Fascia and Cartilage Palisade Tympanoplasty: Nine Years' Experience

J, Heermann; Heermann, H.; Kopstein, Ernest

doi:10.1001/archotol.1970.00770040334004

Cited by 109 publications

(80 citation statements)

References 2 publications

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“…Many patients have undergone fascia grafting in an attempt to recreate fibrous layer and thereby strengthen the drum, but in patients with chronic eustachian tube dysfunction, this tympanic membrane retracts and adheres again to promontory, thus increasing the rate of cholesteatoma. In these cases, cartilage-perichondrium gives better results than temporalis fascia or perichondrium alone [9][10][11], because of its higher mechanical stability against middle ear pressure changes. Incidence of post operative retraction pocket are seen less frequently with cartilage [3,12,13].…”

Section: Discussionmentioning

confidence: 99%

Cartilage–Perichondrium: An Ideal Graft Material?

Chhapola¹,

Matta²

2011

Indian J Otolaryngol Head Neck Surg

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Temporalis fascia has long been regarded as the ideal graft material for tympanic membrane repair. However it often does not seem to withstand negative middle ear pressure in the post operative period. Tragal cartilage with perichondrium would appear to be a better graft material with good hearing outcome. It can be obtained easily with cosmetically acceptable incision. In the present study, we have compared the graft properties of temporalis fascia verses tragal cartilage perichondrium with respect to healing, hearing and rate of post operative retraction or reperforation. 132 patients of chronic otitis media with pure conductive hearing loss were posted for tympanoplasty. Temporalis fascia graft was used in 71 patients and cartilage perichondrium (composite graft) was used in 61 patients. Post operative healing, hearing and rate of retraction or reperforation was compared for both the graft materials. All the patients were followed up for 2 years. Patients where temporalis fascia graft was used, 60 (84.5%) showed a good neotympanum, 7(9.85%) had reperforation and 5(7.04%) had retraction pockets. Patients where tragal cartilage perichondrium was used, 60(98.36%) showed a healed tympanic membrane and only 1(1.63%) had reperforation. None of the patients showed retraction pocket or cholestetoma. Postoperative hearing was accessed 6 months after surgery. Patients with temporalis fascia graft showed an air bone gap of less than 10 dB in 49 (82%) patients and more than 10 dB in 11 (18%) patients. Air bone gap closure with tragal cartilage perichondrium was less than 10 dB in 45 (78%) patients and more than 10 dB in 13 patients (22%). Tragal cartilage perichondrium (\0.5 mm) seems to be an ideal graft material for tympanic membrane in terms of postoperative healing and acoustic properties. It can easily withstand negative middle ear pressure which may have contributed to the development of otitis media and significantly affect healing outcomes in postoperative period. Tragal cartilage being composed of collagen type II is also physiologically similar to the nature of the tympanic membrane.

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Section: Discussionmentioning

confidence: 99%

Cartilage–Perichondrium: An Ideal Graft Material?

Chhapola¹,

Matta²

2011

Indian J Otolaryngol Head Neck Surg

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“…6 Heermann was the first to introduce cartilage palisade technique in 1962. 7 Cartilage shield tympanoplasty (CST)…”

Section: Introductionmentioning

confidence: 99%

Cartilage Shield Tympanoplasty: A Retrospective Chart Review of 69 Cases

Patadia¹,

Keshri²,

Shah³

2015

An International Journal of Otorhinolaryngology Clinics

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Objective: Cartilage shield tympanoplasty (CST) is an acknowledged procedure to repair total tympanic membrane perforations. The main objective of this study was to share our experience of CST, in form of its technique, graft uptake and hearing outcomes. Patients: A total of 69 cases of type 1 CST, from January 2013 to March 2014. We followed all patients for a minimum period of 6 months.Intervention: Therapeutic. Main outcome measures:Graft uptake rate, along with preand postoperative pure tone audiogram air bone gap (ABG) and postoperative complications, was evaluated. We compared ABG using Student's t-test. Results:Graft uptake was seen in 68 cases (98.5%). The mean pre-and postoperative pure tone audiometry (PTA)-ABG was 37.58 ± 6.43 dB and 20.19 ± 8.14 dB, respectively. Hearing improvement was maximum at 2 kHz with mean postoperative value of 17.73 dB, and the least improvement was seen at 8 kHz with value of 30 dB in postoperative period. Conclusion:The graft uptake rate was excellent, and hearing results were satisfactory. Cartilage shield tympanoplasty should be a recommended procedure for total perforation, subtotal perforation and revision cases. However, long-term results are still awaited.

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“…The greatest advantage of the cartilage graft has been thought to be its very low metabolic rate. It receives its nutrients by diffusion, is easy to work with because it is pliable, and it can resist deformation from pressure variations [6,8,9].…”

Section: Introductionmentioning

confidence: 99%

Cartilage Support for Fascia Graft in Type I Tympanoplasty

Kulkarni

Burse

et al. 2014

Indian J Otolaryngol Head Neck Surg

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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.

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Fascia and Cartilage Palisade Tympanoplasty: Nine Years' Experience

Cited by 109 publications

References 2 publications

Cartilage–Perichondrium: An Ideal Graft Material?

Cartilage–Perichondrium: An Ideal Graft Material?

Cartilage Shield Tympanoplasty: A Retrospective Chart Review of 69 Cases

Cartilage Support for Fascia Graft in Type I Tympanoplasty

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