Case Report
A 31-year-old male patient was admitted to the Ear Nose Throat Clinic in Semptember 2019 with complaint of left fullnes, discharge and conductive hearing loss. Symmetrical nodular cutaneous lesions on malar region, tragus and bilateral meatus acusticus externus were noted first (Figure 1).The patient’s history and family history were competible with TSC. On physical examination, total obstruciton of MAE was detected due to TSC angiofibroma (Figure 2). The lesions were pushed with a 2 mm auto-endoscope by passing through the MAE for external auditory canal (EAC) examination. On EEC examination, there was a slight purulent secretions and cerumen impaction was detected, the tympanic membrane was intact. Temporal bone Computed Tomography showed bilaterall soft tissue thickening of the one-third exteranl part of EAC. The structures of middle ear cavity and temporal bone were natural. EAC aspiration for cerumen and discharge was performed weekly. Ciprofloxacin / dexamethasone local therapy prescirebed for three consequtive week, But normal self-cleaning EAC has not been achieved for 3 weeks. Upon this, it was decided to meatoplasty. The surgery was performed under local anesthesia. Angiofibromas on the MAE and tragus were excised. The defect was repaired by sliding a 3x2x3 cm fasciocutaneous island flap inferiorly created in the preauricular area (Figure 3). Self-cleaning EAC was achieved with an open and MAE. Immunohistochemistry analysis showed that some tumor cells were positive for CD31, Actin(SM), CD34 and vimentin, negative expression for smooth muscle actin (SMA), desmin, S100, and AE1/AE3. Ki-67 proliferation index was less than 5%. The pathology specimen was histopathologically diagnosed as angiofibroma.