Medio-lateral graft tympanoplasty for anterior or subtotal tympanic membrane perforation: An update

Abstract

Objective: The purpose of this study is to describe and evaluate the medio-lateral graft tympanoplasty for the reconstruction of anterior or subtotal tympanic membrane (TM) perforation. Study design and setting: This is a retrospective study of 100 patients who underwent the medio-lateral graft tympanoplasty at both community and tertiary care center from 1995 to 2001. Posterior tympanomeatal flap is elevated same as in the medial (underlay) graft tympanoplasty. Anterior-medial canal skin is elevated down to the annulus. At the annulus only squamous epithelial layer of TM is elevated up to anterior half of the TM perforation. Temporalis fascia is grafted medial to posterior half of the perforation and lateral (overlay) to anterior half of the de-epithelialized TM perforation up to the annulus. Anterior canal skin is rotated to cover the fascia graft and TM perforation as a second layer closure. Patients were followed for at least 6 months. Outcome was considered successful if TM is intact. Results: There were three failures (97% success rate) due to a postoperative infection, anterior blunting, and recurrent cholesteatoma. Conclusion and significance: The medio-lateral graft method is superior to the traditional medial or lateral graft technique for the reconstruction of large anterior or subtotal TM perforation. This new method should help otologic surgeons to improve outcome of tympanoplasty for anterior or total TM perforation.