Endoscopic butterfly inlay myringoplasty: new technique extended perichondrium butterfly

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

“…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).…”

“…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). However, no de-epithelialization of the drum remnant and annulus was performed in the present technique, presumably consequent to epithelium being ''buried'' by the lateral perichondrial graft component.…”