Double Medial and Lateral Graft in Myringoplasty

Excising or preserving perforation margins in endoscopic transtympanic cartilage myringoplasty does not affect surgical success

“…If edges are not removed, the primary concern is the risk of iatrogenic cholesteatoma and epithelial pearls. Theoretically, the underlay cartilage and perichondrium serve as a barrier preventing ingrowth of squamous epithelium, and Johnson et al 20 found that closure of the fibrous layer prevented epidermal accumulation in the middle ear, but iatrogenic cholesteatomas and epithelial pearls can occur even in edges that have been refreshed, 21–23 and so this risk may be independent of whether the rim is excised or preserved. Although squamous epithelial ingrowth at the inner surface appears to be a common histological finding, not all such ingrowths progress to clinical cholesteatoma 5 .…”

Transcanal Endoscopic Cartilage and Perichondrium Graft Myringoplasty for Large Tympanic Membrane Perforations

“…These double-layer graft techniques required elevation of the tympanomeatal flap (3,4,7). Our technique is similar to that described by Ahmed et al (10), who did not perform elevation of the tympanomeatal flap.…”

“…For the over-under tympanoplasty, the single-layer graft is placed over the malleus and under the annulus (6). Some double-layer graft techniques have been introduced to strengthen the graft in recent years (3,4,7). However, tympanomeatal flap elevation is inevitable for these approaches.…”

“…A major concern with our technique is iatrogenic keratin pearls and cholesteatoma as we drape perichondrium over keratinizing epithelial remnant tympanic membrane and EAC. In the cartilage butterfly or inlay myringoplasty, overlap of !1 mm is present between cartilage or perichondrium and the perforation edges of the TM remant (9,(13)(14)(15)(16); in previous chondroperichondrial clip or double-layer graft technique, the lateral grafting was laid over the TM remnant (3,4,7,10). Neither cholesteatoma nor epithelial pearl formation has yet been reported following these technique; nevertheless, any remnant drum or portions of the annulus to be ''covered'' by graft are de-epithelialized beforehand (3,4,9,10,(13)(14)(15)(16).…”

Endoscopic Suspended Cartilage Myringoplasty for the Repair of Central Tympanic Membrane Perforation

“…19 Some authors have described a double layer graft technique in recent years. 1,9,10 In Nemade et al’s technique, 1 the temporalis fascia graft is underlaid medial to the handle of the malleus, and the areolar fascia graft is overlaid lateral to the handle of the malleus and the fibrous layer of the tympanic membrane. In Bedri et al’s technique, 9 the cartilage island grafts or the perichondrium single layer are placed over the manubrium and under the fibrous layer of the remnant of the tympanic membrane.…”