Cartilage Support for Fascia Graft in Type I Tympanoplasty

Abstract

To evaluate the success rate, in terms of anatomical and functional results, in our technique of cartilage support for fascia graft in type I tympanoplasty. Retrospective study of tragal cartilage support for fascia graft in tympanoplasty for large central perforation in 748 patients was carried at an academic institution during January 2004 to March 2012. Patients' age ranged from 11 to 65 years. 325 (43.4 %) male and 423 (56.6 %) female patients were operated and mean post-operative follow up was of 24 months (range 6-48 months). The inclusion criteria were large central or subtotal perforation, anterior quadrant perforation, anterior tympanosclerotic patch with perforation and revision myringoplasty. Small central perforation, posterior perforations, traumatic perforations and Ossiculplasty were excluded from this study. In this technique, a piece of tragal cartilage carved in semi lunar shape is inserted medial to anterior remnant of tympanic membrane. Temporalis fascia graft is sandwiched between cartilage and anterior remnant of tympanic membrane. Post-operative closure of perforation was noted. Pure-tone average pre and post-operative air-bone gap in dB at 250, 500, 1000, 2000, and 4,000 Hz were compared. The overall success rate of our technique was 98.3 % in terms of graft uptake and within 13.35 ± 5.22 dB of air bone gap closure in terms of hearing improvement. This study reveals that cartilage support for fascia graft in type I tympanoplasty is a highly reliable technique and gives significant improvement in graft take-up and hearing status.

Cartilage rim augmented fascia tympanoplasty: a more effective composite graft model than temporalis fascia tympanoplasty

“…In a similar technique, Mundra et al 21 . and Kulkarni et al 5 . reported anatomical success (perforation closure) rates of 95.74 per cent and 98.3 per cent respectively.…”

“…Since the introduction of tympanoplasty by Wullstein in 1952, 2 and Zollner in 1955, 3 different types of graft materials have been used for the repair. As a result of ease of accessibility at the surgical site, abundant availability, low basal metabolic rate and similar thickness to the tympanic membrane, temporalis fascia grafts have been extensively used worldwide, with successful closure of tympanic membrane defects in over 90 per cent of normally ventilated middle ears 4 , 5 . However, temporalis fascia has much poorer healing in cases of tubal dysfunction, an adhesive process, tympanic fibrosis and total perforation, and in revision surgical procedures.…”

“…To overcome these shortcomings, and utilising the favourable properties both of temporalis fascia and cartilage grafts, a technique of temporalis fascia reinforcement with cartilage has been put forward 5 , 10 , 21 . We introduce yet another novel technique of cartilage rim augmented fascia tympanoplasty (‘CRAFT’), which involves underlay placement of temporalis fascia, which acts as reinforcement, achieved by placing a horseshoe-shaped conchal cartilage as an annular graft under the tympanic annulus.…”

Cartilage Shield Tympanoplasty: A Retrospective Chart Review of 69 Cases

“…13,14 However, the routine use of CST in all cases is still controversial. In a study by Kulkarni et al, 15 all patients who underwent type 1 tympanoplasty, had an additional support of cartilage anteriorly, medial to annulus. The limitation in the study was that mean follow-up in our patient group is 9 months.…”

Results of cartilage shield tympanoplasty in revision cases of myringoplasty

“…Kulkarni et al also observed males as 43.4% and females 56.6% in their study. 10 Khan et al also found males 57.85% and females 42.15% in their study. 11 Kyrodimos et al found males 50% and females 50%, Boone males 55.79% and females 44.21%.…”