LEFT EXTERNAL AUDITORY CANAL SKIN

See Skin graft protocol and Sural Nerve Graft Harvest protocol for specific draping if necessary.

Split sheet around cranium leaving the entire ipsilateral face visible.

Clear plastic drape over ipsilateral face and neck split sheet around cranium leaving entire ipsilateral face visible, and drainage bag placed 1 cm behind intended incision.

Towels around head and towels to square off graft site.

LEFT EXTERNAL AUDITORY CANAL FREE

Head drape (leave ipsilateral face free of tape).Place NIMS (Neurologic Integrity Monitoring System) electrodes into glabella, orbicularis oculi, and orbicularis oris.Ipsilateral face prepped to allow intraoperative visualization.Wide 10% providone iodine prep from head to xiphoid (in case of need for a pectoralis major myocutaneous flap), left lower quadrant of abdomen (for fat harvest), and left leg (for sural nerve graft).Hair shaven 6 cm posterior to postauricular sulcus.Ringer's irrigation solution, 1000 cc bottles, in warmer x 4.Ringer's injection, 1000 cc bag x 6 for irrigation while drilling.1:100,000 epinephrine for preauricular/periparotid infiltration.1% lidocaine with 1:100,000 epinephrine for postauricular incision site.

Major Instrument Tray 2, Otolaryngology.Major Instrument Tray 1, Otolaryngology.Nerve stimulator control unit and instrument.NIMS (Neurologic Integrity Monitoring System).Requires 'dual setup' for both an otologic procedure and neck procedure with possibility of a craniotomy setup with the neurosurgeons.Osteoradionecrosis of the temporal bone.Stress that hearing will often be significantly worsened or sacrificed to achieve surgical goals.Stress that facial nerve excision and grafting may be required.Your ear canal will be oversewn, and the mastoid bone will be filled with fat from your abdomen or will require an additional piece of tissue from elsewhere in your body to fill the cavity created behind your ear.' Removal of your hearing and balance organs, facial nerve, parotid gland, and lymph nodes in your neck may also be necessary. Description: 'At minimum, remove your mastoid cells, ear canal, ear drum and hearing bones to encompass the tumor excision.Depending on particular type of carcinoma and presentation, may consider pre-operative interventional radiology evaluation.Multimodality treatment options should be explored (radiation, chemotherapy, etc.).Advanced surgical procedures should be considered.Early stage: complete surgical resection may be possible with direct and relatively limited surgical resection in some carcinomas of the EAC.Acinic cell (0.5 cm) soft tissue involvement.Histologic Types of External Auditory Canal (EAC) Cancer.Cancer may be primary, through direct extension or metastatic.Associated with chronic otorrhea in approximately two-thirds of cases (possibly related to chronic irritation or chronic exposure to aflatoxin B1).Usually history of outdoor occupations (increased sun exposure) or history of ear frostbite.Rare cancer, approximately 250 cases per year in the USA.

Left external auditory canal