Cartilage-perichondrium Composite Graft Research Articles

New Cartilage Slicer for Slicing Techniques in Tympanoplasty: Design and Applications.

Cartilage-perichondrium composite graft is used in middle ear surgery for tympanic membrane, ossicular and for soft wall reconstruction. The thickness of the cartilage is thought to interfere with the sound conduction. In our otology practice for tympanic membrane reconstruction, we prefer the sliced cartilage graft to achieve acoustic benefit. At times in the process of slicing, the cartilage gets wasted if not sliced with a precision slicing instrument. We have designed and developed a multi-purpose cartilage slicer for precise reduction of the thickness of the cartilage. To describe the design of our cartilage slicer and to report our preliminary experience with the cartilage slicer. Descriptive study. The technique of slicing with our new cartilage slicer and its usage has been described in detail. A total number of 689 cartilages in tympanoplasty and mastoidectomy have been sliced with it from 2013 to 2017. Our study reports the technique of slicing the tragal cartilage for tympanoplasty, highlighting its advantages and precision of the cartilages slices obtained. Our cartilage slicer is a good option for cartilage slicing in tympanoplasty. Level 4.

The Prevention of Recurrent Cholesteatoma in CWU Surgery: The Use of Titanium Sheeting.

Assessment of the outcomes of a technique of prevention of recurrent cholesteatoma in canal wall up (CWU) mastoidectomy, using titanium sheeting to repair the external auditory canal wall. Sixty four cholesteatoma cases were managed during a period from 2007 to 2015. The cases were unselected; the surgery was performed by the senior author. Cholesteatoma Patterns Were: Forty two attic, nine pars tensa, seven combined attic-pars tensa, three congenital, and three other. Primary surgery was undertaken in 33 cases. All cases underwent CWU surgery that employed canal wall repair using fine titanium sheeting combined with overlying organic material to repair canal wall defects. Drum repairs employed cymba conchae cartilage-perichondrium composite grafts. Chain reconstruction used Spanner struts or Grace Alto PORPs or TORPS. Two cases suffered mesotympanic residual disease, and three, mesotympanic recurrence one of which extended into the attic. Two other cases incurred atticomastoid residues. Transient myringitis occurred in three cases. The surgery was judged on its ability to avoid atticomastoid recurrence, and was regarded as highly successful. The titanium sheeting offers a relatively simple but effective technique. The mesotympanic complications are those also commonly found in both CWD and other CWU methods. As in other CWU procedures, the problems of the open cavity were avoided.

Cartilage Myringoplasty: An Ideal Grafting Technique for Complex Perforations.

Tympanoplasty is one of routinely performed surgeries in ENT practice. Using cartilage-perichondrium composite graft in selective cases gives better outcome. To study the outcome and feasibility of cartilage-perichondrium composite graft in repair of complex tympanic membrane perforations. This cross-sectional, intervention study was conducted at SSIMS and RC, Tertiary Care Teaching Hospital, Davangere, Karnataka, Southern India. Study sample consisted of 30 patients with chronic otitis media- tubo tympanic type in inactive stage. Patients were randomly selected and evaluated between January 2015 to June 2016. A detailed history, clinical examination, diagnostic nasal endoscopy, otoendoscopy were done for all patients preoperatively and postoperatively at three weeks, three months and six months. Audiological evaluation was done at six months postsurgery. Cartilage-perichondrium composite graft from tragal and conchal cartilage was used for the repair of tympanic membrane in all the cases. The data were presented in proportions, percentages. Of 30 cases who underwent surgery, 24 patients (80%) had large central and subtotal perforations. Only one patient had a total perforation. The remnant tympanic membrane showed atrophic changes in 16 cases (53%) and sclerotic plaque was seen in 14 cases (46%). In our study, tragal cartilage was used in 17 and conchal cartilage in 13 cases. All the patients underwent type-1 tympanoplasty. Successful graft uptake was seen in 28 cases (93%) by six months. Two patients (7%) had a residual perforation at three months and in four cases (13%), the neotympanum showed anterior blunting by the end of six months. With respect to hearing, maximum air bone gap closure achieved in our study was 21db in one patient and minimum was 3db. Average air bone gap closure achieved was 10.1db. Cartilage-perichondrium composite graft can be considered a good choice in repair of tympanic membrane perforations with specific selective indications.

Is cartilage- perichondrium composite graft tympanoplasty the ideal treatment for revision tympanoplasty

<p class="abstract"><strong>Background:</strong> The objective of the study was <span lang="EN-IN">to evaluate the anatomical and audiological outcomes of cartilage-perichondrium composite graft tympanoplasty by underlay technique in revision tympanoplasties. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A series of 55 patients who underwent revision tympanoplasty with cartilage-perichondrium composite Island graft, at the department of Otorhinolaryngology, Harsh ENT Hospital, Ghaziabad. Tympanoplasty with cartilage-perichondrium composite island graft was done using underlay technique after slicing the cartilage with help of slicer. Ossiculoplasty was performed as and when needed. </span></p><p class="abstract"><strong>Results:</strong> Graft uptake rate was found to be 96.36% (53 of the 55 cases) in our study without any serious complications. Audiological outcomes with closure of 94.55% air bone gap within 0 to 30 dB was achieved (p <0.05)<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Nearly 97% success rate can be achieved with cartilage-perichondrium composite graft tympanoplasty for Revision tympanoplasty<span lang="EN-IN">.</span></p>

Evaluation of the anatomical and auditory outcomes of minimally invasive cartilage myringoplasty: Our technique and experience

The purpose of this study was to assess closure rates in tympanic membrane perforations of various dimensions using the tragal cartilage-perichondrium composite graft and its effect on hearing values and also to present our own experiences. Materials and methodsSixty-one patients presenting to our clinic in 2014–2015 and diagnosed with tympanic membrane perforation were included in the study. Otomicroscopic and otoendoscopic examinations were performed preoperatively and at the 12th month postoperatively. Patients were divided into three groups depending on perforation diameter. Pure tone audiometry was performed at 500, 1000, 2000, and 4000Hz (Hz) preoperatively and at the 12th month postoperatively, air-bone values were recorded, and air-bone gap (ABG) was calculated. Surgery was performed under local anesthesia usıng the transcanal, push-through (transperforation) technique. Perichondrium supported by thinned cartilage graft obtained from the tragal cartilage was used for tympanic membrane repair. ResultsGraft acceptance levels after 12months in small, medium, and large perforations were 100%, 93.5%, and 93.75%, respectively, and 95% on average. Preoperative air-bone gap values were 18.64±9.63 decibel (dB), 22.51±9.66dB, and 28.43±11.36dB, respectively, and 23.18±11.36dB on average, while 12th month postoperative air-bone gap values were 9.14±8.27dB, 11.25±6.73dB, and 17.37±9.22dB, respectively, and 12.37±8.28dB on average. The difference between pre- and postoperative 12th month air-bone gap values was statistically significant (p<0.005). ConclusionThe use of thinned cartilage-supported perichondrial grafts in patients with all sizes of tympanic membrane perforation is safe and effective in terms of both anatomical healing and restoration of hearing and can represent a first-choice technique that is easy to perform and involves minimal morbidity.

Three Autologous Substitutes for Myringoplasty

Evaluation of 3 different kinds of autologous substitutes for simple myringoplasty. Retrospective review of myringoplasty cases. A total of 117 patients (52 women with 52 ears and 65 men with 65 ears) with an average age of 25.6 years (range, 12-51 yr) were examined. Forty-two cases exhibited large perforations, and 75 exhibited small perforations. Myringoplasty with temporal fascia, tragus perichondrium, or tragus cartilage-perichondrium composite grafts were randomly used in this comparative study. All the 117 operations were performed by a single surgeon. Otoscopic findings as assessed by a hearing examination using a quad-frequency pure-tone average air-bone gap. Recurrent defects were not observed in the small perforation group repaired with autologous substitutes. The graft acceptance rate in this group was 100%. For the large perforation group, the graft acceptance rate was highest with the cartilage-perichondrium composite grafts group (p < 0.05) 1 year after the operation. Tympanic membranes repaired with temporalis fascia or perichondrium eventually perforated again or seemed invaginated and adherent. Early hearing improvements in the temporalis fascia and perichondrium groups were better than that of cartilage-perichondrium composite grafts, but there was no significant difference 1 year after surgery. Temporal fascia, tragus perichondrium, and tragus cartilage-perichondrium composite grafts are all suitable for myringoplasty after a minor tympanic membrane perforation. However, cartilage-perichondrium composite graft material for myringoplasty has superior long-term benefits in regard to both hearing improvements and tympanic membrane morphology, which are especially evident in cases with large perforations.

Results of Revision Tympanoplasty for Chronic Non‐cholesteatomatous Otitis Media

Objective: Evaluate the success rate for revision tympanoplasty using different graft materials, to compare results of primary and retympanoplasty using the same technique, and to analyze the effect of potential influencing factors on closure of tympanic membrane (TM) and hearing outcome. Method: Patients who underwent tympanoplasty (n = 617) or re-tympanoplasty (n = 94) for chronic otitis media without cholesteatoma. The different data were analyzed. The temporal fascia, perichondrium, and cartilage-perichondrium composite grafts were used. Ossiculoplasty was performed as needed. The interrelation between preoperative parameters, postoperative morphological outcomes, and functional outcomes was analyzed. Results: Successful closure rates of the TM perforation were 93.6% and 90.2% in the primary and revision tympanoplasty groups. Graft take rate and hearing results did not depend on graft material. Structural changes were found more frequently in the re-tympanoplasty group (63.4%, compared with 29.5% of primary cases). Ossiculoplasty was performed more often in revision cases (24.4%, compared with 11.4% of primary cases). Successful hearing (ABG within 20 dB) for primary tympanoplasties was achieved in 81.1% and for re-tympanoplasty in 69.5% ( P &lt; .01). There were no interrelation between any estimated parameters and the graft take rate for either primary or revision tympanoplasty. Conclusion: Patients who underwent tympanoplasty (n = 617) or re-tympanoplasty (n = 94) for chronic otitis media without cholesteatoma. Different data were analyzed. The temporal fascia, perichondrium, and cartilage-perichondrium composite grafts were used. Ossiculoplasty was performed as needed. The interrelation between preoperative parameters, postoperative morphological outcomes, and functional outcomes was analyzed.

Results of revision tympanoplasty for chronic non-cholesteatomatous otitis media

Objective To evaluate the success rate for revision tympanoplasty using different graft materials, to compare results of primary and re-tympanoplasty using the same technique and to analyse the effect of potential influencing factors on closure of tympanic membrane (TM) and hearing outcome. Methods Study included all patients, who underwent tympanoplasty ( n = 617) and re-tympanoplasty ( n = 94) for chronic otitis media without cholesteatoma in the period between September 1998 and 2007. The data of all patients on preoperative disease, perforation size and localization, middle ear status, surgical approach, graft material, adjunctive procedures, pre- and postoperative morphological (otomicroscopy) and functional (hearing examination evaluating pure-tone audiogram) results were analyzed. All operations were performed using an underlay technique and either the retroauricular or transcanal approach. The temporal fascia, perichondrium or cartilage–perichondrium composite grafts were used for the reconstruction of TM. Ossiculoplasty was performed as needed. The interrelation between multiple pre-operative parameters and post-operative morphological (closure of the perforation) and functional (hearing level) outcomes was analysed. Results Successful closure rates of the TM perforation were 93.6% and 90.2% of the patients in the primary and revision tympanoplasty groups, respectively. Graft take rate and hearing results did not depend on graft material. Structural changes were found more frequently in the re-tympanoplasty group (63.4% comparing to 29.5% of primary cases). Ossiculoplasty was performed more often in revision cases (24.4% comparing to 11.4% of primary cases). Successful hearing (ABG within 20 dB) for primary tympanoplasties was achieved in 81.1%, and for retympanoplasty – in 69.5% of the cases. ( p < 0.01). There were no interrelation between any estimated parameters and the graft take rate for either primary or revision tympanoplasty. Conclusions There is no evidence of increased risk of graft failure in re-tympanoplasty cases when compared to primary tympanoplasty operations. Hearing results depend on structural changes in the middle ear (ossicular abnormalities and tympanoscerosis) which in revision cases are found more often. No differences were found between fascia, perichondrum or cartilage-perichondrium grafts in terms of graft healing and hearing results.

Cartilage tympanoplasty methods: Proposal of a classification

The 23 known cartilage tympanoplasty methods to reconstruct the eardrum are classified in six main groups. Each method is briefly defined, described, and illustrated: Cartilage tympanoplasty with palisades, stripes, and slices. The eardrum is reconstructed by several, various, full-thickness pieces of cartilage with attached perichondrium on the ear canal side. In this group six different methods are described. Cartilage tympanoplasty with foils, thin plates, and thick plates, not covered with the perichondrium. In this group four methods are included. GROUP C: Tympanoplasty with cartilage-perichondrium composite island grafts. The perichondrium flap suspends or fixates the cartilage. In this group four methods are included. GROUP D: Tympanoplasty with special total pars tensa cartilage-perichondrium composite grafts. All three methods are used to close a total perforation, but differ from each. Three special methods are included in this group. GROUP E: Cartilage-perichondrium composite island grafts tympanoplasty for anterior, inferior, and subtotal perforations. Two on-lay and two underlay methods are included.GROUP F: Special cartilage tympanoplasty methods: The cartilage disc is placed under the perforation, the perichondrium onto the denuded eardrum remnant.

Wheel-shaped cartilage-perichondrium composite graft for the prevention of retraction pocket development

Conclusion. Our technique can decrease the formation of retraction pockets and improve hearing function. The wheel-shaped cartilage-perichondrium composite graft (Wheel CPCG) can be considered a good material for a drum graft, and it is easy to insert a ventilation tube, in case of initial drum retraction. Objective. The purpose of this study was to introduce the novel surgical technique of a Wheel CPCG with one-stage ossiculoplasty to prevent a retraction pocket and subsequent cholesteatoma after intact canal wall tympanomastoidectomy. Patients and methods. A total of 47 patients were reviewed; 43 cases were selected for audiologic testing. The results of operations were evaluated by comparing preoperative and postoperative hearing results and postoperative drum findings. Results. A retraction pocket was observed in three cases (6.7%). Slight protrusion of partial ossicular replacement prosthesis (PORP) and lateral healing of drum was observed in one case each, and there were two cases of postoperative infection. The number of cases with an air–bone gap (ABG)<20 dB increased from 9 (23%) cases before operation, to 20 cases (51%) after operation. The ABG average statistically decreased from 30.0 dB to 24.0 dB, and the mean air conduction thresholds decreased from a preoperative level of 47.3 dB to a level of 35.7 dB.

Repair of tympanic membrane perforation using a modified cartilage–perichondrium composite ring graft

Ring graft is a modified cartilage-perichondrium composite graft (CPCG) with only a peripheral ring shaped cartilage. In this series, tympanic membrane perforations were repaired using (ring graft) during treatment of 18 cases of non-cholesteatomatous chronic suppurative otitis media (CSOM). This study showed that ring graft has the advantages of both CPCG and perichondrial graft but without their disadvantages. Complete closure of the perforations was achieved in all cases without delay in hearing improvement. It is recommended to use the ring graft whenever needed to repair central tympanic membrane perforations even with difficult anterior or total perforations.

Cartilage perichondrium composite graft (CPCG) in pediatric tympanoplasty

Different policies on the treatment of tympanic membrane perforation in the pediatric age group continue to exist. Thirty patients were included in this study over a period of 2 years, where cartilage perichondrium composite graft (CPCG) was used to close the tympanic membrane perforation. Successful drum closure was achieved in 86.6% of cases, regardless of the site of perforation or the status of the operated ear. The graft was taken from the tragus and was placed in an underlay fashion with cartilage towards the promontory and the perichondrium immediately to the tympanic membrane remnants. The postoperative hearing gain although delayed up to 6 months was excellent either subjective or objective. So, CPCG has proved advantageous as a graft material to close perforation in the tympanic membrane in pediatric age group.

Autologous perichondrium-cartilage graft in the treatment of total or subtotal perforations of the tympanic membrane

In myringoplasty or tympanoplasty, fascia of the temporalis muscle and perichondrium or cartilage-perichondrium composite grafts are most commonly used to reconstruct the tympanic membrane (TM). Primary failures or recurrent perforations in the anterior part of the TM frequently occur in cases of eustachian tube dysfunction or total perforations of the TM. The purpose of this paper is to introduce a perichondrium-cartilage composite graft for closure of total perforations of the TM. Twenty-one patients (17 adults, 4 children) were included in this study, all of whom had a total perforation of the TM. An oval shaped piece of cartilage with perichondrium on one side was harvested from the cavum conchae. The cartilage was cut in the shape of a U without removing the inner layer of perichondrium. The inner diameter of the cartilage ring should be nearly the same as the diameter of the tympanic ring. This cartilage framework stabilizes and fixes the perichondrium and prevents the perichondrium from subsiding into the middle ear cavity. Shrinking of the perichondrium is also reduced by the cartilage ring. In all patients introduced in this study, the TM was closed and no residual perforation occurred. The hearing results in tympanoplasty were the same as in other techniques with a residual air-bone gap of about 20 dB. This technique seems to be a valuable method for the closure of total perforations of the TM. Especially in perforations near the anterior anular region the underlay technique with fascia or perichondrium is an uncertain method. The soft material which is only fixed by adhesion can easily be displaced during wound healing. The hearing results are comparable to that achieved in other techniques. Further studies with greater number of patients are necessary to assess long term results.

Mastoidectomy elimination.

Surgery that eliminates the open radical cavity takes three forms: obliteration (cavity fill-in, reconstruction (canal wall defect repair), or ablation (external canal closure). The evolution of each variety is reviewed in detail and a personal series of 240 cases is discussed. These included obliterations and reconstructions employing porous hydroxylapatite ceramic implants. Larger defects required Grote implants, but high facial ridge cases were managed with attic defect plates and limited canalplasty. Canal repair success rates improved with the use of the middle temporal flap to improve canal wall vascularity Residual cholesteatoma has been prevented by staged surgery, and recurrent disease has been virtually abolished by aggressive prevention techniques which employ drum reinforcement with finely shaven cartilage-perichondrium composite grafts. Ossiculoplasty procedures included 85 Plastipore columellas, 107 Oval-Top hydroxylapatite/Teflon columellas and, more recently, 17 Spanner malleus-stapes/footplate assemblies. Earlier poor results have been succeeded by more satisfactory levels. Since 1990, the air-bone gap has been closed to within 10 dB in 33% of cases and to within 20 dB in 66% of cases. Studies using SPITE (surgical, prosthetic, infection, tissues, and eustachian) adverse indicators have demonstrated high levels of pathology in elimination cases, when compared with nonelimination series. The SPITE studies have also demonstrated the reduction of pathology levels by staged surgery. Elimination surgery now provides permanent relief from the problem cavity in all but a few cases.