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A simple technique to close subtotal perforations of the tympanic membrane Sylvester Valentine Fernandes
BSc(Hons),MB,BS,MCPS,FRCSEd,FRACS,FACS,LLB
Senior Surgeon & Senior Clinical Lecturer
Newcastle University, Australia
Email: mdsfe@yahoo.com.au
Temporalis fascia technique Disadvantages
Lifting of tympanomeatal flap
Bleeding may impair visualisation
Flap tears may occur
Packing may cause displacement of graft, unbeknown to surgeon Postoperative care
Not suitable for very young children
Composite graft Advantages
Available very locally
Minimal non visible scar
Has all the advantages of temporalis graft
Cartilage easy to handle, provides firm scaffolding and resistance from infection
Good fixation ensured
Occurrence of retraction pockets and chances of recurrent perforation reduced
No packing
Postoperative care minimal
Both ears can be done at the same time
CRITERIA
Small to medium sized perforation (maximum one-half of tympanic membrane)
Nonmarginal perforation with clear view of margins
Dry ear and no granular myringitis
Conductive loss no greater than 35dB in any frequency
Atleast 12 months of clinical observation for non healing
Typical perforation
Tragal cartilage – Donor site
Circumperipheral separation of perichondrium from cartilage
In larger perforations use reflected perichondrim from other side
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