gms | German Medical Science

77th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

24.05. - 28.05.2006, Mannheim

Cartilage Tympanoplasty

Meeting Abstract

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Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie. 77. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e.V.. Mannheim, 24.-28.05.2006. Düsseldorf, Köln: German Medical Science; 2006. Doc06hnod305

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Published: April 24, 2006

© 2006 Tos.
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Application of autogeneous cartilage, harvested from the concha or the tragus, for reconstruction of the eardrum has become increasingly popular and several new methods have been described. The methods applied today will be defined, classified, illustrated and discussed.

1) Palisade underlay- technique with small palisades (J.Heermann), placed in total perforation mostly in inferior-superior direction, the first palisade under the bony or fibrous annulus in the anterior part of the tympanic cavity, the last in the posterior. In total 5-8 palisades are used. Since 1995 we have applied this technique in sinus- and entire tensa retraction cholesteatomas in children with surprisingly good hearing results and better long term stability than in series reconstructed with fascia. The results were especially better in ears with poor tubal function.

2) Palisade underlay- technique with 3-4 broad palisades (M.Bernal-Sprekelsen).

3) Palisade on lay – technique in anterior, inferior, subtotal and total perforations. I have either removed, or elevated the squamous epithelium around the perforation and placed the palisades onto the edges of the perforation being soon covered with the epithelium.

4) Cartilage stripes underlay technique (A. Naumann) with thin stripes sectioned in an oblique manner from a tragal or conchal perichondrium-cartilage graft. In contrast to palisade technique, the stripes are positioned like roof tiles, slightly overlapping each other.

5) Cartilage stripes as on lay technique are in my experience especially suitable for closure of anterior, inferior, subtotal and total perforations.

6) Inlay butterfly cartilage technique (R.Eavey) creating a special round or oval graft from tragal cartilage. The graft is covered on both sites with perichondrium. It is shaped like a butterfly and is hanging on the edges of the perforation as on lay and as an underlay graft. This trans-canal technique is applied in small and medium sized perforations.

7) Cartilage follies or thin plates, (T. Zahnert, K-B Hüttenbrink)

8) cut by Kurz chondrotome are mostly placed as underlay grafts, but can be placed as overlay grafts as well. Thin follies can be placed on each other.

9) Compound perichondrium-cartilage island grafts are applied in various modifications at various locations:

a) Posterio-superior island graft in posterior retraction or perforation (R. E. Linde ; M. Glasscock).

b) Superior or attic island graft in attic retraction with resorbtion of the scutum and after atticotomi (D.E. McCleve)

c) Posterio-superior and attic graft (D.E.Poe and A.K. Gadre).

d) Total pars tensa island graft in entire tensa retraction, atalectasis, adhesive otitis media and total perforation with poor tubal function (P. Tolsdorff).

e) Thick cartilage plate placed onto the sourrending bone, covering the entire tympanic cavity (O. Kleinsasser, D. Glanschneider)

The island cartilage grafts are connected to the surroundings with perichondrium have better acoustic properties than thick cartilage plates placed onto the bone.

10) Compound perichondrium – U-shaped cartilage ring graft (V. Goodhill) placed onto the annulus in total perforations.

11) Cartilage shield T- tube tympanoplasty (L.G.Duckert), placing a large compound perichondrium- cartilage plate with a hole for the ventilating tube, as an underlay graft.

The various methods will be described, illustrated and discussed.