Maximising Graft Take-Up in Type1 Tympanoplasty Using Peripheral Cartilage Ring and Perichondrium

Abstract

The aim of this study is to evaluate the results of closure of big central and subtotal perforation by Tympanoplasty using underlay technique with Composite graft of tragal perichondrium supported by a ring of cartilage peripherally. Our hypothesis was that the cartilage support offers an extremely reliable method for reconstruction of the tympanic membrane in cases of advanced middle ear pathology and Eustachian tube dysfunction and also revision cases. Prospective study of patients undergoing tympanoplasty in big central and subtotal perforation with graft supported by a ring of cartilage peripherally between June 2016 and August 2016. Hearing results were reported using four frequency (500, 1000, 2000 and 3000) pure tone average air-bone gap. During the study period, composite graft comprising of tragal perichondrium and peripheral ring of cartilage prepared from ipsilateral tragus was used for tympanic membrane reconstruction in 30 patients. Overall graft take rate was 93.33%. Complications included residual perforation in 6.67%. Cartilage ring support offers an extremely reliable method for reconstruction of tympanic membrane in cases of high-risk perforation (big central perforation, subtotal perforation, anterior perforation of tympanic membrane, revision cases).

Endoscopic Fascia-Cartilage Composite Grafting in Chronic Suppurative Otitis Media

“…This composite grafting system gave a 93% success rate with tympanic membrane reconstruction and nearly 80% air-bone gap closure rate. 15 Gozeler et al in a prospective study spanning over three years, compared fascia grafting with composite fascia-cartilage graft in Type-I tympanoplasty of 113 patients. Tympanic membrane closure rate and air bone-bone gap closure rates were statistically better in composite fascia cartilage grafting compared to fascia alone grafts.…”

A Study of Success Rate of Butterfly Technique

“…In another study [10], 95% success rate is reported with boomerang-shaped chondroperichondrial graft. Another study reported 93% success rate of graft takeup based on composite graft comprising perichondrium and peripheral ring of tragal cartilage [11]. New technique is introduced called Cartilage plug or butterfly cartilage tympanoplasty which is considered to be pioneered by Evaey in 1998.…”