambridge University Press: 10 April 2025
Abstract
Objectives
To identify ‘on-table optimal meatal opening size’ that predicts post-operative mastoid cavity healing in the canal wall down tympanomastoidectomy. To develop a specific, measurable, achievable, acceptable, replicable and time-bound (SMAART) meatoplasty.
Method
A double-blind randomised control trial where patients were randomly assigned to standard Portmann 3 flap and new SMAART 2 flap technique.
Results
There were 18 and 17 participants in the former and latter, respectively. Dry ear was achieved when the on-table ratio of tympanomastoid cavity volume to meatal opening size was 2:1. In a mastoid cavity of 6 ml or less, among the 2 flap patients, the majority had epithelialisation completed by the first month, meatoplasty having significantly shorter duration (12.2 versus 32.3 minutes) and cosmetically better than 3 flap.
Conclusion
Optimal meatoplasty is when tympanomastoid cavity volume ratio to meatal opening size is 2:1. When the on-table mastoid cavity is either 6 ml and less or is obliterated to 6 ml and less, the new SMAART 2 flap meatoplasty should be considered.
Information
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- Copyright
- © The Author(s), 2025. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED.
Footnotes
I would like to mention that this study was a part of my post-graduation thesis and has been presented at the International Federation of Otorhinolaryngological Societies (IFOS) Dubai in January 2023.
References
World Health Organization Chronic suppurative otitis media: burden of illness and management options. In http://iris.who.int/handle/10665/42941 [July 2023]Google Scholar
Bhatia, R, Chauhan, A, Kaur, K, Rana, M, Pradhan, P, Singh, M. Prevalence of ear infections in children (0 to 15 Years) of India: a systematic review and meta-analysis. Int Arch Public Health Community Med 2022;6:080Google Scholar
Kveton, JF. Open cavity mastoid operations. In: ME III, Glasscock, Gulya, AJ, eds. Glasscock-Shambaugh Surgery of the Ear, 5th edn. Hamilton: Elsevier, 2010:499–516Google Scholar
Roulleau, P. Development of the surgery of chronic otitis. Rev Laryngol-Otol-Rhinol. 1993;114:87–91Google Scholar
Raut, v.v. The Toronto meatoplasty: enhancing one’s results in canal wall down procedures. Laryngoscope. 2002 Nov;112(11):2093-5.Google Scholar
Portmann, M. “How I do it” – otology and neurotology. A specific issue and its solution. Meatoplasty and conchoplasty in cases of open technique. Laryngoscope 1983;93:520-2Google Scholar
Wormald, PJ, Van Hasselt, CA. A technique of mastoidectomy and meatoplasty that minimizes factors associated with a discharging mastoid cavity. Laryngoscope 1999;109:478–82Google Scholar
Suskind, DL, Bigelow, CD, Knox, GW. Y modification of the Fisch meatoplasty. Otolaryngol Head Neck Surg 1999;121:126–7Google Scholar
Rombout, J, Van Rijn, PM. M-meatoplasty: results and patient satisfaction in 125 patients (199 ears). Otology Neurotol. 2001;22:457–60Google Scholar
Fisch, U, May, JS, Linder, T. Tympanoplasty, Mastoidectomy, and Stapes Surgery. New York: Thieme Publishers 2007Google Scholar
Tong, MC, Liu, KC, Van Hasselt, CA. Sling stitch endaural meatoplasty. Laryngoscope 1996;106: 1438–40Google Scholar
Murray, DP, Jassar, P, Lee, MSW, Veitch, DY. Z-meatoplasty technique in endaural approach mastoidectomy. J Laryngol Otol. 2000;114:526–7Google Scholar
Patil, S, Ahmed, J, Patel, N. Endaural meatoplasty: the Whipps Cross technique. J Laryngol Otol. 2011 125:78–81Google Scholar
Elsamanody, AN, Topsakal, V, Grolman, W, Tange, RA. How I do it: modified Todd’s meatoplasty. J Laryngol Otol. 2016 May;130:497–500Google Scholar
Bansal, C, Singh, VP. Meatoplasty in a CWD procedure using an endaural approach: a case series of 31 cases. Indian J Otolaryngol Head Neck Surg. 2015;67:60–3Google Scholar
Memari, F, Delarestaghi, MM, Mir, P, GolMohammadi, M, Koushki, ES. Meatoplasty in canal wall down surgery: our experience and literature review. Iran J Otorhinolaryngol. 2017;29:11–17Google Scholar
Tos, M. Manual of Middle Ear Surgery. Volume 2: Mastoid Surgery and Reconstructive Procedures. New York Thieme Medical Publishers 1995Google Scholar
Sadé, J, Weinberg, J, Berco, E, Brown, M, Halevy, A. The marsupialized (radical) mastoid. J Laryngol Otol. 1982;96:869–75Google Scholar
Vadiya, SI, Makwana, P, Mehta, N, Khetani, S. Comparison of different techniques of meatoplasty after canal wall down mastoidectomy. Indian J Otolaryngol Head Neck Surg 2022;74(Suppl 1):589–92Google Scholar
Hovis, KL, Carlson, ML, Sweeney, AD, Haynes, DS. The one-cut meatoplasty: novel surgical technique and outcomes. Am J Otolaryngol. 2015;36:130–Google Scholar
Choi, IJ, Song, JJ, Jang, JH, Chang, SO. A novel meatoplasty method in canal wall down tympanomastoidectomy: a perichondrial posterior fixation technique. Clin Exp Otorhinolaryngol. 2009;2:164–8Google Scholar
Kim, CW, Oh, JI, Choi, KY, Park, SM, Park, MI. A technique for concurrent procedure of mastoid obliteration and meatoplasty after canal wall down mastoidectomy. Auris Nasus Larynx. 2012;39:557–61Google Scholar
Tansuker, HD, Ş, Öğreden, Özyılmaz, C, Cengiz, AB, ŞE, Beder, Oktay, MF, Korkut, N. Effect of the fascia graft size on healing rate of cavities in patients undergoing CWD tympanomastoidectomy: a clinical prospective study. J Int Adv Otol. 2019;15:189–92Google Scholar
Lakra, RG. What is an adequate meatoplasty? Bengal J Otolaryngol Head Neck Surg. 2014;22:10–12Google Scholar