Abstract
Background: Auricular carcinoma is a malignant neoplasm arising from the epithelial or adnexal tissues of the external ear, most commonly representing cutaneous squamous cell carcinoma, basal cell carcinoma, or, less frequently, melanoma, characterized by early cartilage invasion and regional spread due to the thin soft-tissue envelope of the ear. Such malignancies involve radical resection, producing wide defects, which require complex reconstructive approach. Case Presentation and Methods: We describe a 45-year-old male patient who presented with a basal cell carcinoma, affecting the lobulus of the ear and the retroauricular and mastoid region. He underwent successful tumor resection with clear resection margins in an ENT department with a subsequent referral to our department for reconstruction. This report presents a successful reconstruction of a large post-excisional defect, 10 × 10 cm in diameter, with mastoid process exposure. Temporal muscle flip flap and skin graft, along with the preservation of the external auditory canal with Z-plasty, were incorporated for reconstruction after subtotal auricular amputation due to BCC. It highlights the importance of a diligent long-term follow-up, the preservation of the canal, preventing meatal stenosis, and the reconstructive potential of the muscle flap in patients with mastoid bone exposure in a single stage. Conclusions: A temporalis muscle flap with skin graft coverage offers a reliable, vascularized solution for large post-oncologic auricular defects while preserving the external auditory canal. Z-plasty remains a critical technique for preventing meatal stenosis.