# Effectiveness of the Temporal Flap in Reconstruction After Advanced External Ear Tumor Resection: A Case Report

## TL;DR

This case report describes a successful reconstruction of a large ear defect after tumor removal using a muscle flap and skin graft, with no complications or recurrence after four years.

## Contribution

The paper presents a novel combined reconstructive approach using a temporalis muscle flap and Z-plasty for post-tumor ear reconstruction.

## Key findings

- Temporalis muscle flap and skin graft effectively reconstructed a 10x10 cm ear defect with bone exposure.
- Z-plasty preserved the external auditory canal and prevented meatal stenosis.
- Four-year follow-up showed no recurrence and no complications.

## Abstract

Basal cell carcinoma affecting the external ear poses several challenges: It is classified as a high-risk cancer in the head and neck region, often requires radial and extensive resection, and reconstruction options are difficult to execute. We present a 45-year-old man with subtotal ear amputation, wide retroauricular resection with bone exposure, and reconstruction of the defect with a combined approach—Z-plasty to prevent meatal stenosis of the external auditory canal, temporalis muscle flip flap to cover the bone, and a skin graft to the muscle. This resection was performed after histological confirmation; 4-year follow-up revealed long-lasting results, no complications, and no recurrence of the disease.

Background: Auricular carcinoma is a malignant neoplasm arising from the epithelial or adnexal tissues of the external ear, most commonly representing cutaneous squamous cell carcinoma, basal cell carcinoma, or, less frequently, melanoma, characterized by early cartilage invasion and regional spread due to the thin soft-tissue envelope of the ear. Such malignancies involve radical resection, producing wide defects, which require complex reconstructive approach. Case Presentation and Methods: We describe a 45-year-old male patient who presented with a basal cell carcinoma, affecting the lobulus of the ear and the retroauricular and mastoid region. He underwent successful tumor resection with clear resection margins in an ENT department with a subsequent referral to our department for reconstruction. This report presents a successful reconstruction of a large post-excisional defect, 10 × 10 cm in diameter, with mastoid process exposure. Temporal muscle flip flap and skin graft, along with the preservation of the external auditory canal with Z-plasty, were incorporated for reconstruction after subtotal auricular amputation due to BCC. It highlights the importance of a diligent long-term follow-up, the preservation of the canal, preventing meatal stenosis, and the reconstructive potential of the muscle flap in patients with mastoid bone exposure in a single stage. Conclusions: A temporalis muscle flap with skin graft coverage offers a reliable, vascularized solution for large post-oncologic auricular defects while preserving the external auditory canal. Z-plasty remains a critical technique for preventing meatal stenosis.