Cartilage reinforcement graft versus fascia graft in tympanoplasty*

Abstract

IntroductionThe main aim of successful tympanoplasty is to create a well aerated closed cavity after total removal of the disease. Numerous types of grafting materials have been used for closure of the tympanic membrane including fascia, periosteum, perichondrium, cartilage, vein, skin, and fat tissue (1-4). Autografts are thought to be the most compatible grafting materials with the best surgical results in tympanoplasty. Temporalis muscle fascia (TMF) is the most popular one with the ease of obtainment and the satisfactory functional and anatomical results. TMF has been used in nearly 90% of surgeries (5). Cartilage as a grafting material was popularized by Utech in the 1950s (6). It is a stable and stiff barrier when compared to fascia, particularly in atelectatic ears or eustachian tube dysfunction. Initial studies showed that cartilage is an appropriate material for grafting after cholesteatoma removal or large defects in scutum. On the other hand, the hearing results were not favorable in the preliminary reports.In this study we aimed to compare TMF and cartilage as grafting materials focusing on the hearing and anatomical outcomes in different pathologies. Materials and methods Patient population and study designA retrospective chart review was conducted for patients who had undergone tympanoplasty with/ without ossiculoplasty and/or mastoidectomy at Ankara University Otolaryngology Department from November 2006 through September 2013 with a minimum follow-up period of 6 months.The patients were divided into two main groups: grafted with TMF alone (fascia group) and TMF reinforced with cartilage (cartilage group). In the cartilage group, conchal, tragal, or cymbal cartilage was used with underlay technique together with the TMF as a part of reinforcement technique as stated by Sarac ( 7). An elliptic cartilage graft was harvested from the concha, tragus, or cymba with a thickness of 1-3 mm and a diameter of 1 × 1 Background/aim: The purpose of this study was to compare cartilage reinforcement graft results with temporalis fascia graft alone in terms of hearing and anatomical outcomes in tympanoplasty. Materials and methods:Patients who underwent tympanoplasty with/without ossiculoplasty and/or mastoidectomy at a university hospital from 2006 through 2013 were reviewed retrospectively. The patients were divided into those grafted with temporalis muscle fascia alone and with fascia reinforced with cartilage. The postoperative air bone gap, gain in hearing thresholds, and graft status were evaluated for each group. Results:The study subjects included 179 patients. There were 82 patients in the fascia group and 97 patients in the cartilage group. Successful hearing results were elicited in 79.2% of the fascia group and 85.5% of the cartilage group. There was no significant difference in overall graft success. The graft was intact in 82.9% of the fascia group and 86.5% of the cartilage group. Conclusion:In this comparative study the use of cartilage to reinforce the temporalis muscle fascia was analyzed, showin...