Post-auricular mastoid fistula is a rare occurrence. It typically appears following repeated soft tissue injury, and is commonly caused by chronic suppurative otitis media and repeated surgical treatments. Management is challenging, with few reported successful surgical techniques, which often have limited applicability.

This paper presents the case of a 58-year-old male with a persistent right-sided post-auricular cutaneous mastoid fistula resulting from two previous mastoidectomies. Although the patient underwent two simple primary closures, the fistula recurred. This was successfully treated with a new technique utilising a sternocleidomastoid rotational and cervical-fascial advancement flap, which was completely healed at the one-year follow up without a recurrence of the fistula.

This novel technique provided definitive obliteration of a persistent cutaneous mastoid fistula. Utilising a double-layered flap and a facelift incision results in excellent functional and cosmetic outcomes.

Osteoradionecrosis of the temporal bone is an uncommon but well documented finding after radiotherapy in the head and neck region, and results in exposed, necrotic bone with a soft tissue defect in the external auditory canal. The defect can be treated either conservatively or surgically. This paper aims to describe the results of reconstruction of the external auditory canal by transpositioning of the superficial layer of either the anterior or posterior part of the temporalis muscle to cover the defect.

Three patients with large, symptomatic defects in the external auditory canal were treated with transposition of the superficial layer of the temporalis muscle.

The duration of follow up was 4 to 16 months. No complications occurred. In all patients, re-epithelialisation was complete within 3 months.

During reconstruction of the external auditory canal, transposition of the superficial layer of the temporalis muscle provides a reliable flap with a satisfactory outcome.