Original contributionPrimary cartilage tympanoplasty: our technique and results☆
Introduction
Temporalis fascia remains the most frequently used graft material with closure of the tympanic membrane in 70% to 90% of primary tympanoplasties in different hands. However, in some situations such as advanced middle ear pathology, retraction pockets, and atelectatic ears, temporalis fascia tends to undergo atrophy in the subsequent postoperative period regardless of placement techniques [1]. Our dissatisfaction with the temporalis fascia with a higher incidence of recurrent perforations compelled us to use a tougher material that would not only prevent reperforation but also prevent retractions. Cartilage has shown to be a promising graft material to close perforations in the tympanic membrane. Although it is similar to temporalis fascia, its more rigid quality tends to resist resorption, retraction, and reperforation, even in the milieu of continuous eustachian tube dysfunction [2].
Of the 23 well-defined cartilage tympanoplasty methods, Tos [3] has classified them into 6 groups:
- 1.
Underlay palisade method of Heermann
- 2.
Onlay palisade method
- 3.
Method of broad palisades
- 4.
Method of underlay stripes
- 5.
Method of onlay stripes
- 6.
Dornhoffer mosaic cartilage tympanoplasty
The tragal cartilage is yellow fibroelastic cartilage. The cartilage is a relatively avascular tissue. The presence of cartilage canals through which blood vessels may enter cartilage is well documented. Each canal contains a small artery surrounded by numerous venules and capillaries. Cartilage cells receive their nutrition by diffusions from vessels. Cartilage cells–chondrocytes lie in spaces (lacunae) present in matrix. Ground substance is made of complex molecules containing proteins and carbohydrates (proteoglycans). These molecules form a meshwork that is filled by water and dissolved salts. The carbohydrates are chemically glycosaminoglycans including chondroitin sulfate, keratan sulfate, and hyaluronic acid. The core protein is aggrecan. The proteoglycan molecules are tightly bound. Along with the water content, these molecules form a firm gel that gives cartilage its firm consistency [4].
This rigidity of the cartilage that prevents reperforations is, however, considered to interfere with the sound conduction properties of the tympanic membrane. We describe our innovative method for harvesting tragal cartilage from the same endaural incision and also describe the preparation of the graft by slicing it so as to obtain acoustic benefits.
Section snippets
Materials and methods
A retrospective study of type 1 cartilage tympanoplasties operated by both the authors in MIMER Medical College and Sushrut ENT Hospital from May 2005 to January 2008 was carried out.
Results
The data of the operated patients are tabulated in Table 1, Table 2, Table 3.
Discussion
It has been shown in both experimental and clinical studies that cartilage is well tolerated by middle ear, and long-term survival is the norm [5], [6], [7], [8]. The greatest advantage of the cartilage graft has been thought to be its very low metabolic rate. However, in addition, it can receive its nutrients by diffusion; it is very easy to work with because it is pliable and resists deformation from pressure variations and becomes well incorporated in the tympanic membrane [9]. Human and
Conclusion
Our technique of type 1 cartilage tympanoplasty gives good anatomic and functional results. The highlight of our technique is the harvesting of the graft via the same endaural incision. By slicing the cartilage, desired acoustic benefit is obtained. We recommend using sliced cartilage as a first choice for tympanic membrane reconstruction.
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Rates of success in hearing and grafting in the perichondrium-preserved palisade island graft technique
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Intraoperative tragal and conchal cartilage thickness: Comparative study for cartilage tympanoplasty
2020, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryCitation Excerpt :Soft tissue dissection was done and a block of tragal cartilage leaving the inferior part was harvested (Fig. 1). Perichondrium was pulled away from both sides leaving one cartilage and two perichondrium grafts [9]. For harvesting the conchal cartilage, the technique involved using the post auricular surgical incision to minimize visible scar.
Pinna stay suture in two handed endoscopic ear surgery: Our experience
2020, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryCitation Excerpt :A desired size of approximately 15 × 15 mm of the tragus is harvested. The cartilage graft is then sliced with Slice!t (Dr. Khan's Creations, India) with the metallic plates 0.1 mm, 0.2 mm, 0.3 mm or 0.5 mm to get respective desired thickness sliced graft [6–12]. The transcanal incision is taken.
Our Experience of Comparison of Hearing Outcomes in Patients Undergoing Type-1 Tympanoplasty with Different Graft Materials
2024, Indian Journal of Otolaryngology and Head and Neck SurgeryTo Study the Outcome of Cartilage Tympanoplasty Type I in Patients with Medium and Large Perforations Using 0.5 mm Sliced Conchal Cartilage Reinforced with Temporalis Fascia Grafts with 5 Years Follow-up
2024, Indian Journal of Otolaryngology and Head and Neck Surgery
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This study was not financially supported by external sources.