Definition and Overview
Aurilectomy is the resection or excision of the external ear usually as part of or primary treatment of tumours. An external ear removal may be partial, in which only a part of it is removed or complete, wherein the entire ear is excised. If it’s the latter, the procedure is followed by surgery for the attachment of prosthetics.
Who Should Undergo and Expected Results
Aurilectomy is performed if the patient is diagnosed with a tumour in the external ear, which runs from the pinna (flap) to the eardrum. This tumor can be classified as benign or malignant (cancerous).
Although not cancerous, surgeons still highly recommend the removal of benign tumours on the ears as they can continue to grow and create an obstruction, causing the patient to develop either temporary or permanent hearing loss.
A cancerous tumour in the external ear, meanwhile, is very rare. It’s much rarer to find one that grows internally, like the ones that affect the glands that make the earwax. Most of the diagnosed cancers of the external ear are found outside and are categorised as skin cancer.
There are two basic types of skin cancer and these are basal cell carcinoma and melanoma. The former is curable, although it tends to recur on the same spot. The latter, on the other hand, is a deadly form of skin cancer and is very difficult to treat once it has already metastasized. One of the most common symptoms of cancer in the external ear is the appearance of abnormal, irregularly-shaped, or lumpy spots or lesions on the skin.
The surgery is intended to reduce the recurrence, prevent the spread, or treat the disease. It can be performed in conjunction with other procedures depending on the extent of the condition. One such procedure is Mohs surgery where the affected part of the skin and surrounding tissue are removed to get rid of cancer.
How Does the Procedure Work?
Considering the many possible risks and complications as well as the challenges that an ear reconstruction procedure requires, complete aurilectomy is avoided as much as possible and is typically reserved as the last treatment option. In the majority of cases, the surgeon first performs a biopsy to confirm malignancy and determine if other less invasive surgical procedures can be applied. However, if external ear removal has been determined to be the best or the only option, the surgeon plans for both aurilectomy and reconstructive surgery or the attachment of prosthesis once the surgical wounds have healed.
The procedure, which is performed under general anaesthesia, can be done using different techniques depending on the location and size of the tumour. If it’s found in the skin of the ear canal, the affected skin is detached from the bone using a drill and a skin graft is placed. However, if the tumour sits close to the eardrum, the procedure will involve removing the eardrum as well to ensure that no cancer cells will remain that can later on spread to other parts of the ear.
If the tumour is found to be cancerous, a procedure known as en bloc is done. This means that the skin, ear canal, eardrum, and even the bones of the middle ear are surgically removed. The surgeon may also choose to perform another surgery on the parotid glands around the neck area and remove lymph nodes with the goal to control possible spread. If this is the case, a parotidectomy is done first before aurilectomy.
Both partial and complete external ear removal is followed by a reconstructive surgery. If only a part is removed, the remaining skin may be fashioned to form an ear, although in the majority of cases, prosthesis, which can be made from silicone or human tissue, is attached.
Between the two options, the first one is usually preferred. This is because although silicone prosthesis is easier to acquire, it requires regular maintenance and it’s not fixed to the skin.
Possible Risks and Complications
In an external ear removal, the patient can experience pain, hearing loss, bleeding, and infection as well as develop balance problems.
Adhikary B, Bora H, Bandyopadhyay SN, Sen I, Basu SK. Foreign body in ENT--general practitioner's duty. J Indian Med Assoc. 2008 May. 106(5):307-9
Anon JB, Pulec JL. Foreign body (tooth) in the external auditory canal. Ear Nose Throat J. Aug 1994. 73(8):511.