Publication:

Surgical modification for redo mastoidectomy in the presence of a large postauricular keloid: a case report and literature review

Postauricular keloids may complicate mastoid surgery by obscuring landmarks, restricting flap mobility, and increasing recurrence risk. Their presence demands surgical modifications to ensure both safe disease clearance and stable wound healing. A 19-year-old male from a Malaysian indigenous tribe presented with recurrent cholesteatoma and a large postauricular keloid (8×3 cm) following prior mastoidectomy. The keloid limited access and distorted anatomy. Steroid injections were ineffective. A single-stage redo modified radical mastoidectomy with type IV tympanoplasty, meatoplasty, and keloid excision was performed. Elliptical incision, wide undermining, meticulous hemostasis, layered closure, and mastoid bandaging achieved tension-free healing. At six months, the ear remained dry without recurrence of cholesteatoma or keloid. Single stage mastoidectomy with keloid excision is feasible. Careful surgical technique with simple measures such as wide undermining and compression bandaging may obviate the need for adjuvant therapy in selected patients.