Hostname: page-component-76fb5796d-qxdb6 Total loading time: 0 Render date: 2024-04-26T16:12:39.431Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  11 June 2018

A A Kolethekkat ,
R Al Abri ,
K Al Zaabi ,
N Al Marhoobi ,
S Jose ,
S Pillai  and
J Mathew
A A Kolethekkat*
Affiliation:
ENT Division, Department of Surgery, Sultan Qaboos University Hospital, Al Khoud, Oman
R Al Abri
Affiliation:
ENT Division, Department of Surgery, Sultan Qaboos University Hospital, Al Khoud, Oman
K Al Zaabi
Affiliation:
ENT Specialty, Oman Medical Specialty Board, Oman
N Al Marhoobi
Affiliation:
ENT Specialty, Oman Medical Specialty Board, Oman
S Jose
Affiliation:
Department of Statistics, Oman Medical Specialty Board, Oman
S Pillai
Affiliation:
ENT Division, Department of Surgery, Sultan Qaboos University Hospital, Al Khoud, Oman
J Mathew
Affiliation:
ENT Division, Department of Surgery, Sultan Qaboos University Hospital, Al Khoud, Oman
*
Address for correspondence: Dr Arif Ali Kolethekkat, ENT Division, Department of Surgery, Sultan Qaboos University Hospital, PC 123, PO Box 38, Al Khoud, Sultanate of Oman E-mail: arifkolethekkat@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

To validate a newly introduced cartilage rim augmented temporalis fascia tympanoplasty technique by statistically comparing it with the morphological and audiological outcomes of traditional temporalis fascia tympanoplasty.

Methods

A retrospective comparative study was conducted on 115 patients who underwent tympanoplasty during 2013 and 2015. Fifty-eight patients underwent temporalis fascia tympanoplasty and 57 underwent cartilage rim augmented fascia tympanoplasty.

Results

In the cartilage fascia group, graft healing was achieved in 94.7 per cent of cases; in the temporalis fascia group, the graft take-up rate was 70 per cent. In those with a normal ossicular chain, the post-operative air–bone gap was within 20 dB in 92.6 per cent of cartilage fascia group cases and in 69.7 per cent of the temporalis fascia group cases, which was a statistically significant difference. Among the defective ossicular chain cases, the post-operative air–bone gap was within 20 dB in 76.9 per cent in the cartilage fascia group, as against 57.1 per cent in the temporalis fascia group.

Conclusion

Cartilage rim augmented temporalis fascia tympanoplasty has a definite advantage over the temporalis fascia technique in terms of superior graft take up and statistically significant hearing gain in those with normal ossicular mobility.

Keywords

CartilageFasciaTympanoplasty
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 6 , June 2018 , pp. 497 - 504
Copyright
Copyright © JLO (1984) Limited, 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr A A Kolethekkat takes responsibility for the integrity of the content of the paper

References

1Kazikdas, KC, Onal, K, Boyraz, I, Karabulut, E. Palisade cartilage tympanoplasty for management of subtotal perforations: a comparison with the temporalis fascia technique. Eur Arch Otorhinolaryngol 2007;264:985–9Google Scholar
2Wullstein, HL. Functional operations in the middle ear with split thickness skin graft. Arch Otorhinolaryngol 1952;161:422–35Google Scholar
3Zoellner, F. The principles of plastic surgery of the sound conducting apparatus. J Laryngol Otol 1955;69:567–9Google Scholar
4Dermirpehlivan, IK, Onal, K, Arslanoglu, S, Songu, M, Ciger, E, Can, N. Comparison of different tympanic membrane reconstruction techniques in type I tympanoplasty. Eur Arch Otorhinolaryngol 2011;268:471–4Google Scholar
5Kulkarni, S, Kulkarni, V, Burse, K, Sancheti, V, Roy, G. Cartilage support for fascia graft in type I tympanoplasty. Indian J Otolaryngol Head Neck Surg 2014;66:291–6Google Scholar
6Mohamad, SH, Khan, I, Hussain, SS. Is cartilage tympanoplasty more effective than facia tympanoplasty? A systematic review. Otol Neurotol 2012;33:699–705Google Scholar
7Onal, K, Uguz, MZ, Kazidas, KC. A multivariate analysis of ontological, surgical and patient-related factors in determining success in myringoplasty. Clin Otolaryngol 2005;30:115–20Google Scholar
8Uguz, MZ, Onal, K, Kazidas, KC, Onal, A. The influence of smoking on success of tympanoplasty measured by serum cotinine analysis. Eur Arch Otorhinolaryngol 2008;256:513–16CrossRefGoogle Scholar
9Murbe, D, Zahnert, T, Bornitz, M, Huttenbrink, KB. Acoustic properties of different cartilage reconstruction techniques of the tympanic membrane. Laryngoscope 2002;112:1769–76CrossRefGoogle ScholarPubMed
10Tek, A, Karaman, M, Uslu, C, Habesoglu, T, Kilicarslan, Y, Durmus, R et al. Audiological and graft take results of cartilage reinforcement tympanoplasty (a new technique) versus fascia. Eur Arch Otorhinolaryngol 2012;269:1117–26Google Scholar
11Salen, B. Myringoplasty using septum cartilage. Acta Otolaryngol 1963;188:82–93Google Scholar
12Amedee, RG, Mann, WJ, Eiechelmann, H. Cartilage palisade tympanoplasty. Am J Otol 1989;10:447–50Google Scholar
13Milewski, C. Composite graft tympanoplasty in the treatment of ears with advanced middle ear pathology. Laryngoscope 1993;103:1352–6Google Scholar
14Dornhoffer, J. Cartilage tympanoplasty: indications, techniques, and outcomes in a 1000 patient series. Laryngoscope 2003;113:1844–56CrossRefGoogle Scholar
15Goodhill, V. Tragal perichondrium and cartilage in tympanoplasty. Arch Otolaryngol 1967;85:480–91Google Scholar
16Aidonis, I, Robertson, TC, Sismanis, A. Cartilage shield tympanoplasty: a reliable technique. Otol Neurotol 2005;26:838–41Google Scholar
17Arriage, MA. Cartilage tympanoplasty: classifications of methods-techniques-results. Otol Neurotol 2010;31:861–1012Google Scholar
18Poe, DS, Gadre, AK. Cartilage tympanoplasty for management of retraction pocket and cholesteatomas. Laryngoscope 1993;103:614–18CrossRefGoogle ScholarPubMed
19Gerber, MJ, Mason, JC, Lampert, PR. Hearing results after primary cartilage tympanoplasty. Laryngoscope 2000;110:1994–9CrossRefGoogle ScholarPubMed
20Dornhoffer, JL. Hearing results with cartilage tympanoplasty. Laryngoscope 1997;107:1094–9Google Scholar
21Mundra, RK, Sinha, R, Agarwal, R. Tympanoplasty in subtotal perforation with graft supported by a slice of cartilage: a study with near 100% results. Indian J Otolaryngol Head Neck Surg 2013;65:631–5CrossRefGoogle ScholarPubMed
22American Academy of Otolaryngology–Head and Neck Surgery Foundation. Committee on Hearing and Equilibrium guidelines for the evaluation of results of treatment of conductive hearing loss. Otolaryngol Head Neck Surg 1995;113:186–7Google Scholar
23Altuna, X, Navarro, JJ, Martinez, Z, Lobato, R, Algaba, J. Island cartilage myringoplasty. Anatomical and functional results in 122 cases [in Spanish]. Acta Otorhinolaryngol Esp 2010;61:100–5CrossRefGoogle ScholarPubMed
24Gierek, T, Slaska, KA, Majzel, K, Klimczak, GL. Results of myringoplasty and type I tympanoplasty with the use of fascia, cartilage and perichondrium grafts [in Polish]. Otolaryngol Pol 2004;58:529–33Google ScholarPubMed
25Nichlani, SS, Jagade, MV, Ganeshan, A. Reconstruction of the tympanic membrane with partial tragal cartilage graft versus temporalis fascia graft. Bombay Hosp J 2010;52:197–201Google Scholar
26Tos, M. Cartilage tympanoplasty methods: proposal for a classification. Otolaryngol Head Neck Surg 2008;139:747–58CrossRefGoogle ScholarPubMed
27Yung, M. Cartilage tympanoplasty: literature review. J Laryngol Otol 2008;122:663–72Google Scholar
28Duckert, LG, Muller, J, Makielski, KH, Helms, J. Composite autograft shield reconstruction of remnant tympanic membranes. Am J Otol 1995;16:21–6Google ScholarPubMed
29Spielmann, P, Mills, R. Surgical management of retraction pockets of the pars tensa with cartilage and perichondrial grafts. J Laryngol Otol 2006;120:725–9Google Scholar
30Shin, SH, Lee, WS, Kim, HN, Lee, HK. Wheel-shaped cartilage-perichondrium composite graft for the prevention of retraction pocket development. Acta Otolaryngol 2007;127:25–8Google Scholar
31Eavey, RD. Inlay tympanoplasty: cartilage butterfly technique. Laryngoscope 1998;108:657–61Google Scholar
32Yung, M, Vivekanandan, S, Smith, P. Randomized study comparing fascia and cartilage grafts in myringoplasty. Ann Otol Rhinol Laryngol 2011;120:535–41Google Scholar
33Mauri, M, Neto, JF, Fichs, SC. Evaluation of inlay butterfly cartilage tympanoplasty: a randomised clinical trial. Laryngoscope 2001;111:1479–85Google Scholar
34Cabra, J, Moñux, A. Efficacy of cartilage palisade tympanoplasty: randomized controlled trial. Otol Neurotol 2010;31:589–95Google Scholar
35Onal, K, Arslanoglu, S, Oncel, S, Songu, M, Kopar, A, Demiray, U. Perichondrium/cartilage island flap and temporalis muscle fascia in type I tympanoplasty. J Otolaryngol Head Neck Surg 2011;40:295–9Google Scholar
36Ozbek, C, Ciftçi, O, Tuna, EE, Yazkan, O, Ozdem, C. A comparison of cartilage palisades and fascia in type 1 tympanoplasty in children: anatomic and functional results. Otol Neurotol 2008;29:679–83CrossRefGoogle ScholarPubMed
37Couloigner, V, Baculard, F, El Bakkouri, W, Viala, P, François, M, Narcy, P et al. Inlay butterfly cartilage tympanoplasty in children. Otol Neurotol 2005;26:247–51Google Scholar
38Albirmawy, OA. Comparison between cartilage-perichondrium composite ring graft and temporalis fascia in type one tympanoplasty in children. J Laryngol Otol 2010;124:967–74Google Scholar
39Wen, YH, Hsu, LP, Chen, PR, Lee, CF. Design optimization of cartilage myringoplasty using finite element analysis. Tzu Chi Med J 2006;18:370–7Google Scholar
40Zahnert, T, Huttenbrink, KB, Murbe, D, Bornitz, M. Experimental investigations of the use of cartilage in tympanic membrane reconstruction. Am J Otol 2000;21:322–8Google Scholar