Abstract
Objective: 1) Describe the technique of grafting total and near-total tympanic membrane perforations using underlay temporalis- fascia graft augmented by split-thickness skin graft from the ear lobule. 2) Evaluate the procedure in terms of graft take, hearing outcomes, and complications.
Method: This clinical study was conducted on 91 patients (93 perforations) having total (6) or near-total (87) tympanic-membrane perforation from January 2005 till December 2010 in a teaching university hospital. Myringoplasty utilizing temporalis-fascia graft underlay supported externally by split-thickness lobular-skin graft. Graft take, early and late PTA changes, and complications were evaluated.
Results: Graft take was achieved in 86 out of 93 operations (92%), with 7 cases of graft failure (8%). PTA improvement was 16.3 dB at 3-month postoperative versus 15.5 dB at 1 year. Other complications noticed were prolonged graft swelling with discharge (3 cases), 2 of them ended by graft breakdown and the third improved. Bleeding from the jugular bulb during abrasion of middle-ear floor mucosa occurred twice, and in one of them bleeding stopped with surgicel. In the other extraluminal packing of the sigmoid sinus was necessary. The procedure was completed. No blunting or donor site complications were noticed.
Conclusion: Large TM perforations can be managed successfully by underlay temporalis-fascia graft supported externally by STSG from the ear lobule laid in part over the deep meatal skin and in the other part over the graft. One can expect >90% graft take, >15 dB PTA improvement, and a limited number of complications.
Get full access to this article
View all access options for this article.