The skin and periosteum are dissected from the bony canal from lateral to medial along a broad front until the fibrous annulus is reached (Fig. 4-2). Removal of the canal skin medial to the anterior canal bulge may require blind dissection because the bulge often obscures vision of the anterior meatal recess. Tears in the skin are avoided by keeping the dissecting knife firmly against the bone and by not suctioning on the skin. Once the skin is elevated to the level of the annulus, a plane is developed between the skin of the canal and TM remnant, and the annulus and fibrous layer of the TM. Working in a plane parallel to the annulus, the skin of the canal and TM remnant
FIGURE 4 — 1 Transmeatal incisions of vascular strip and lateral ear canal.
are removed. Beginning superiorly and anteriorly, the skin of the canal and TM remnant can often be removed in continuity by using a small cup forceps. To prevent epithelial pearls from developing in the reconstructed drum, it is important that all remaining squamous epithelial components be completely removed from the drum remnant.
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