Transconjunctival approach mostly needs lateral canthotomy that was not needed with subciliary approach. Transient postoperative edema is more in transconjunctival approach while postoperative ectropion and sclera show was detected only with subciliary approach. So, building up of experience in transconjunctival approach will be beneficial for maxillofacial surgeons and more measures to avoid ectropion are needed with subciliary approach.
Introduction: Longstanding tympanic membrane perforation may cause hearing loss and middle ear infection even if they are small in size. The purpose of myringoplasty is to repair such perforations and thus to improve hearing and eliminate the susceptibility to middle ear infection. Methodology: This study was included 40 patients with dry central tympanic membrane perforation, not associated with ossicular pathology, retraction pocket or cholesteatoma showing conductive hearing loss with an air bone gab not exceeding 30 dBHL in the studied ear. Patients were divided into 2 groups (group I and group II) 20 patients who have undergone fat myringoplasty and 20 patients who have undergone perichondrium tympanoplasty. Each group was subdivided into 2 subgroups (A and B) according to size of perforation. Audiological evaluation was done pre and postoperative. Results: In fat myringoplasty, the success rate was 50% with success rate of 80% in group I A (<4 mm) and a success rate of 20% in group IB (>4 mm). In perichondrium tympanoplasty, the overall success rate was about 80% with only 4 failed cases from 20 cases. It was found that there was improvement of hearing in group IA ranging from 7.5-10dB with a mean of 9±1 while in group IIA; there was improvement of hearing ranging from 5-20 dB with a mean of 10±6.5. There was no significant difference as regards improvement of hearing (P=0.67). While in group IB, the 2 successful cases showed improvement of hearing ranging of about 10 dB while in group IIB; there was improvement of hearing ranging from 7.5-20 dB with a mean of 12± 5dB. So, in large perforation, there was no significant difference between the studies groups (P=0.6). Conclusion: Fat graft myringoplasty is a reliable technique with shorter duration less operative care. Success rate is higher for perichondrium graft. Hearing improvement is not significantly different between both groups.
Purpose: To evaluate reconstruction of posterior meatal and/or lateral attic walls in cholesteatoma surgery using the autologous bony posterior canal wall and bone pâté during the first stage operation. Patients and methods: Twenty ears of twenty patients with chronic suppurative otitis media with cholesteatoma. Cases with extensive destruction of posterior canal wall and mastoid cortex, low tegmen, significant anterior or lateral sigmoid sinus, only functioning ear, labyrinthine fistula and previous canal wall down mastoidectomy were excluded. The surgical technique includes cortical mastoidectomy and bone pâté collection,temporary removal of the bony posterosuperior meatal wall(PMW) by cutting the entire PMW as one piece with a microsagittal saw to offer optimal exposure of tympanic cavity,attic and retrotympanum for complete eradication of cholesteatoma and then repositioning of this wall in its anatomical site supported with bone pâté in attic and mastoid.The condition of reconstructed PMW and the status of middle ear were evaluated by computed tomography scan, otoendoscopic examination and staged second-look surgery. Results:Cholesteatoma in the mastoid, antrum , attic and retrotympanum could be removed with safety in all cases; no serous intraoperative complications occurred, intraoperative difficulties included: damage of posterosuperior canal wall during saw cutting in one case(5%) and mild dural injury during superior cutting in one case(5%) , through follow-up , the new reconstructed canal appeared to be of near normal size, shape and contour, and no dislocation or necrosis of the reconstructed posterior canal wall was noted. The postoperative complications included: wound infection in one case (5%) , tinnitus in two cases (10%) and recurrent cholestearoma in one case(5%). Conclusion: Our surgical technique which includes reconstruction of posterior meatal and/or lateral attic walls in cholesteatoma surgery using the autologous bony posterosuperior meatal wall after its temporary removal provides optimal surgical exposure during the procedure, restores near normal anatomy of the external auditory canal , has low recurrence rate(5%) and avoids the troubles of open mastoid cavity, making this surgical procedure an attractive alternative to the standard CWU and CWD procedures.
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