Comparative study of sliced tragal cartilage and temporalis fascia in type I tympanoplasty

Khan, Mubarak Muhamed; Parab, Sapna Ramkrishna

doi:10.1017/s0022215114003132

Cited by 49 publications

(41 citation statements)

References 16 publications

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“…In another study, Jiang et al reported significantly better anatomical results with cartilage graft (11). Similar results were published about anatomical outcomes by numerous researchers (12)(13)(14)(15).…”

Section: Discussionsupporting

confidence: 69%

Cartilage reinforcement graft versus fascia graft in tympanoplasty*

Ocak¹,

Beton²,

Taş³

et al. 2017

Turk J Med Sci

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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...

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Section: Discussionsupporting

confidence: 69%

Cartilage reinforcement graft versus fascia graft in tympanoplasty*

Ocak¹,

Beton²,

Taş³

et al. 2017

Turk J Med Sci

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“…Khan et al [14] included patients with both “small” and “large” perforations and is by far the largest study, with 390 total patients reported. Kazikdas et al [12], Sishegar et al [15] and Demirpehlivan et al [16] only included subtotal perforations, with the defect being described as more than 50% of the area of the whole tympanic membrane.…”

Section: Resultsmentioning

confidence: 99%

“…First, with the exception of the study by Khan et al [14], which reported on 223 patients, the remaining studies had small cohorts of twenty three to thirty patients in the palisade group. These studies represented the results of single surgeons.…”

Section: Discussionmentioning

confidence: 99%

The palisade cartilage tympanoplasty technique: A systematic review and meta-analysis

Jeffery

Shillington

Andrews

et al. 2017

Journal of Otolaryngology - Head & Neck Surgery

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BackgroundTympanoplasty is a common procedure performed by Otolaryngologists. Many types of autologous grafts have been used with variations of techniques with varying results. This is the first systematic review of the literature and meta-analysis with the aim to evaluate the effectiveness of one of the techniques which is gaining popularity, the palisade cartilage tympanoplasty. PubMed, EMBASE, and Cochrane databases were searched for "palisade", “cartilage”, “tympanoplasty”, "perforation" and their synonyms.Main body of abstractIn total, 199 articles reporting results of palisade cartilage tympanoplasty were identified. Five articles satisfied the following inclusion criteria: adult patients, minimum 6 months follow-up, hearing and surgical outcomes reported. Studies with patients undergoing combined mastoidectomy, ossicular chain reconstruction, and/or other middle ear surgery were excluded. Perforation closure, rate of complications, and post-operative pure-tone average change were extracted for pooled analysis. Study failure and complication proportions that were used to generate odds ratios were pooled. Fixed effects and random effects weightings were generated. The resulting pooled odds ratios are reported. Palisade cartilage tympanoplasty has an overall take rate of 96% at beyond 6 months and has similar odds of complications compared to temporalis fascia (OR 0.89, 95% CI 0.62, 1.30). The air-bone gap closure is statistically similar to reported results from temporalis fascia tympanoplasty.ConclusionsCartilage palisade tympanoplasty offers excellent graft take rates and good postoperative hearing outcomes for perforations of various sizes and for both primary and revision cases. This technique has predictable, long-term results with low complication rates, similar to temporalis fascia tympanoplasty.

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“…Autogenous grafts of temporalis fascia are frequently used for ophthalmological, maxillofacial, or otorhinolaryngological procedures, such as orbit and eyelid reconstructions following complex traumas or malignancy,10,11 tympanoplasty,12 nasal septal perforation,13,14 or cerebrospinal fluid leak repair 15. Fascia sampled from other sites, such as fascia lata, are also often employed for eyelid surgery 16–18.…”

Section: Discussionmentioning

confidence: 99%

Argus II retinal prosthesis implantation with scleral flap and autogenous temporalis fascia as alternative patch graft material: a 4-year follow-up

Matet¹,

Amar²,

Mohand‐Saïd³

et al. 2016

OPTH

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IntroductionThe Argus II retinal prosthesis is composed of an epiretinal electrode array positioned over the macula and connected to an extrascleral electronics case via a silicone cable, running through a sclerotomy. During implantation, the manufacturer recommends to cover the sclerotomy site with a patch of processed human pericardium to prevent postoperative hypotony and conjunctival erosion by the underlying electronics case. Due to biomedical regulations prohibiting the use of this material in France, we developed an alternative technique combining a scleral flap protecting the sclerotomy and an autogenous graft of superior temporalis fascia overlying the electronics case.MethodsThe purpose of this study is to describe the 4-year outcomes of this modified procedure in three subjects who underwent Argus II Retinal Prosthesis System implantation. Clinical data consisting of intraocular pressure measurements and tolerance in terms of conjunctival erosion or inflammation were retrospectively assessed over a 4-year postoperative follow-up.ResultsNone of the three patients implanted with the modified technique developed ocular hypotony over 4 years. A normal, transient conjunctival inflammation occurred during the first postoperative month but conjunctival erosion was not observed in any of the three patients over 4 years. Four years after implantation, the autogenous temporalis fascia graft remained well tolerated and the retinal prosthesis was functional in all three patients.ConclusionThe combination of an autograft of superficial temporalis fascia and a scleral flap efficiently prevented leakage through the sclerotomy site, ocular hypotony, and conjunctival erosion by the extrascleral electronics case. This modified technique is suitable for the implantation of existing and forthcoming retinal prostheses. Superficial temporalis fascia may also be used as alternative to commercial tectonic tissues for scleral wound repair in clinical settings where they are not available.

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Comparative study of sliced tragal cartilage and temporalis fascia in type I tympanoplasty

Abstract: The overall success rate for primary cartilage tympanoplasty is higher when using sliced cartilage than with temporalis fascia grafting.

Cited by 49 publications

References 16 publications

Cartilage reinforcement graft versus fascia graft in tympanoplasty*

Cartilage reinforcement graft versus fascia graft in tympanoplasty*

The palisade cartilage tympanoplasty technique: A systematic review and meta-analysis

Argus II retinal prosthesis implantation with scleral flap and autogenous temporalis fascia as alternative patch graft material: a 4-year follow-up

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