Perichondrium Group Research Articles

Mucosal Epithelial Preservation of Free Nasal Grafts Depending on the Recipient Site.

Reconstruction of mucosal defects using free mucosal grafts has become a common procedure during endoscopic sinus surgery. Epithelialization of mucosal grafts affects postoperative complications and outcomes, which could be influenced by different recipient tissue. However, morphological changes occurring in the grafts transplanted over different tissues remain unexplored. An animal study. Free mucoperichondrial grafts were prepared from the nasal septum of rabbits; the cartilage group had reconstruction on the nasal septal cartilage, and the perichondrium group had reconstruction on the contralateral perichondrium. The nasal septum was removed after 1 and 4 weeks of reconstruction, and the graft was histologically evaluated. After 1 week of reconstruction, the mucosal epithelium of grafts in the cartilage group disappeared, whereas the columnar epithelium of grafts was preserved in the perichondrium group. After 4 weeks of reconstruction, the mucosal defect site was covered with mucosal epithelium in both groups. However, while squamous epithelium was mostly observed in the cartilage group, columnar epithelium containing the healthy ciliary and goblet cells was observed in the perichondrium group. Statistically significant differences were detected in the parameters of epithelial morphology between the two groups, which were higher in the perichondrium group. In the reconstruction of mucosal defects using free mucosal grafts, difference in recipient tissue affects the graft epithelial morphology. NA Laryngoscope, 132:2301-2306, 2022.

A comparative study of temporalis fascia versus tragal perichondrium graft in myringoplasty

<p class="abstract"><strong>Background:</strong> This study aimed to compare the efficacy of temporalis fascia and tragal perichondrium grafts in myringoplasty and to assess the hearing improvement following surgery.</p><p class="abstract"><strong>Methods:</strong> This was a clinical prospective study involving 50 patients of chronic suppurative otitis media inactive mucosal disease who were assigned to two groups. Group I was temporalis fascia group and group II was tragal perichondrium group and subsequently underwent myringoplasty. Patients were followed up at 3 and 6 months.</p><p class="abstract"><strong>Results:</strong> There was a preponderance of ear disease among children, with a male to female ratio of 1:1.63. Preoperative dry ear for 1-6 months was associated with 82.9% success rate (group I 76.5%, group II 87.5%). Patients with cellular mastoids were associated with 100% success rate.</p><p class="abstract"><strong>Conclusions:</strong> In this study we found that patients with cellular mastoids and dry ear for 1-6 months were associated with higher success rates. The study also revealed that in terms of hearing gain postoperatively, the temporalis fascia graft fared slightly better than the tragal perichondrium graft. Tragal perichondrium and temporalis fascia grafts appear to have almost similar graft take rates.</p>

Tragal cartilage versus tragal perichondrial graft in tympanoplasty type 1

Background Chronic suppurative otitis media is a common health problem. It causes tympanic membrane perforation, otorrhea, and conductive hearing loss. Type 1 tympanoplasty is a common otological procedure done to eliminate the infection and improve hearing and quality of life. Objective To compare graft uptake and hearing outcome using autologous grafts (tragal cartilage, temporalis fascia (control group), and tragal perichondrium) in tympanoplasty type 1. Patients and methods A total of 45 patients with chronic suppurative otitis media were included in this comparative study. They were divided into three groups, with 15 patients in each group: group A received tragal cartilage graft, group B received temporalis fascia graft (control group), and group C received tragal perichondrial graft. Patients were subjected to detailed history taking, proper clinical examination, routine blood investigations, audiometry, and tympanometry preoperatively. They underwent underlay tympanoplasty type 1. Postoperative follow-up was done after 3 months by otoscopy to evaluate graft uptake and hearing outcome by audiometry, and results were compared. Results Graft uptake was 93.3% in the cartilage group, 73.3% in fascia (control) group, and 66.7% in perichondrium group. There was hearing improvement in cartilage group than fascia (control) group, which was better than perichondrium group, with no statistically significant difference among the three groups regarding graft uptake (P=0.188) or hearing gain. Conclusion Graft uptake and hearing improvement were better with tragal cartilage graft in comparison with fascia (control group) and perichondrium grafts, with no statistically significant difference between them.

A PROSPECTIVE COMPARATIVE STUDY OF A-B GAP IMPROVEMENT IN PURE TONE AUDIOMETRY BETWEEN CSOM CASES UNDERGOING TYPE 1 TYMPANOPLASTY USING TRAGAL PERICHONDRIUM AND TEMPORALIS FASCIA GRAFT

Aim: To ascertain whether the A-B gap improvement of tragal perichondrial grafting is better than TF grafting in CSOM patients undergoing type 1 tympanoplasty by underlay technique.
 Methodology: A prospective comparative study was done in CSOM patients presenting to a tertiary health care establishment. 60 patients underwent type 1 tympanoplasty, using TF graft in 30 and tragal perichondrial graft in 30 patients. Both groups of patients were compared in terms of A-B gap improvement following surgery.
 Results: A-B gap improvement of all the 60 patients were analysed. 8(26.67%) patients had A-B gap improvement </= 15dB in both the tragal perichondrium and TF graft group. Rest 22(73.33%) patients had A-B gap improvement of 16-25dB in either group. In cartilage group, 14 out of 15 patients i.e, 93.33%, while in Fascia group, 10 out of 12 pateints i.e, 83.33% patients who had perforation involving anterior quadrant had A-B gap closure between 16-25dB post- operatively. Therefore, cartilage graft showed better A-B gap closure than fascia graft in anterior quadrant.
 When both the quadrants were taken into consideration, 11 out 17 i.e, 65% patients in fascia group while 8 out of 13 i.e, 61% patients in cartilage group showed AB gap closure between 16-25dB. Therefore, fascia graft showed better result.
 Conclusions: This study showed that A-B gap improvement is similar in CSOM patients undergoing type 1 tympanoplasty using either TF or tragal perichondrial graft. Either of these can be good for improving the hearing in CSOM patients but tragal cartilage with perichodrium showed better results with perforation involving anterior quadrants.

Comparison of acellular dermal allograft and tragus cartilage perichondrium in type Ⅰ tympanoplasty under otoendoscopy

Objective:To compare the therapeutic effect of otoendoscopic tympanoplasty with acellular dermal allograft（AlloDerm） and tragus cartilage perichondrium. Method:121 patients who underwent type Ⅰ tympanoplasty under otoscope were retrospectively analyzed. According to the grafts used, they were divided into two groups: AlloDerm group （56 cases） and tragus cartilage perichondrium group （65 cases）. The operative time, postoperative tympanic membrane healing rate, and hearing recovery were compared between two groups. The follow-up time was twelve months. Result:The operative time in the AlloDerm group were lower than those in the tragus cartilage perichondrium group（P<0.05）. The successful closure rates between the acellular dermal allograft group and tragus cartilage perichondrium group at 1-month follow-up were 92.86% and 92.31% respectively, while the closure rates between two groups at 6-month follow-up were drop to 91.07% and 90.77% respectively, the closure rates between two groups at 12-month follow-up were also 91.07% and 90.77% respectively,the was no statistically difference between two groups（P>0.05）. The difference in pre-and post-operative air bone gap（ABG） values between two groups was no statistically significant（P>0.05）. Conclusion:Both the AlloDerm and the tragus cartilage perichondrium tympanoplasty can achieve satisfactory healing rate of the tympanic membrane and audiologic improvement. However, AlloDerm has a short operation time, no need to obtain materials and less trauma, and is worth of promotion and application.

Two-component surface replacement implants compared with perichondrium transplantation for restoration of Metacarpophalangeal and proximal Interphalangeal joints: a retrospective cohort study with a mean follow-up time of 6 respectively 26\u2009years

BackgroundThe aim of our study was to compare the long-term outcome after perichondrium transplantation and two-component surface replacement (SR) implants to the metacarpophalangeal (MCP) and the proximal interphalangeal (PIP) joints.MethodsWe evaluated 163 joints in 124 patients, divided into 138 SR implants in 102 patients and 25 perichondrium transplantations in 22 patients. Our primary outcome was any revision surgery of the index joint.ResultsThe median follow-up time was 6 years (0–21) for the SR implants and 26 years (1–37) for the perichondrium transplants. Median age at index surgery was 64 years (24–82) for SR implants and 45 years (18–61) for perichondium transplants. MCP joint survival was slightly better in the perichondrium group (86.7%; 95% confidence interval [CI]: 69.4–100.0) than in the SR implant group (75%; CI 53.8–96.1), but not statistically significantly so (p = 0.4). PIP joint survival was also slightly better in the perichondrium group (80%; CI 55–100) than in the SR implant group (74.7%; CI 66.6–82.7), but below the threshold of statistical significance (p = 0.8).ConclusionIn conclusion, resurfacing of finger joints using transplanted perichondrium is a technique worth considering since the method has low revision rates in the medium term and compares favorable to SR implants.Level of evidenceIII (Therapeutic).

Is type 1 tympanoplasty effective in elderly patients? Comparison of fascia and perichondrium grafts

Background: Tympanoplasty is regularly performed in various ages but data about the procedure in elderly is insufficient.Objectives: To compare the success rates and hearing outcomes of fascia and perichondrium grafts used for tympanoplasty in patients >65 years and to evaluate the prognostic factors affecting the success of tympanoplasty.Methods: Reviewing records of 49 elderly patients underwent tympanoplasty, two groups were constituted: perichondrium (25 patients) and fascia (24 patients) groups. Ages, genders, perforation sides, type and location of perforation, graft success rates, functional success rates and air–bone gap (ABG) gains were compared.Results: Overall graft success rate was 85.7%. After a mean follow-up of 23.3 ± 8.32 months, overall mean ABG gain was 11.33 ± 8.42 dB. Overall median postoperative ABG value (9 dB) was significantly lower compared to the median preoperative value (24 dB) (p < .001). Graft success rate was higher in perichondrium group (96%) compared to fascia group (75%) (p = .04). Functional success rate did not significantly differ between perichondrium (68%) and fascia groups (62.5%) (p = .68).Conclusion and significance: Tympanoplasty is an effective procedure with a graft success rate of 85.7% in elderly. Both fascia and perichondrium are suitable materials; however, perichondrium had higher success rate.

Temporalis Fascia versus Tragal Mucoperichondrium Graft in Myringoplasty

Background: Chronic suppurative otitis media (CSOM) constitutes a major public health problem in children and adults in the developing world. It is an infection characterized by recurrent middle-ear discharge through a persistent tympanic membrane perforation. Objective: the aim of the present study is to compare the surgical and audiological results of temporalis fascia versus tragal perichondrium in myringoplasty Patient and Methods: a randomized prospective study concerned with 60 patients for whom myringoplasty was done. Patients were randomly assigned into two groups; in the first group temporalis fascia graft was used (30 patient) and tragal perichondrium graft was used in the second group (30 patients). Results: our study included 60 patients, 27 males and 33 females with a range from 19- 45 years. Surgical success rates for the first and second groups are 80% and 73.3%, respectively. There was 10.5 dB improvement in mean hearing threshold in fascia group, compared to 8.16 dB improvement in perichondrium group, giving an average of 9.33 dB improvement in mean hearing threshold of the total series. Conclusions: mean value of gain among temporalis fascia graft group was higher than tragal perichondrium graft group. There was statistically significant difference between the two groups regarding gain and no significant difference in surgical success rate between the two groups.

Type 1 tympanoplasty in pediatric patients: Comparison of fascia and perichondrium grafts

ObjectiveThe timing of tympanoplasty in the pediatric age group is an ongoing debate. The purpose of this study was to analyze and compare the success of grafts in type 1 tympanoplasty in pediatric patients, and to evaluate the prognostic factors that may affect its success. Materials and methodsA retrospective study of 42 pediatric patients who were younger than 18 years and underwent a primary type 1 tympanoplasty using tragal cartilage perichondrium and temporalis fascia from January 2013 to December 2018, were evaluated. A total of 42 medical records of children aged between 8 and 18 years (20 female, 22 male) were reviewed. Age, gender, co-morbidities, perforation size and location, type (central, marginal), pre- and post-operative hearing levels, mean air-bone gap (ABG), graft material (fascia, perichondrium), length of follow up and surgical outcomes were collected. ResultsThe overall graft success rate was 83.3% (out of 35 patients). The graft success rate was significantly higher 95.2% (20/21) for the perichondrium group compared with 71.4% (15/21) for the temporal fascia group(p = 0.023). The functional success rate (postoperative air–bone gap<20 dB) obtained in the perichondrium group was 90.4% (19/21) and 85.7% (18/21) in the fascia group, respectively. After a mean follow-up of 27.5 ± 11.55 months, the mean hearing improvement was 11.26 ± 7.53 dBHL for overall the group. Presence of contralateral otitis media with effusion (OME) was found a risk for reperforation and bilateral perforations were negatively affected graft success rate (p < 0.01). Graft success did not affected by age, gender and type and location of perforation (p > 0.05). ConclusionBoth temporalis fascia and tragal cartilage perichondrium are suitable graft materials for pediatric tympanoplasty with 83.3% of graft success rate. Tragal cartilage perichondrium may be the first choice of graft material due to its high success rates. There were no significant differences between the fascia and perichondrium groups in terms of functional results. Reperforation is more likely to occur in bilateral perforations and contralateral OME, and should be treated with perichondrium or cartilage graft.

Comparison of the anatomical and functional success of fascia and perichondrium grafts in transcanal endoscopic type 1 tympanoplasty

BackgroundThere are no studies in the literature, comparing the functional and anatomical successes of the use of fascial and perichondrial grafts in endoscopic type 1 tympanoplasties.ObjectivesTo compare the anatomical and functional outcomes of grafting with the fascia of the temporalis muscle and with the perichondrium of the tragal cartilage in patients undergoing primary transcanal type 1 tympanoplasty with endoscopy.MethodsWe enrolled a total of 151 patients (80 females and 71 males with a mean age of 26.0 ± 9.3 years in the age range between 18-57) with MERI scores ranging from 1 to 3 and who underwent a transcanal endoscopic type 1 tympanoplasty without tympanomeatal flap elevation. The patients were assigned to two groups according to the type of the graft used. The patients were assigned to either the tragal cartilage perichondrium group (Group A) or the fascia of the temporal muscle (Group B). The groups were compared according to the pre- and postoperative air-bone gaps and to the status of the tympanic membrane.ResultsThere were no statistically significant differences in the distribution of the age, gender, localization, MERI scores, the duration of the operation, and the size of the perforation (all p values> 0.05). The pre-operative air-bone gap values of Group A and B did not show a statistically significant difference (p = 0.073). The postoperative improvement in the air-bone gap value did not demonstrate a significant difference between Group A and B (p = 0.202). The graft retention rates were 94.9 and 97.2% in Group A and in Group B respectively. There were no statistically significant differences between the two groups in terms of the graft retention success rates (p = 0.743).ConclusionPerichondrium and fascia were suitable for use in endoscopic tympanoplasties.

Surgical outcomes of tympanoplasty using a sterile acellular dermal allograft: a prospective randomised controlled study.

SUMMARYAcellular human dermal allografts have been shown to be effective for soft-tissue implantation. We compared treatment outcomes of tympanoplasty using tragal perichondrium and acellular human dermal allograft (MegaDerm®). In a prospective randomised controlled study, 60 patients scheduled to undergo tympanoplasty were randomly assigned to the autologous tragal perichondrium group (n = 33) or acellular human dermal allograft group (n = 27). Postoperative hearing gain, graft success rate at 1 and 6 months and operation times were compared between groups. Graft success rate, defined as the complete closure of tympanic membrane perforation, did not show any significant intergroup difference (75.8% vs 85.2%, p = 0.519). Air conduction thresholds and air-bone gaps showed significant improvements in both groups; from 38.7 ± 15.9 dB to 30.2 ± 15.6 dB (p < 0.001) and from 17.8 ± 7.3 dB to 11.5 ± 7.0 (p = 0.001) in the autologous tragal perichondrium group, and from 30.4 ± 12.2 dB to 24.5 ± 13.0 dB (p = 0.006) and from 14.3 ± 5.1 dB to 7.6 ± 4.6 dB (p < 0.001) in the acellular human dermal allograft group. The amount of hearing gain (p = 0.31) and closure of air-bone gap (p = 0.863) were not meaningfully different between groups. The mean operation time was significantly lower in the acellular human dermal allograft group (35.2 min vs 27.4 min, p = 0.039). In this prospective randomised controlled study, acellular human dermal allograft was shown to be an effective alternative to tragal perichondrium, with similar graft success rates and postoperative hearing results, but with reduced operation times.

Comparative study of type I tympanoplasty using temporalis fascia and tragal cartilage with perichondrium as graft material

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Temporalis fascia and cartilage are the most commonly used graft materials, though contradictory reports are available in literature as regards their efficacy. The purpose of this study was to compare graft acceptance and auditory outcomes of tympanoplasty using cartilage versus temporalis fascia as graft material.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective study included 40 consecutive cases of chronic otitis media in a tertiary care centre randomised in two groups of 20 patients each to be subjected to tympanoplasty using either tragal cartilage-perichondrium or temporalis fascia graft from January 2011 to November 2012. Graft uptake rates and subjective as well as objective hearing improvement at 2 months and 6 months postoperative follow-up were compared. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean age of presentation was 34.4 years (range 15-60 years). At 2 months post operatively, the graft uptake was better with tragal cartilage group (95%) than temporalis fascia (90%), while at the end of 6 months graft uptake was better with temporalis fascia (75%) compared to tragal cartilage (70%). Hearing improvement was better for tragal cartilage group compared to the temporalis fascia group at both 2 months and 6 months follow-up. The subjective improvement in hearing at the end of 6 months was also better for tragal cartilage- perichondrium group than the temporalis fascia group.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Both temporalis fascia and tragal cartilage–perichondrium are suitable graft materials for tympanoplasty. Graft uptake was superior with temporalis fascia, while hearing improvement was better with tragal cartilage- perichondrium, although the results were not statistically significant.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Comparative Study of Hearing Improvement of Type 1 Tympanoplasty Using Temporalis Fascia and Conchal Cartilage as Graft Material.

Tympanic Membrane perforation is a common cause of hearing loss. Various surgical techniques with different types of graft materials have been described for the treatment of perforations. The conchal cartilage and temporalis fascia graft are most widely used. We conducted a prospective Randomized control trial at Sri Guru Ram Das Institute of Medical Sciences and Research to compare the post operative hearing outcomes between the patients of safe CSOM (n=40) using temporalis fascia (n=20) and conchal cartilage (n=20). It was found that the AB gap closure at 2months post-operatively was 11.55±8.173 for conchal perichondrium group as compared to 10.49±9.069 for temporalis fascia group. At 6months the AB gap closure was 14.98±9.915 for conchal cartilage group as compared 11.41±8.288db for temporalis fascia group. Thus hearing improvement was better for conchal cartilage group both at 2 and 6months but the comparison of the AC gain at the end of 6months and subjective improvement in hearing between the two techniques was not statistically significant owing to the small sample size of the study. Both Temporalis fascia and conchal cartilage with perichondrium were acceptable graft material for successful closure of tympanic membrane perforation, hearing improvement was better with conchal cartilage group.

Hearing results with cartilage tympanoplasty

Cartilage has shown promise as a graft material to close perforations in the tympanic membrane (TM), particularly in cases of advanced middle ear pathology. Although it is similar to fascia, its more rigid quality tends to resist resorption and retraction. However, it is this rigid quality that has led many to anticipate a significant conductive hearing loss when using cartilage to reconstruct the TM. Because little has been reported in the literature comparing hearing results using cartilage with results using other grafting materials, this retrospective study was conducted to compare the hearing results of patients with cartilage tympanoplasty with results in patients who underwent revision tympanoplasty using perichondrium. Both series of patients had undergone type I tympanoplasty, and the middle ear pathology was considered to be similar between the two groups. TM closure was achieved in all 22 patients undergoing cartilage reconstruction, but three of the 20 patients undergoing perichondrium reconstruction had a recurrent perforation during the follow-up period (approximately 1 year). The average pre- and postoperative pure-tone average air-bone gap (PTA-ABG) was 21.1 dB and 6.8 dB for the cartilage group and 17.9 dB and 7.7 dB for the perichondrium group, respectively. These gains in hearing were statistically significant (P < 0.001 in each case), but there was no statistically significant difference in hearing results between the two groups. Analysis of the PTA-ABG as a function of percentage of TM reconstructed showed no statistically significant difference in hearing results due to percentage of cartilage used. These results indicate that cartilage tympanoplasty offers the possibility of a rigorous TM reconstruction with excellent postoperative hearing results.