Postoperative Wound Complications in Modified Meatoplasty vs Z- Meatoplasty in Canal Wall Down Mastoidectomy at a Tertiary Hospital: A Randomized Controlled Trial
DOI:
https://doi.org/10.32412/pjohns.v25i2.619Keywords:
meatoplasty, mastoidectomy, complicationsAbstract
Objective: To compare the postoperative complications (narrowing of the enlarged canal and perichondritis) of a meatoplasty without conchal cartilage removal and more raw skin area (modified meatoplasty) versus a meatoplasty with conchal cartilage removal and less raw skin area (Z meatoplasty) including other sequelae (hyperemia, formation of granulation tissue and discharge from the cavity) which may lead to complications in canal wall down post-auricular mastoidectomy.
Methods:
Design: Concealed, randomized controlled clinical trial
Setting: Tertiary Public Hospital
Patients: Twenty-one ears of 19 patients with chronic suppurative otitis media (CSOM) undergoing postauricular open mastoidectomy (radical or modified radical mastoidectomy) between February to July 2009 were randomly assigned to undergo modified meatoplasty (Group A: n=11 ) and Z meatoplasty (Group B:n=10). Main outcome measures were postoperative rates of meatoplasty complications and mastoidectomy sequelae that may lead to complications, on weeks 1, 2 and 4.
Results: On the 1st postoperative week, the Z meatoplasty was associated with a higher incidence of hyperemia at the incision site [A: 36.4%, B: 90% (p <0.02)]. The specific complication of perichondritis or other sequelae (discharge from the cavity, granulation tissue) or were no different in both types of meatoplasty. On the second postoperative week, the modified meatoplasty was associated with a higher incidence of narrowing of the canal (73% vs 20%) P<0.02; [RR = 3.64 (CI:1.00,13.23)] The only factor associated with this complication was the modified meatoplasty procedure itself [RR = 3.64 (CI: 1.00, 13.23)]. Perichondritis, and the sequelae of mastoidectomy (discharge from the cavity, granulation tissue) were no different in both types of meatoplasty.
Conclusion: Among CSOM patients who underwent postauricular open mastoidectomy, the Z meatoplasty was associated with a greater risk of hyperemia at the incision site than the modified meatoplasty in the 1st operative week. Compared to the Z meatoplasty, the modified meatoplasty was associated with greater risk of narrowing of the canal on the 2nd postoperative week.
Keywords: meatoplasty; mastoidectomy; complications
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