Fascia Graft Research Articles

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.
 Aims: To compare clinical and audiological outcomes of type 1 tympanoplasty where temporalis fascia and tragal cartilage were used as the graft material.
 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.
 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<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.
 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.

Kashimé: A Novel Knotless Surgical Suture to Simplify Dural Stitches in Endoscopic Transnasal Surgery.

Dural suturing is an effective adjunct to skull base dural repair in endoscopic transnasal surgery, although it is technically cumbersome. Here, we presented a novel surgical suture "Kashimé" (Kono Seisakusho) that can be tightened without tying. To examine the efficacy of Kashimé for skull base dural repair in endoscopic transnasal surgery. Kashimé was used in 8 patients with skull base dural defects during nonpedicled flap-based multilayered skull base reconstruction to close or approximate the gaps between the dural edges or secure a free fascial graft. The time required for each dural stitch (passing a needle through the dura, pulling out the thread, and tightening it) and the incidence of postoperative cerebrospinal fluid leakage were the study end points. Based on our preliminary experiences with 12 stitches used, no postoperative cerebrospinal fluid leakage was observed. The learning curve was steep, and the mean (±SD) time was 127 (±44) seconds for a single stitching procedure, except for the first case. Regarding the metal artifact, although a beam hardening artifact was not observed on computed tomography, a 4- to 9-mm diameter image defect was observed on magnetic resonance imaging. Kashimé can help surgeons to complete a single dural stitch in endoscopic transnasal surgery for approximately 2 minutes. It may be an optimal tool for skull base reconstruction, but the efficacy and safety need to be investigated.

The Effect of Autologous Temporal Fascia Graft on Erectile Function and Psychometric Properties in Peyronie's Disease Patients.

The aim of this study is to evaluate the results of the surgical technique used by the authors on Peyronie's disease (PD) patients who underwent surgical treatment with a temporalis fascia autograft. Patients with normal erectile functions and > 60° penile curvature who underwent surgical treatment with temporalis fascia autografts were included in this retrospective study. The patients were recruited between January 2017 and May 2021. Preoperative assessment included the International Index of Erectile Function erectile function (IIEF-EF) score, penile duplex and penile curvature angle measurement. Postoperative self-reports, penile deformity, IIEF-EF scores and the Patient Global Impression of Improvement (PGI-I) questionnaire were assessed every three months. Twenty-two patients with a mean age of 52.09 ± 6.61 years were included in the study, and no major complications developed in any case. Postoperative assessment revealed curvature relapse in seven patients (31.8%), although no intervention was performed on five patients with < 20° curvature. Six patients experienced a postoperative decrease in penile length and erectile function was completely preserved in 68.18%. The mean level of satisfaction with surgery measured using the visual analogue scale was 79.13 ± 21.23. The temporalis fascia graft, thin and durable graft, is a highly successful therapeutic option in the surgical treatment of PD patients and a good alternative in terms of its cosmetic and functional results.

Smile Reanimation with Masseteric-to-Facial Nerve Transfer plus Cross-Face Nerve Grafting in Patients with Segmental Midface Paresis: 3D Retrospective Quantitative Evaluation

Facial paresis involves functional and aesthetic problems with altered and asymmetric movement patterns. Surgical procedures and physical therapy can effectively reanimate the muscles. From our database, 10 patients (18–50 years) suffering from unilateral segmental midface paresis and rehabilitated by a masseteric-to-facial nerve transfer combined with a cross-face facial nerve graft, followed by physical therapy, were retrospectively analyzed. Standardized labial movements were measured using an optoelectronic motion capture system. Maximum teeth clenching, spontaneous smiles, and lip protrusion (kiss movement) were detected before and after surgery (21 ± 13 months). Preoperatively, during the maximum smile, the paretic side moved less than the healthy one (23.2 vs. 28.7 mm; activation ratio 69%, asymmetry index 18%). Postoperatively, no differences in total mobility were found. The activity ratio and the asymmetry index differed significantly (without/with teeth clenching: ratio 65% vs. 92%, p = 0.016; asymmetry index 21% vs. 5%, p = 0.016). Postoperatively, the mobility of the spontaneous smiles significantly reduced (healthy side, 25.1 vs. 17.2 mm, p = 0.043; paretic side 16.8 vs. 12.2 mm, p = 0.043), without modifications of the activity ratio and asymmetry index. Postoperatively, the paretic side kiss movement was significantly reduced (27 vs. 19.9 mm, p = 0.028). Overall, the treatment contributed to balancing the displacements between the two sides of the face with more symmetric movements.

Type 1 Tympanoplasty Outcomes between Cartilage and Temporal Fascia Grafts: A Long-Term Retrospective Study.

Background: To compare the functional and anatomical results of two different types of grafts in type 1 tympanoplasty (TPL I). Methods: A retrospective comparative bicentric study was conducted on patients treated with TPL I using temporal fascia or tragal cartilage. We evaluated the functional and anatomical results with intergroup and intragroup analyses. Variables predicting long-term success were also evaluated. Results: A total of 142 patients (98 fascia graft vs. 44 cartilage) were initially assessed, with a mean follow-up of 67.1 ± 3.2 months. No significant differences were observed between the two groups on the intergroup analysis of age, gender, ear side, or pre-operative hearing data (all p > 0.05). At the intragroup analysis of auditory outcomes, both groups demonstrated a significant improvement in post-operative air conduction, with greater gain for the fascia group at 6 months follow-up (p < 0.001 for both); however, at long-term follow-up, cartilage demonstrated better stability results (p < 0.001). When comparing the pre-and post-operative air-bone-gap (ABG), both groups showed a significant gain (p < 0.001); the fascia group showed that at 6 months, a greater ABG increase was found, but the difference was not statistically significant (4.9 ± 0.9 dB vs. 5.3 ± 1.2 dB; p = 0.04). On the contrary, the cartilage group at long-term follow-up at 5 years maintained greater outcomes (10 ± 1.6 dB vs. 6.4 ± 2 dB; p < 0.001). Lower age (F = 4.591; p = 0.036) and higher size of perforation (F = 4.820; p = 0.030) were predictors of long-term functional success. Conclusions: The graft material selection should consider several factors influencing the surgical outcome. At long-term follow-up, the use of a cartilage graft could result in more stable audiological outcomes, especially in younger patients or in case of wider perforations.

Asian rhinoplasty using a thin rib cartilage graft and ultrafine diced cartilage wrapped in fascia: A comparative study between septal cartilage graft and rib cartilage graft

A 1-2-mm thin rib cartilage graft was used as a septal extension graft to overcome the drawbacks of traditional rib cartilage rhinoplasty, which often results in a stiff nasal tip. The remaining rib cartilage was placed on the nasal dorsum as an ultrafine diced cartilage wrapped in fascia (UDCWF) graft. This study aimed to assess the stability of thin rib cartilage grafts and measure the resorption rate of the UDCWF graft. This retrospective study included 53 patients who underwent rhinoplasty with septal extension grafting and nasal dorsum augmentation using a septal cartilage (SC group) or rib cartilage (RC group) graft between June 2017 and June 2020. The nasal length, tip height, sellion height, and nasolabial angle in the preoperative, immediate postoperative, and long-term postoperative periods were analyzed using three-dimensional photogrammetry. A total of 26 patients received rib cartilage grafts and 27 patients received septal cartilage grafts. The RC group showed greater maintenance of tip height, nasal length, and tip derotation over time. The relapse ratio in tip height was -3.3±1.6% and -8.4±4.3% in the RC and SC groups, respectively (p=0.001). The resorption rate of the UDCWF graft was -7.5±3.6% and -7.8±2.3% at the sellion and rhinion, respectively. The thin rib cartilage provided sufficient intrinsic strength to maintain tip height and tip rotation. It can be an effective alternative to rhinoplasty in Asians with features such as thick skin and a short nose. Moreover, the UDCWF graft exhibited an approximately 7.5% resorption rate, leading to lower probabilities of dorsal irregularity and stepping deformity.

Comparison of Graft Materials in Multilayer Reconstruction with Nasoseptal Flap for High-Flow CSF Leak during Endoscopic Skull Base Surgery.

Cerebrospinal fluid (CSF) leak is a crucial complication after endoscopic skull base surgery. Therefore, multilayer reconstruction with grafts is as essential as a reconstruction with pedicled flaps. Although widely used, the multilayer technique with autologous fascia lata has drawbacks, such as additional wound and donor site complications. We compared acellular dermal graft and banked homologous fascia lata graft (alternative grafts) with autologous fascia lata graft for high-flow CSF leak repair. We retrospectively enrolled 193 subjects who underwent endoscopic skull base reconstruction with multilayer fascial grafts and nasoseptal flap for high-flow CSF leaks from November 2014 to February 2020 at a single institution. Acellular dermal matrix (ADM), banked homologous fascia lata, and autologous fascia lata were used in 48 (24.9%), 102 (52.8%), and 43 (22.3%) patients, respectively. Postoperative CSF leaks occurred in 23 (11.9%) patients and meningitis in 8 (4.1%). There was no significant difference in postoperative CSF leak (p = 0.36) and meningitis (p = 0.17) across the graft groups. Additionally, we could not find out contributing risk factors for postoperative CSF leak and meningitis. ADM and banked homologous fascia lata are non-inferior to autologous fascia lata for endoscopic skull base reconstruction in water-tight reconstruction or safety without additional donor site morbidities.

Dry versus wet temporalis fascia graft in type-I tympanoplasty: a systematic review and meta-analysis of randomized controlled trials.

To conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) that examined the efficacy of dry versus wet temporalis fascia graft among patients undergoing type-I tympanoplasty. Web of Science, Scopus, PubMed, and CENTRAL databases were screened from inception until July 2022. The Cochrane risk of bias tool was used to assess the quality of included RCTs. The outcomes were summarized as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) in a random-effects model. Eight RCTs with 989 patients (dry group = 514 and wet group = 475) were included. The overall quality was 'low', 'some concerns', and 'high' risk of bias in five, two, and one RCT(s), respectively. There were no significant differences between both groups regarding the surgical success rate (n = 8 RCTs, RR 0.99, 95% CI [0.95, 1.03], p = 0.6), audiological success rate (n = 5 RCTs, RR = 0.93, 95% CI [0.73, 1.13], p = 0.48), mean difference in pure tone average (n = 2 RCTs, MD = 2.73Hz, 95% CI [- 2.31, 7.77], p = 0.29), and mean difference in graft placement time (n = 3 RCTs, MD = - 2.18min, 95% CI [- 5.11, 0.76], p = 0.15). However, the mean difference in operative time was significantly lower in favor of the wet compared with the dry temporalis fascia group (n = 2 RCTs, MD = 2.95min, 95% CI [- 1.80, 4.11], p < 0.001). The surgical success rate was not significantly different between both groups according to the tympanic membrane perforation size and site. The type of temporalis fascia graft (dry or wet) did not influence the clinical outcomes of type-I tympanoplasty.

A Prospective Randomised Comparative Study Between Cartilage and Fascia Tympanoplasty in a Tertiary Care Hospital to Look for Better Alternative in High Risk Cases.

CSOM patients are most commonly managed surgically by type I tympanoplasty using either cartilage shield technique or underlay grafting technique. In our study, we have compared the graft uptake and hearing results of type I tympanoplasty using temporalis fascia and cartilage shield, and also reviewed the literature regarding the results of these two methods. 160 patients aged between 15 and 60 years were randomized into two groups of 80 patients each, with odd numbers subjected to conchal or tragal cartilage shield grafting in group I, while in group II with even numbers, the patients underwent temporalis fascia grafting by underlay technique. Three months post-surgery, the graft uptake was seen in 76 patients (95%) in the cartilage shield group as compared to 58 patients (72.5%) in the temporalis fascia group, which was statistically significant between the two groups [Fisher's exact value = 0.000]. The uptake rate was much higher in cartilage shield graft as compared to fascia graft even in complicated cases like revision tympanoplasty (TP), discharging ear, subtotal perforation and retracted/adhered TP. Also, the hearing improvement in fascia and cartilage shield group was not statistically significant comparing pre- and post-operative patients, indicating that there was not much difference in audiological outcomes between the two groups. We advocate the use of cartilage shield graft as a substitute for fascia graft in all feasible cases as well as in complicated situations to improve the success rate of type I tympanoplasty, without compromising on the hearing improvement, as seen in our study. The online version contains supplementary material available at 10.1007/s12070-022-03175-1.

Comparison of cartilage and temporalis fascia grafts in type 1 tympanoplasty: A meta-analysis.

To systematically review the results of type 1 tympanoplasties with temporalis fascia (TF) vs cartilage grafts in patients with chronic otitis media. Eligible studies were identified from PubMed, Ovid, and EMBASE databases prior to November 2021. We analyzed the pure tone audiometry (PTA) and air-bone gap (ABG) data as continuous variables, and the success rate was analyzed as a dichotomous variable. Forty-four studies, including 4582 patients, were eligible. The cartilage graft overall morphologic success rate was higher than that of the TF grafts (P < .001). In the palisade (P < .004) and island grafts (P < .001) subgroups, the analysis was significantly different. However, there was no significant difference in the inlay butterfly grafts subgroup. For hearing outcomes, the analysis revealed that TF grafts had a smaller mean post-operative ABG (P = .009). However, the subgroup analysis showed no significant difference in the mean post-operative ABG. For PTA, there was no significant difference in hearing improvement. However, the palisade cartilage graft subgroup resulted in a better hearing outcome than the TF graft subgroup in terms of the mean post-operative PTA (P = .007). There was no significant difference in the functional success rate or mean ABG gain. Cartilage grafts have a better success rate than TF grafts in tympanoplasty. Both cartilage and TF tympanoplasty provided similar improvements in hearing outcome, while TF grafts generated a better outcome in post-operative ABG and palisade cartilage grafts in post-operative PTA. This may be related to the biological characteristics of the grafts. Further thorough studies need to be conducted.

Evaluation of the use of autologous platelet-rich fibrin in myringoplasty operation

BackgroundPlatelet-rich fibrin (PRF) which is considered a second-generation platelet-rich plasma having a high content of growth factors could be implied as a sealant and adjuvant to grafting materials during tympanoplasty operation. This work aimed to evaluate the role of autologous platelet-rich fibrin as an adjuvant in type 1 tympanoplasty (myringoplasty) for the closure of central tympanic membrane perforations. A prospective comparative study was conducted including one-hundred patients with chronic suppurative otitis media with dry central TM perforations. The patients were classified into two equal groups: group A (case group) was subjected to myringoplasty operation with the use of autologous PRF added to the temporalis fascia graft, and group B (control group) was subjected to myringoplasty operation using graft only without PRF. Both groups were assessed for successful closure of perforation defined as an intact eardrum, success in terms of hearing defined as closure of air-bone gap down to 10 dB or lesser, and hearing gain at 6 months postoperatively.ResultsAt 6 months postoperatively, the success rate (graft taking) in group A (90%) was significantly higher than in group B (70%). Success in terms of air-bone gap closure (< 10 dB) revealed that in group A, success was achieved in 39 patients (78%), which was significantly higher than in group B 27 patients (54 %). Air-bone gap at 6 months postoperatively was more in the graft taken cases in the case group than in the control group with a significant difference. There was a nonsignificant correlation between graft uptake and either hemoglobin or platelet concentrations in both groups. In addition, there was a nonsignificant correlation between graft uptake and the size of the perforation in both groups.ConclusionPlatelet-rich fibrin is a cheap, cost-effective, and completely autologous platelet concentrate with enriched growth factors. It improves the overall success rate of myringoplasty with no noticeable side effects.

Modifications in Abdominal Wall Graft Retrieval: When the Donor Closure Is Not Guaranteed

Twenty percent of intestinal transplant recipients will require a surgical alternative to conventional primary abdominal wall closure. Abdominal wall transplant is adevelopingtechnique that is increasingly performed for this purpose in isolated intestinal or multivisceral recipients; however, adequate closure of the donor is paramount while simultaneously obtaining a large enough graft. The aim of this study is to describe alternative surgical techniques for closure of the donor in cases in which abdominal wall graft extraction hinders subsequent donor abdominal closure. We describe the cases of 2 young donors in whom intestinal extraction was not carried out and in whom wall closure was not feasible, following standard techniques after abdominal wall graft extraction. We performed 2 different procedures to obtain adequate closure. 1. Hemifascia and hemiabdominal wall graft extraction: It is an option when the recipients require an extension of the abdominal aponeurosis yet have enough skin to guarantee skin closure. The perfusion of both epigastric arteries is needed. The remaining cutaneous half is used for closing the donor's abdomen.2. Hemiabdominal wall graft extraction: Full-thickness abdominal wall is harvested from the donor, selecting the most vascularized half. It is an alternative for recipients who need a skin implant in addition to an aponeurosis extension. This option should be used for recipients who do not require a large fascial graft but do require a significant cutaneous graft. The nontransplanted half of full-thickness abdominal wall is used for donor closure. Abdominal wall transplant allows forexpansion of the abdominal cavity in organ recipients and reduces the risk of compartmental syndrome and subsequent ischemia. However, the donor wall defect must be considered. The choice of donation technique was based on the magnitude of the defect in the donor as well as the size of defect to be covered in the recipient while ensuring a tight and complete closure of the donor's abdomen. Abdominal wall graft extraction can be performed using nonconventional techniques that account for the extension and type of coverage needed by the recipient while guaranteeing proper closure of the donor.

Success Rate of Revision Myringoplasty Using Temporalis Fascia Graft

Background and Aim: To evaluate the success rate of revision myringoplasty using temporalis fascia graft and to assess the effect of potential influencing factors on closure of tympanic membrane (TM) and hearing outcome such as size and site of perforation, whether the patient is smoking or not and condition of contralateral ear. Methods: Thirty patients were included in this prospective study, who underwent revision myringoplasty for chronic otitis media without cholesteatoma in the period between 2017- 2019 in the Department of Ear, Nose, and Throat-Head and Neck Surgery in Almowasat University Hospital. Data of all patients: perforation size and site, middle ear status, surgical approach, graft material, pre and postoperative morphological and functional results were assessed. The temporal fascia was used for the reconstruction of TM. The interrelation between multiple preoperative parameters and postoperative morphological (closure of the perforation) and functional (hearing level) outcomes were assessed. Results: Successful closure rate of the TM perforation was 86.66% and failure rate was 13.34% in revision myringoplasty. The improvement of the air bone gap between 10-20 dB was 76.66% while the air bone gap between 20-30 dB was unchanged 23.33%. Conclusion: Revision myringoplasty can offer reasonably good chances for postoperative graft healing and hearing improvement with a high success rate. This gives the patient a good benefit in protecting the ear from developing complications that may have poor structural changes in the middle ear (ossicular necrosis and tympanosclerosis) which in turn leads to hearing loss. Keywords: Revision myringoplasty; temporalis fascia; tympanic membrane perforation

Comparative study between temporalis fascia graft with and without addittion of cyanoacrylate glue in myringoplasty

Background: Tissue adhesives are often used in myringoplasty because they can hold the graft in place and help the graft absorb by acting as a framework. Aim of the study: The goal is to look at the temporalis fascia graft used in myringoplasty with and without cyanoacrylate glue and compare the two. Patients, and methods: Fifty patients with dry central tympanic membrane perforation were treated with type I tympanoplasty over the course of 1.5 years. In each instance, the autogenous temporalis fascia graft was spot welded and fixed to flaps and the surrounding tissue using glue. Myringoplasty was done on 50 people, and they were randomly put into two groups: those who had cyanoacrylate glue put on the temporalis fascia graft and those who didn't. Results: Each group had 25 cases, and there were no big differences between the groups in terms of age, direction, or size of the tympanic membrane hole. After 6 weeks, there wasn't much difference between the glue group and the control group. In the glue group, 72% had healed and 28% had perforated, while in the control group, 64% had healed and 36% had perforated (p-value 0.544).

Fat graft in cerebrospinal fluid leak repair after sellar and parasellar lesion surgery of 2000 patients; a multicenter study

IntroductionThis study investigates the outcome of cerebrospinal fluid leakage repair after endoscopic transsphenoidal surgery (ETSS) sellar and parasellar lesions with fat graft. Method and materialsThis is a cross-sectional study designed to evaluate the results of sellar and parasellar repair with simplified method of using only fat graft as the primary choice in patients undergoing ETSS surgery at three referral hospitals between 2011 and 2021. ResultsIn 2000 sellar and parasellar transsphenoidal surgeries, 860 patients had intraoperative CSF leak and were repaired to stop CSF leak mostly with fat graft only. 58 patients came back with delayed cerebrospinal fluid leak. Of these, 21 patients did not have intraoperative leak with no primary surgical repair but came back with a delayed CSF leak. Repair method for 37 ‘re-leak’ cases was fat in 29 patients, fat with fascia and/or nasoseptal flap for the rest of them. The success rate was 96.3% for intraoperative leaks that were primarily managed with fat graft alone. ConclusionOur study suggests that fat graft can be considered a reliable material for sellar reconstruction which is easy to harvest and use, regardless of the type of leak flow (high vs low). Using other materials or more complex multilayer methods such as facial grafts or pedicled vascularized flaps are advisable choices for unusual and very large defects or secondary postoperative CSF leaks.

A fascia bow traction method for the treatment of unilateral marginal mandibular nerve paralysis after mandibulectomy for head and neck cancer

BackgroundUnilateral paralysis of the marginal mandibular nerve (UPMMN) after head and neck cancer surgery is a relatively common condition that causes deformity and an asymmetric appearance of the lower lip and impairs the quality of life of patients. We developed a novel fascia grafting method to improve the appearance of the lower lip in patients with UPMMN. MethodsTwo fascia strips and a small fascia loop connecting the two strips are used: one is fixed horizontally to pull the lower lip toward the paralyzed side, and the other is fixed in a bow shape at rest to avoid approaching the lateral mandibular margin. When patients smile or open their mouths, the bow-shaped graft straightens, pulling the paralyzed lower lip laterally downward through the small connecting loop. We used this method to treat four patients with UPMMN who had undergone head and neck cancer ablation. The symmetry and movement of the lower lip were assessed using preoperative and postoperative photographs of three poses (at rest, smiling, and opening the mouth). ResultsThe fascia grafting procedure restored the symmetry of the lower lip at rest and greatly improved symmetrical lower lip movement when smiling and opening the mouth. According to photographic evaluation scores, all patients had poor lower lip symmetry in the three poses before the procedure, whereas after the procedure, three had excellent lower lip symmetry, and one had good lower lip symmetry. There was a significant difference between the scores before and after the surgery. ConclusionsFascia grafting is easy and minimally invasive, allows patients to generate an almost symmetrical smile, and consequently improves their QOL. This method may be particularly useful when the lateral mandibular bone is resected during cancer surgery, and the defect is reconstructed with metal plates/soft tissue, as the method does not require approaching the lateral mandibular region.

Comparative study of tympanoplasty using endomeatal approach using tragal cartilage and perichondrium with postauricular approach using temporalis fascia graft

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic suppurative otitis media is a disease which is a major cause of morbidity in our country. A large proportion of patients have safe (mucosal) chronic suppurative otitis media which leads to ear discharge and deafness which hampers the productivity of many individuals. Otolaryngologists play an important role in its correction and amelioration by conservative or operative procedures. One such procedure is tympanoplasty.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Patients of either sex having symptoms and signs suggestive of chronic suppurative otitis media and fulfilling the inclusion and exclusion criteria are taken for the study My sample size is 60 and these 60 patients were divided into 2 groups. A. tympanoplasty with temporalis fascia graft. B. tympanoplasty with cartilage island graft. 30 patients were included in each group. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In the cartilage island group, the graft uptake rate was 96.7% as compared to the temporalis fascia group in which the same was 90%. There is no significant difference in Air Bne gap between 2 groups.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Cartilage Island graft is as good a graft material as temporalis fascia for tympanoplasty.&lt;/p&gt;

A 5 YEAR PROSPECTIVE COMPARATIVE STUDY OF ENDOSCOPIC VERSUS MICROSCOPIC TYMPANOPLASTY IN A TERTIARY CARE CENTRE OF SOUTH INDIA.

CONTEXT: Type 1 tympanoplasty is one of the commonest performed surgeries by otolaryngologists across the world. Endoscopic ear surgeries (EES) are gaining more popularity in recent times. The objective of this study is to evaluate the outcomes of endoscopic type 1AIMS: tympanoplasty and compare with that of microscopic tympanoplasty A prospective observational comparative studySETTINGS AND DESIGN: of two surgical techniques was conducted in a tertiary care hospital of south India from 2015- 2019. All patientsMETHODS AND MATERIAL: underwent type 1 tympanoplasty either endoscopic or microscopic using temporalis fascia graft. S StatisticalTATISTICAL ANALYSIS USED: package for the social sciences (SPSS) version 17 was used to analyse the data. Chi square test/Fisher's exact test was used to analyse the qualitative data. Student t test was used to analyse the quantitative data A total of 152 patients who satised the study criteria were included in this. RESULTS: study. 80 patients underwent endoscopic tympanoplasty (Group A), while 72 patients microscopic tympanoplasty (Group B). Both the groups were comparable with respect to age gender, size and location of perforation. The mean operative time for group A and group B were 45.3 ± 7.1 and 50.2± 8.1 mins respectively (P=0.01). Successful graft uptake was observed in 75/80(93.75%) and 68/72(94.4%) in group A and group B (P= 0.45). Mean pre and post operative ABG were 30.2 ± 3.2 dB &amp;29.8± 3.6 dB and 11.6± 1.8 dB &amp; 11.9± 2 dB respectively (p= 0.32 and P=0.24). Group A had better post-operative VAS scores(P=0.01) and lesser canalplasty requirement(p=0.04) In this study, the hearing results ofCONCLUSIONS: endoscopic and microscopic tympanoplasty were comparable and no signicant difference was observed. However, endoscopic tympanoplasty had better outcomes in terms of lesser canalplasty requirement and post operative pain scores.