Surgical Management of a Rare Complication of Mastoidectomy: A Retroauricular Cutaneous-Mastoid Fistula

Abstract

Our goal was to describe a case of a rare complication that developed as a result of multiple surgical interventions over the years due to chronic mastoiditis - specifically, a pathological connection between a retroauricular skin defect and the mastoid cavity - and its surgical management. Based on subjective and objective findings, a surgical intervention was planned, including radical cavity obliteration and closure of the cutaneous-mastoid fistula using the temporomastoid periosteum. The surgery was successfully completed, resulting in improved hearing and the elimination of the infectious focus.

Keywords: chronic mastoiditis; chronic suppurative otitis media; cutaneous-mastoid fistula; hearing loss; mastoidectomy.

Figure 1. Retroauricular cutaneous-mastoid fistula

The preoperative image describes the pathological connection between the skin and the mastoid.

Figure 2. Pre- and postoperative audiometry, showing improvement in conductive hearing loss

A: Preoperative audiometry showing left-sided conductive hearing loss of 60-70 dB; B: Postoperative audiometry: one month after the surgery, a hearing evaluation was performed through audiometry, revealing an improvement in hearing by 20-30 dB.

Figure 3. Computed tomography of the temporal bone: partially resectioned mastoid process

A: Coronal view; B: axial view On computed tomography of the temporal bone, the following was noted: partial resection of the mastoid process, a viscous fluid accumulation dorsally in the mastoid air cells, and pneumatization of the tympanic cavity on the left side.

Figure 4. Image taken one month post-surgery, showing the closed cutaneous-mastoid fistula