[Background]
Malignant tumors of the external auditory canal are rare and usually need lateral temporal bone resection and further external auditory canal (EAC) reconstruction. Many surgical approaches, including secondary healing, skin grafting, and a variety of local skin flaps, were reported for the reconstruction of EAC. However, there were some drawback of the previously defined techniques, such as the resulting stenosis of the EAC. Some studies used the free flap for the circumferential EAC defect reconstruction, but need meticulous flap dissection and micro-anastomosis. In this study, we demonstrated two cases, which underwent EAC reconstruction using lateral cervical twisted flap (snail flap)- an easy and safe way.
[Materials and Methods]
The first case was a 60-year-old man who suffered from right external auditory canal squamous cell carcinoma. The patient received the operation of right external auditory canal resection, superficial parotidectomy and mastoidectomy. To reconstruct the circumferential EAC defect, a lateral cervical twisted flap was designed on the ipsilateral cervical region and based posteriorly on the left mastoid region. Twisting the flap on its main axis created a final shape resembling a snail and a tube with epithelium-lined canal inside. The second case was a 71-year-old woman who was diagnosed as left EAC squamous cell carcinoma. After total resection of left external auditory canal, superficial parotidectomy and mastoidectomy, the lateral cervical twisted flap was raised and twisted to yield a tube for the EAC defect reconstruction.
[Result]
Two operations of the external auditory canal reconstruction with lateral cervical twisted flap were performed successfully without the flap failure or partial loss. No evidences of tumor recurrence were noted during the follow-up and the EAC was patent without signs of stenosis.
[Conclusions]
Our experience with the lateral cervical twisted flap revealed the that this flap could obtain an epithelium-lined lumen for EAC reconstruction, and cosmetically and functionally acceptable results.

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