Fascia Graft Research Articles

A case of microtia with bilateral conductive hearing loss with unusual findings

Microtia refers to a group of congenital auricle malformations that range in severity from minor partial structural abnormalities to full auricle absence (anotia). A 17-year-old female, who was also a known case of left ear microtia presented to OPD with chief complaint of reduced hearing from both ears since 4 years. Examination showed Left ear microtia with narrow canal with retracted tympanic membrane while right ear had a normal pinna and canal with grade 3 retraction present in the tympanic membrane. In pure-tone audiometry (PTA) a conductive hearing loss of 57 dB in the right ear and 52 dB in the left ear, and impedance audiometry showed a curve of "Ad" and bilaterally ipsilateral reflexes were found to be absent. During exploratory tympanotomy, intraoperatively facial nerve was found to be low lying over the promontory, showing an abnormal course. A piece of cartilage was placed over the posterosuperior region. Temporalis fascia graft was placed over it. Any such case that has a congenital anomaly like microtia should not be planned for any kind of surgical intervention as they might have abnormal findings like an aberrant course of the facial nerve, and any kind of intraoperative manipulation with the ear might further increase the complications of the patient like facial nerve paresis. These patients should be properly assessed and counselled to directly go for a hearing aid rather than undergo any kind of surgical risk or complication.

V-053 USE OF ABDOMINAL FASCIA TRANSPLANTATION FOR COMPLEX GIANT INCISIONAL HERNIA AFTER LIVER TRANSPLANT

Abstract Incisional hernias are a well-known complicationafter liver transplantation, with an incidence of up to 15%. Conventional closure techniques such as synthetic or biological meshes do not have proper results, probably due to a variety of factors including tension in a definitive wall closure and the use of immunosuppressive drugs that can cause necrosis and wound infection. Alternative techniques such as a complete abdominal fascia transplantation can sometimes be needed. We present the case of a 57-year-old man with a history of liver transplantation due to HCV Cirrhosis, Portal Thrombosis and Pulmonary Hypertension. The patient developed a hernia of the Mercedes scar with a large fascial defect that caused him pain and obstructive symptoms. Surgical intervention was performed for hernia repair. During surgery, a large aponeurotic defect was identified with a ring of 25×15cm associated with an adhesion syndrome within the hernial sac. During surgery, the hernial sac was released, followed by release of the anterior aponeurosis and peritoneal closure. An abdominal wall transplant was performed from a 56-year-old donor after the graft had been preserved for 10 days in Celsior® at 4°. The fascial graft was placed to cover the abdominal wall defect and sutured to the edges of the recipient's fascia, using 4 interrupted 2-0 polypropylene non absorbable stitches. This patient's loss of domain of the abdominal cavity, associated with the existing vascular complications, were more than sufficient reasons to choose this technique. The patient's postoperative course was uneventful, but developed bulging during follow-up, without any additional complications.

V-013 NEW TECHNIQUE FOR ABDOMINAL WALL GRAFT RETRIEVAL

Abstract Aim show our technique for abdominal wall graft retrieval minimizing warm ischemia time. Material and methods a video report of an abdominal wall graft retrieval (full-thickness) from a female brain death donor. Results better graft perfusion with a lower picnosis in the studied cells. Lower tissue damage in both full-thickness and isolated fascia grafts. Surgical technique: An “house-flap” incision is done as opposed to a conventional cross-line laparotomy. The flap is extended until the inguinal ligament, divided afterwards to gain easier access to the femoral vessels. After abdominal organ dissection, the common iliac arteries are dissected from close to the aortic bifurcation up to the femoral vessels, beyond the origin of the inferior epigastric arteries. After cannulation of the aorta, cava vein and inferior mesenteric vein for the intraabdominal organs, both common iliac arteries are cannulated beyond the origin of external iliac artery. To achieve optimal perfusion of the rectus fascia we have to clamp the artery distal to the origin of the inferior epigastric artery (usually at the level of the femoral artery). The abdominal wall graft perfusion is done simultaneously with all the abdominal organs. Afterwards, we cover the graft with cold pads to avoid direct contact between the ice and the graft. A closure of the donor abdominal wall must be ensured after removing the wall graft. Conclusions our technique has showed better pathological outcomes than those previously published with a lower warm ischemia time of the abdominal wall graft.

Race and sex demographics in the surgical management of facial nerve palsy.

Facial palsy affects patients of all backgrounds, yet no existing studies describe differences in its treatment patterns between demographic groups. We used the National Surgical Quality Improvement Project database to investigate whether race and sex disparities exist in facial reanimation surgery. Patients were identified using CPT codes corresponding to facial-nerve procedures. Seven hundred sixty-one patients met criteria; 681 self-identified as White (89.5%), 51 as Black (6.7%), 43 as Hispanic (5.6%), 23 as Asian (3.0%), and 5 patients as other (0.61%). White patients were more than twice as likely to undergo brow ptosis repair than Non-White patients (OR 2.49, 95% CI 1.16-6.15, p = .03). After controlling for malignancy, men had longer operative times than women (480.2 vs. 413.9 min, p = .04) and higher likelihood of free tissue transfer (OR 4.1, 95% CI 1.9-9.8), fascial free tissue transfer (OR 10.7, 95% CI 2.1-195), and ectropion repair (OR 1.8, 95% CI 1.2-2.8). Most patients undergoing facial reanimation surgery in the United States are White. Men have longer operative times and a higher likelihood of undergoing free fascial grafts and cutaneous and fascial free tissue transfer than women regardless of malignancy status. 2c.

Outcome evaluation using an artificial intelligence‐based facial measurement software for facial nerve grafting in head and neck and skull base surgery

Interposition nerve grafting is an indispensable technique for facial nerve reconstruction in head and neck, and skull base surgery. The prognostic factors are inconclusive, partly due to limited objective assessment systems for facial nerve function. This study aimed to apply an artificial intelligence (AI)-based facial asymmetry measurement system to assess facial nerve grafting outcomes. We retrospectively reviewed data of 23 patients who underwent facial nerve grafting between 2011 and 2020. Oral asymmetry and synkinesis severity were measured using AI. Oral movement recovered at 12-18 months postoperatively. Postoperative radiotherapy and a larger number of anastomosed distal stumps were significantly associated with poor and good final oral symmetry, respectively. Synkinesis severity was weakly correlated with the degree of oral movement recovery. Oral function recovered without a strong correlation with synkinesis. Caution should be exercised in facial nerve grafting for cases with postoperative radiotherapy.

Trilayer temporalis fascia interposition graft: A reliable technique for nasal septal perforation repair

PurposeNasal septal perforation (NSP) repair is a complex procedure with variable techniques and success rates. In this study we describe NSP repair using a trilayer interposition graft of temporalis fascia and thin polydioxanone (PDS) plate without intranasal flaps and report outcomes in our patient population. Materials and methodsIRB-approved retrospective review of 20 consecutive patients presenting to a tertiary medical center with NSP from September 2018 to December 2020 and who underwent NSP repair via our trilayer temporalis fascia interposition graft. De-identified patient data was obtained from the medical record and stored on an encrypted secure server. Descriptive statistics were examined for each variable. ResultsAll 20 NSP repairs demonstrated durable repair with complete mucosal coverage at last follow-up (average 7 months). Complete resolution of preoperative symptoms was achieved in 85 % of patients, with partial resolution in the remaining 15 %. Of the 20 perforations 25 % were small (<1 cm), 50 % medium (1-2 cm), and 25 % large (>2 cm). The only surgical complication was a single intranasal synechiae. No graft harvest site complications were noted. ConclusionThe application of a trilayer temporalis fascia - PDS plate interposition graft without intranasal flaps is highly effective for repair of NSP.

Dynamic Superior Capsular Reconstruction for Irreparable Massive Rotator Cuff Tears: Histologic Analysis in a Rat Model and Short-term Clinical Evaluation

Background: Superior capsular reconstruction (SCR) has been demonstrated to be a valuable treatment for patients with irreparable massive rotator cuff tears (IMRCTs). However, the torn medial supraspinatus (SSP) tendons, which acted as dynamic stabilizers, were left untreated in conventional SCR, and the dynamic force from the SSP tendon was not restored. Purpose: To evaluate the effect of dynamic SCR (dSCR) on fascia-to-bone healing in a rat model, and to compare the short-term clinical effectiveness of dSCR and SCR using autologous fascia lata (FL) in patients with IMRCTs. Study Design: Controlled laboratory study and cohort study; Level of evidence, 3. Methods: A total of 50 rats were divided randomly into 2 groups: the dSCR group and the SCR group (25 rats per group). First, chronic IMRCTs were created, and then the torn tendons in both groups were subjected to SCR using autologous thoracolumbar fascial (TLF) grafts. The remnant of the SSP tendon was sutured to the medial part of the TLF graft in the dSCR group but not in the SCR group. Histologic sections were assessed at 1, 2, 4, 8, and 16 weeks postoperatively. In the clinical study, 22 patients (9 SCR, 13 dSCR) were analyzed. The recovery of shoulder function, including the active range of motion (ROM), visual analog scale (VAS), American Shoulder and Elbow Surgeons score, Constant score, and University of California Los Angeles score, acromiohumeral distance (AHD), and fatty infiltration, was evaluated before surgery and at the last follow-up. Results: Histologic analysis of the fascia-to-bone junction in the rat model showed that the TLF gradually migrated into tendon-like tissue over the rotator cuff defects in both groups, and the modified tendon maturation score of the fascia-to-bone interface in the dSCR group was higher than that in the SCR group at 4 weeks (12.20 ± 1.30 vs 14.60 ± 1.52; P = .004), 8 weeks (19.60 ± 1.14 vs 22.20 ± 1.10; P = .019), and 16 weeks (23.80 ± 0.84 vs 26.20 ± 0.84 P = .024). The dSCR group showed earlier fibrocartilage cell formation and angiogenesis. In the clinical study, all 22 patients completed a minimum of 12 months of follow-up after surgery, and the mean follow-up duration was 22.89 ± 7.59 months in the SCR group and 25.62 ± 7.32 months in the dSCR group. The patients in both groups showed significant improvements in terms of ROM, shoulder function scores, and AHD. At the last follow-up, abduction (56.67°± 27.39° vs 86.54°± 30.37°; P = .029), external rotation (25.00°± 9.35° vs 33.08°± 8.55°; P = .049), internal rotation cone rank (–2.78 ± 2.44 vs –4.38 ± 1.12; P = .049), VAS (–3.00 ± 0.87 vs –3.92 ± 0.95; P = .031) and Constant (47.89 ± 15.39 vs 59.15 ± 9.74; P = .048) scores, and the AHD improvement degree (3.06 ± 1.41 mm vs 4.38 ± 1.35 mm; P = .039) in the dSCR group were significantly improved compared with those in the SCR group. The results of fatty infiltration at the last follow-up showed that there was significant improvement compared with the preoperative results in both the conventional SCR (P = .036) and the dSCR (P = .001) groups. However, there were no significant differences between the 2 groups (P = .511). Conclusion: dSCR can promote faster fascia-to-bone healing in a rat model, and the dSCR technique could provide a preferable treatment option for patients with IMRCTs. Clinical Relevance: dSCR might restore the dynamic of SSP in some sense and then improve the fatty infiltration in the SSP.

Early Simultaneous Cross Facial Nerve Graft and Masseteric Nerve Transfer for Facial Paralysis after Tumor Resection.

Patients undergoing masseter nerve transfer and CFNG for facial paralysis after skull base tumor resection were consented to participate in video interviews. Facial Clinimetric Evaluation (FaCE) Scale (0-100) patient-reported outcome, eFACE, and Facial Grading Scale scores were compared. Nine patients had unilateral facial paralysis from resection of a schwannoma (56%), acoustic neuroma (33%), or vascular malformation (11%). Five underwent early simultaneous CFNG and masseter nerve transfer (mean 3.6 days after resection), whereas four underwent two-stage reanimation including a babysitter procedure (mean 218 days after resection). Postoperative FaCE scale and Facial Grading Scale scores were similar in both groups (P > 0.05). Postoperative mean eFACE scores were similar for both groups for smile (early: 71.5 versus delayed: 75.5; P = 0.08), static (76.3 versus 82.1; P = 0.32), and dynamic scores (59.7 versus 64.9; P = 0.19); however, synkinesis scores were inferior in the early group (76.4 versus 91.1; P = 0.04). Early simultaneous masseter nerve transfer and CFNG provides reanimated movement sooner and in fewer stages than a staged approach in a delayed timeline. The early technique appears to result in similar clinician- and patient-reported outcomes compared with delayed procedures; however, in this preliminary study, the early approach was associated with greater synkinesis, meriting further investigation.

Facial Allograft Donation: An Interpretative Phenomenological Analysis of the Experiences of Family Members.

Facial allograft transplantation can be regarded as a particular and complex type of donation because of its perceptibility and the importance of the face as an identity characteristic. As research on this topic is currently lacking, the objective of this study is to explore the experiences of the family members of the donor in facial allograft donation. In-depth, semi-structured interviews were conducted separately with the donor's family members and analyzed using interpretative phenomenological analysis. Six themes were identified: (1) Contrasting facial donation to that of more commonly donated organs; (2) Consenting to facial donation; (3) Expectations towards the recipient of the facial graft; (4) Expectations and consequences of restoration of the donor's face; (5) Relationship with the medical team during the process; and (6) Media attention. The findings of our study help to better support donor families through the facial donation process and to improve facial transplantation procedures.

Negative Outcome of Temporalis Fascia Graft in Tympanoplasty with Excessive Bleeding: A Retrospective Study.

Background and Objectives: Non-autologous graft materials hold promise for tympanic membrane (TM) perforation closure. In the present manuscript, we aimed to evaluate the influence of clinical and surgical (i.e., graft materials) characteristics on tympanoplasty outcome in chronic otitis media (COM). Materials and Methods: We retrospectively reviewed clinical and surgical characteristics of COM patients with TM perforation treated with tympanoplasty and mastoidectomy. Univariate and multivariate appropriate tests were applied. Results: We used xenograft (porcine submucosal collagen) in 163 patients, and temporalis fascia in 210. The mean follow-up time was 37.2 months. Postoperative TM perforation (i.e., negative outcome) was detected in 11.6% of cases with xenograft, and in 12.8% with temporalis fascia. Performing uni- and multivariate analysis, we determined that large (three or all quadrants) TM perforation (p = 0.04) and moderate-to-severe intraoperative bleeding (p = 0.03) were independent prognostic factors of negative outcome. Considering the 197 patients with moderate-to-severe intraoperative bleeding, we disclosed that the use of temporalis fascia (p = 0.03) was an independent risk factor of postoperative TM perforation. Conclusions: According to our results, large TM perforation and moderate-to-severe intraoperative bleeding were independent prognostic factors of negative outcome in adult COM patients treated with tympanoplasty. In the sub-group of COM patients with excessive intraoperative bleeding, use of temporalis fascia was associated with negative outcome; these patients could benefit from xenograft materials. These findings should be tested in large randomized clinical trials.

A Novel Technique for the Permanent Restoration of Pretarsal Fullness of the Lower Eyelids.

The presence of static pretarsal fullness is an essential aesthetic feature in Asian culture that endows a youthful and smiling attractive look to the face. The restoration of static pretarsal fullness using acellular dermal matrix implantation or autogenous fascia grafting can result in suboptimal outcomes because of the unpredictable resorption rate. Therefore, a new method is required to achieve a stable, long-term, and natural result. The authors describe a new method to address the deficiency of static pretarsal fullness. Sixteen Asian female patients with a deficiency of static pretarsal fullness who received implantation of a bundle of implants consisting of segmented Gore-Tex sutures (W. L. Gore & Associates, Inc., Flagstaff, AZ) overlaid with a mastoid fascia graft were retrospectively evaluated in a 15-year period from July 2007 to July 2022. Patients were assigned to categories based on the pretarsal fullness contour. Sixteen female patients aged between 22 and 40 years (mean age: 30.375 ± 7.580) underwent the procedure. The mean follow-up period was 52.25 (±33.757) months (range, 6-120 months). Fourteen patients were considered to have satisfactory results. However, 2 patients encountered complications, one of which was a case of infection that was successfully managed through revision and led to an excellent outcome. The other patient experienced malposition, which was also corrected successfully through revision. Our new method for creating pretarsal fullness using Gore-Tex suture implants overlaid with a retroauricular mastoid fascia graft is effective in achieving aesthetic static pretarsal fullness and obtaining excellent permanent cosmetic outcomes.

Comparative Study of Outcome of Platelet-Rich Plasma (PRP) and Temporalis Fascia in Myringoplasty

Aim: this study aims to evaluate the efficacy of a PRP hourglass graft compared with the conventional methodemploying a temporalis fascia underlay graft in treating tympanic membrane perforation.Materials and methods: this randomized controlled trial randomized was conducted in the period fromOctober 2018 to December 2020 on forty patients with chronic otitis media safe dry mucosal disease presented todepartment of otorhinolaryngology, Beni Suef University. They were randomly assigned into two groups (the firstgroup underwent myringoplasty using autologous PRP graft and the 2nd group underwent myringoplasty usingautologous temporalis fascia graft only (20 in each)).Results: Though all post-operative A-B gaps at 500, 1000 and 2000 Hz seemed to be to be lower with temporalisfascia graft, yet not significant. However, the average A-B gap was statistically higher in PRP group than temporalisfascia, P-value = 0.035. Myringoplasty with temporalis fascia graft showed significant reduction in A-B gaps at500, 1000 and 2000 Hz. While PRP showed no significant improvement was shown at low frequencies (500 Hz),with significant improvement at higher frequencies (1000 &amp; 2000 Hz). Both methods showed an improvement inaverage A-B gaps, P-value =0.001 in temporalis fascia group and 0.034 in PRP group. Post-operative full healingafter 3 months, complications, graft lateralization, and displacement into the middle didn’t differ significantly inboth groups.Conclusion: After a successful myringoplasty treatment, patients with PRP grafts had comparable hearing resultsto those with fascial grafts, as shown by significant reductions in the mean air-bone gap from pre-operative topost-operative.

Comparison of Results of Myringoplasty with Temporalis Fascia and Perichondrial: Cartilage Composite Graft in High Risk Perforations

Background: The objectives of this study were to compare the graft uptake and post-operative hearing results of underlay myringoplasty with temporalis fascia and perichondrial-cartilage composite graft in high risk perforations. Materials &amp; Methods: Patients of ages of 13 years and above with diagnosis of chronic otitis media – mucosal type with high risk perforations undergoing myringoplasty were included. Criteria of high risk were &gt;50% perforation of tympanic membrane, revision cases, absent/eroded handle of malleus, oedematous/unhealthy middle ear mucosa and marginal perforation of any size. Pure tone audiometry was done within 1 week before surgery. Seventy cases included for myringoplasty were randomly allocated by lottery method into two groups with 35 cases each in temporalis fascia group and perichondrial - cartilage composite graft group. After 6 weeks graft uptake results were assessed and post-operative hearing was evaluated and compared within and between the groups. Results: Graft uptake rates in temporalis fascia group and perichodrial - cartilage composite graft group were 88.57% and 91.43%, respectively with no statistically significant difference between the groups (p = 0.69). The mean pre- and post-operative air bone gaps in temporalis fascia group were 31.81 ± 10.49 dB and 17.87 ± 7.96 dB. The mean pre- and post-operative air bone gaps in perichondrial - cartilage composite group were 35.19 ±7.26 dB and 22.62 ± 8.77 dB. These differences in both the groups were statistically highly significant (p &lt; 0.001) showing improvement in the hearing after surgery. The mean post-operative ABG gains were 13.94 ± 8.36 dB and 12.57 ± 8.21 dB in temporalis fascia and perichondrial - cartilage composite groups respectively.&#x0D; Conclusion: The graft uptake rates and hearing results after perichondrial - cartilage composite graft are similar to those of temporalis fascia graft. Perichondrial- cartilage composite graft even though more rigid and thicker than temporalis fascia did not affect post-operative hearing results adversely

Comparative evaluation of temporal fascia and dermal fat graft in the management of temporomandibular joint ankylosis.

Temporomandibular joint (TMJ) ankylosis is a debilitating condition usually afflicting children and young adults, causing long-term functional, aesthetic, and severe psychological impacts on the lives of these patients. To compare the postoperative outcomes after using one of the most commonly employed inter-positional graft, i.e., temporalis fascia, and a recently introduced 'more suitable' graft, i.e., dermal fat. A prospective study in which 20 patients of TMJ ankylosis were randomly assigned into two groups of 10 patients each. Temporalis fascia was used as an inter-positional graft in one group, while dermal fat graft was used in the other group. Post-surgical clinical parameters were evaluated, including interincisal mouth-opening and pain. Interincisal mouth opening at six months was greater in group A (32.1 ± 12.93) as compared to group B (33.8 ± 4.89), but statistically, it was not significant (P = 0.478). The mean pain score in group A was 4.60 ± 1.17, 1.50 ± 0.70, 0.20 ± 0.42 on day 1, 7, and 15, respectively. The mean pain score in group B was 4.10 ± 0.99, 1.30 ± 0.48, 0.20 ± 0.42 on day 1, 7, and 15, respectively. Both the graft materials work well in terms of maximum interincisal opening. For more clarification, a larger sample size with a longer duration of follow-up is needed to validate the study.

Double-layer fascial grafts in Type I tympanoplasty for subtotal perforation: A case–control study

Objective: The objective of this study was to assess the double-layer temporalis fascia grafting for myringoplasty for subtotal tympanic membrane (TM) perforation regarding graft uptake and hearing gain. Patients and Methods: The study included 60 patients with subtotal TM perforation attributed to tubotympanic suppurative otitis media. Myringoplasty was done through a postauricular approach using the underlay technique by two layers of the temporalis fascia grafts in the study group and one layer of the temporalis fascia graft in the control group. The procedure was considered successful if there was no residual TM perforation within the follow-up period. Results: Within included 60 patients, 30 patients in the study included 60 patients, 30 patients in the study group (11 males and 19 females) and 30 patients in the control group (9 males and 21 females). The success rate of TM healing was 100% in the case group and 87.7% in the control group with significant difference (P = 0.038). The hearing gains (>10 dB) were reported in 96.7% in the case group while it was 70% in the control group which is significantly better (P = 0.00558). Conclusion: The double-layer temporalis fascia graft is effective for both postoperative graft taking and hearing improvement for subtotal (Grade 4) TM perforation.

Comparison of the Functional and Audiological Success of Temporalis Fascia and Tragal Perichondrium as a Graft in Type 1 Tympanoplasty

Context: Temporalis fascia and tragal perichondrium are the most commonly used graft materials in tympanoplasty, though contradictory reports are available in literature regarding their efficacy. Aims: To investigate the success rates and hearing outcomes of temporalis fascia and tragal perichondrium as grafts used for Type 1 tympanoplasty. Settings and Design: The present prospective study was carried out for a period of 18 months including 60 patients of either sex from 18 to 70 years of age. Subjects and Methods: This prospective study included 60 consecutive cases of chronic otitis media in a tertiary care center randomized in two groups of 30 patients each to be subjected to Type 1 tympanoplasty using either temporalis fascia graft (Group A) or tragal perichondrium (Group B). Graft uptake rates and subjective as well as objective hearing improvement at 1 and 3 months postoperative follow-up were compared. Statistical Analysis Used: IBM-compatible Statistical Package for the Social Sciences (SPSS) version 21.0. Results: The mean age of presentation in Group A was 31.30 years and in Group B was 30.67. In our study, the graft uptake after 3 months of surgery was 87% in the temporalis fascia graft group and 90% in the tragal perichondrium graft group. The mean pre- and postoperative PTA at 1 month and 3rd month postoperatively showed that there was significant improvement in hearing after 1 month in the temporalis fascia graft group compared to the tragal perichondrium graft group. Conclusions: Both temporalis fascia and tragal cartilage perichondrium are suitable graft materials for tympanoplasty. Graft uptake was superior with tragal perichondrium, while hearing improvement was better with temporalis fascia at 1 month postoperatively, although the results were not statistically significant at 3 months postoperative.

Comparative study between anterior tucking and tunneling of graft in Type-1 tympanoplasty

Background: Tympanoplasty is the surgical procedure performed to repair a perforated tympanic membrane, with or without reconstruction of the ossicles, with the aim of preventing reinfection and restoring hearing ability. There are various techniques to perform Type 1 tympanoplasty. Aims and Objectives: · To compare anterior tucking and tunneling of temporalis fascia graft in Type 1 tympanoplasty based on the clinical and audiological outcome. · To study the hearing outcome and graft uptake in anterior tucking technique and anterior tunneling technique in Type 1 tympanoplasty. · To compare the hearing outcome and graft uptake in anterior tucking versus anterior tunneling technique in Type 1 tympanoplasty. Materials and Methods: The study was carried out in the Department of Otorhinolaryngology (ENT), Maharishi Markandeshwar Institute of Medical Sciences and Research Hospital, Mullana over 2 years from September 2020 to September 2022. One hundred cases of inactive, chronic otitis media (COM) were included in this study and subjected to Type 1 tympanoplasty with 50 belonging to the anterior tucking technique (Group A) and 50 to the anterior tunneling technique (Group B). Results: The graft uptake rate was 96% in Group A (anterior tucking technique) and 98% in Group B (anterior tunneling technique). The average hearing gain in Group A was 9.94 dB and in Group B was 9.36. Chances of complications like residual perforation were found to be low (4% in Group A and 2% in Group B) in both techniques. Conclusion: In our study, we concluded that both the techniques of anterior tucking and anterior tunneling of temporalis fascia graft in Type 1 tympanoplasty surgery are equally effective to achieve intactness of graft and hearing improvement in patients of inactive, mucosal COM.

A rare pediatric case of proximal radius exostosis with radio-capitellar joint dislocation-marginal resection with joint reconstruction

We present a case of a patient with an incidental finding of an isolated radial head osteochondroma. This progressively enlarged to become symptomatic causing gradual subluxation of the radio-capitellar joint. Marginal excision and an annular ligament reconstruction was performed using a forearm fascia graft. The patient made a full recovery with symptom resolution and preservation of range of movement. He successfully returned to physical activity by the 3-month mark.

Comparative Study of Temporalis Fascia Graft versus Cartilage Shield Tympanoplasty in Chronic Otitis Media - Mucosal Type

Introduction: Tympanoplasty is the procedure of choice for surgical correction of tympanic membrane perforation triggered by either chronic otitis media or trauma. Various types of autologous grafts have been used to close tympanic membrane perforations among which temporalis fascia and tragal cartilage are preferred, due to their anatomic proximity, ease of harvesting and suppleness.&#x0D; Aims: To compare clinical and audiological outcomes of type 1 tympanoplasty where temporalis fascia and tragal cartilage were used as the graft material.&#x0D; Methods: A prospective study was conducted on 50 patients of ages ranging from 10 to 50 years with Chronic Otitis Media - Mucosal. All the patients underwent type 1 tympanoplasty and were categorized into Group-A (Temporalis fascia graft) and Group-B (Cartilage graft), each group comprising of 25 patients. Graft uptake rate, hearing gain and air bone gap closure were compared between the groups in 4 and 8 weeks after surgery.&#x0D; Results: Out of total 50 patients, 20 were male and 30 were female. The average age of the patients was 28.20 years. The total hearing gain in the whole series was 14.94 dB while the total air bone gap closure was 14.78 dB respectively. The difference between pre and post-operative hearing was statistically significant for both air bone gap and air conduction, (P&lt;0.05) in the whole series. There was 15.56 dB improvement in mean hearing threshold and 15.64 dB mean air bone gap closure in the fascia group, compared to 14.32 dB improvement in mean hearing and 13.92 dB mean air bone gap closure in the cartilage group. Graft uptake rate in the temporalis fascia group was 84% and the cartilage group was 92 % with significant difference in the graft uptake rate between the groups.&#x0D; Conclusion: The graft uptake rate and hearing results of tragal cartilage are comparable to those of temporalis fascia. Cartilage tympanoplasty has a higher graft uptake rate with low failure rate and also shows a high degree of reliability in high risk cases. Both cartilage and fascia tympanoplasty provided similar improvements in the hearing outcome post-operatively. Thus, cartilage tympanoplasty is recommended as an alternative option.

SURGICAL OUTCOME OF MYRINGOPLASTY WITH AND WITHOUT CORTICAL MASTOIDECTOMY IN CHRONIC OTITIS MEDIA MUCOSAL INACTIVE TYPE

Background: Chronic otitis media is usually complicated due to perforation of tympanic membrane and ultimately leading to hearing loss. The objective of this study was to compare the results of myringoplasty alone with myringoplasty with cortical mastoidectomy in COM (Chronic Otitis Media) mucosal inactive type in terms of graft uptake. Methods: This was a descriptive, prospective, qualitative type of study. A total of thirty patients of COM mucosal inactive type were included in the study of which 15 patients were selected alternatively for myringoplasty alone while another 15 patients were selected for myringoplasty with cortical mastoidectomy. Pure tone audiometry was done within 1 week prior to surgery. Graft uptake was assessed after 6 weeks and results were compared within and between the groups using Chi-square test. Results: Graft uptake rate of myringoplasty alone and myringoplasty with cortical mastoidectomy done using temporalis fascia graft and underlay technique was same 86.66% (n=26) and failure rate was 13.33% (n=4).The graft take was higher 88.9%(n=8) in small perforation worsened in medium (85 %) and then in subtotal perforation (79%). Graft uptake rate was highest in central perforation (86.9%) followed by posterior perforation (84.6%) and least in anterior perforation (77.7%). Mean age of presentation was 27.7 years, ranging from 15 to 60 years. Most common approach was permeatal in myringoplasty and postaural in case of myringoplasty with cortical mastoidectomy. Conclusions: The graft uptake rate myringoplasty alone are comparable to those of myringoplasty with cortical mastoidectomy. The choice of surgery is based on surgeon’s preference.