Ballance, of London, makes a plastic operation that is used by many operators and undoubtedly yields good results. He cuts through the inferior wall of the cartilaginous meatus (Fig. 27) from its tympanic end to the inferior portion of the concha. This incision is then curved (Fig. 28) upward and backward until the level of the anterior beginning of the helix is reached where it stops.
This cartilaginous flap is thinned of all possible superfluous tissue, and sometimes of some of its cartilage, and is then turned back and the curved portion fastened with through and through sutures (Fig. 29) to the large anterior mastoid flap (Fig. 30). The parts are thus placed in position (Fig. 31) and the meatus expanded and forced against the bone as well as possible by firm gauze packing (Fig. 32). Some operators do not trust to the various flap operations to epidermize the bone