Abstract
Objective: The purpose of this study is to describe and evaluate the medio-lateral graft tympanoplasty for the reconstruction of anterior or subtotal tympanic membrane (TM) perforation.
Study design and setting: This is a retrospective study of 100 patients who underwent the medio-lateral graft tympanoplasty at both community and tertiary care center from 1995 to 2001. Posterior tympanomeatal flap is elevated same as in the medial (underlay) graft tympanoplasty. Anterior-medial canal skin is elevated down to the annulus. At the annulus only squamous epithelial layer of TM is elevated up to anterior half of the TM perforation. Temporalis fascia is grafted medial to posterior half of the perforation and lateral (overlay) to anterior half of the de-epithelialized TM perforation up to the annulus. Anterior canal skin is rotated to cover the fascia graft and TM perforation as a second layer closure. Patients were followed for at least 6 months. Outcome was considered successful if TM is intact.
Results: There were three failures (97% success rate) due to a postoperative infection, anterior blunting, and recurrent cholesteatoma.
Conclusion and significance: The medio-lateral graft method is superior to the traditional medial or lateral graft technique for the reconstruction of large anterior or subtotal TM perforation. This new method should help otologic surgeons to improve outcome of tympanoplasty for anterior or total TM perforation.
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References
Rizer FM. Overlay versus underlay tympanoplasty. Part I: Historical review of the literature; part II; the study. Laryngoscope. 1997;107:26–36.
Kriskovich M, Shelton C. Surgical treatment of chronic otitis media & cholesteatoma. In: Canalis RF, Lambert PR, editors. The ear: comprehensive otology. Philadelphia: Lipponcott Williams & Wilkins; 2000.
Applebaum EL, Deutsch EC. An endoscopic method of tympanic membrane fluorescein angiography. Ann Otol Rhinol Laryngol. 1986;95:439–43.
Farrior JB. Sandwich graft tympanoplasty: experience, results, and complications. Laryngoscope. 1989;99:213–7.
Weider DJ. Use of the Williams microclip in various aspect of tympanoplastic surgery. Laryngoscope. 1981;91:2106–25.
Kartush JM, Michaelides EM, Becvarovski Z, et al. Over-under tympanolasty. Laryngoscope. 2002;112:802–7.
Jung T, Park S. Mediolateral graft tympanoplasty for anterior or subtotal tympanic membrane perforation. Otolaryngol Head Neck Surg. 2005;132:532–6.
Jung T, Youhyun K, Yoonhwan K, Park S, Martin D. Medial or medio-lateral graft tympanoplasty for repair of tympanic membrane perforation. Int J Ped Otorrhinolaryngo. 2009;73:941–3.
House WF. Myringoplasty. Arch Otolaryngol. 1960;71:399–404.
Shea JJ Jr. Vein graft closure of eardrum perforations. J Laryngol Otol. 1960;74:358–62.
Karlan MS. Gelatin film sandwich in tympanlasty. Otolaryngol Head Neck Surg. 1979;87:84–6.
Hartwein J, Leuwer RM, Kehrl W. The total reconstruction of the tympanic membrane by the ‘Crowncork’ technique. Am J Otolaryngol. 1992;13:172–5.
Schwaber MK. Postauricular undersurface tympanic membrane grafting: some modifications of the ‘swinging door’ technique. Otolaryngol Head Neck Surg. 1986;95:182–7.
Escudero LH, Castro AO, Drumond M, et al. Argon laser in human tympanoplasty. Arch Otolaryngol. 1979;105:252–3.
Goodman WS, Wallace IR. Tympanoplasty: 25 years later. J Otolaryngol. 1980;9:155–64.
Willians JD. Microclip application in tympanoplasty. Ann Otol Rhinol Laryngol. 1977;86:223–6.
Sperling NM, Kay D. Diagnosis and management of the lateralized tympanic membrane. Laryngoscope. 2000;110:1987–93.
Acknowledgments
I gratefully acknowledge John Jenkins in the Media Development Service at the Jerry L. Pettis Memorial Veterans Medical Center, Loma Linda, California for producing computer graphic figures used in this paper.
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Jung, T.T.K. (2023). Medio-Lateral Graft Tympanoplasty for Anterior or Subtotal Tympanic Membrane Perforation: An Update. In: Goycoolea, M.V., Selaimen da Costa, S., de Souza, C., Paparella, M.M. (eds) Textbook of Otitis Media. Springer, Cham. https://doi.org/10.1007/978-3-031-40949-3_52
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