← All decks
ENT
Tympanoplasty Underlay Technique
Built from Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
What’s inside
10 sections · 107 slides
Overview
- Scope of this presentation
Definitions and goals
- Definition of tympanoplasty
- Tympanoplasty versus myringoplasty
- Underlay and overlay classification
- Principle of tympanic membrane grafting
- Primary goal: a safe, dry ear
- Hearing goal and the middle ear transformer
- Reinforcing structural integrity
Indications and contraindications
- Indications for tympanoplasty
- Absolute contraindications
- Relative contraindications
- The actively draining ear
- Eustachian tube dysfunction
- Tympanoplasty in the elderly
- Timing of tympanoplasty in children
Preoperative evaluation
- Neurotologic history
- Otologic examination and audiometry
- Assessment of the perforation margin
- Optimising the draining ear before surgery
- Indications for temporal bone CT
- MRI and informed consent
Graft materials
- Evolution of graft materials
- Loose areolar tissue: fool's fascia
- Cartilage as a graft material
- Graft options in revision surgery
Surgical approaches
- Determinants of surgical approach
- Comparison of transcanal and postauricular surgical approaches for tympanoplasty: indications
- Comparison of transcanal and postauricular surgical approaches for tympanoplasty: advantages
- Comparison of transcanal and postauricular surgical approaches for tympanoplasty: disadvantages
- Transcanal approach: caveat on perforation size
- Relative merits of the two approaches
- Endoscopic ear surgery
Surgical technique
- Anaesthesia for tympanoplasty
- Patient positioning
- Local infiltration and haemostasis
- Skin preparation and ototoxicity
- Vascular strip injection
- Preparing the drum head
- Scarifying the medial drum surface
- Tympanomeatal flap design for the transcanal approach
- Transcanal canal incisions
- Classic vascular strip incision for the postauricular approach
- Vascular strip incision technique
- The swinging-door tympanomeatal flap
- Swinging-door flap design
- Postauricular incision and fascia harvest
- Postauricular incision
- Temporalis fascia harvest
- Exposing the ear canal
- Pitfalls in vascular strip elevation
- Canalplasty for the prominent anterior canal wall
- Canalplasty technique
- Tympanomeatal flap elevation
- Elevating the drum off the malleus
- Removal of middle ear disease
- Middle ear packing before grafting
- Underlay grafting for near-total perforations
- Graft placement in near-total perforations
- Underlay grafting for subtotal perforations
- Manoeuvres for anterior graft advancement
- Lowering the canal wall skin flaps
- Closure in transcanal cases
- Closure in postauricular cases
- Sequence of the underlay tympanoplasty
Cartilage tympanoplasty
- Rationale for cartilage tympanoplasty
- Tragal cartilage-perichondrial graft harvest
- Tragal cartilage harvest technique
- Conchal cartilage harvest
- Perichondrial-cartilage island flap in position
- Perichondrium-cartilage island flap technique
- Palisade and mosaic cartilage reconstruction
- Palisade and mosaic techniques
- Cartilage thickness and acoustics
Additional grafting techniques
- Lateral-to-malleus (over-under) tympanoplasty
- Anterior marginal perforations
- Swinging-door flaps with anterior advancement
- Anterior graft stabilisation techniques
- Anterior-hitch or hammock technique
- Three points of graft fixation
Postoperative care and outcomes
- Discharge and wound instructions
- Postoperative medication
- Follow-up schedule
- Tympanometry after cartilage grafting
- Prognostic factors for graft take
- Smoking as a prognostic factor
- Reported graft-take rates
- Timing of graft failure
- Reperforation and chorda tympani injury
- Hearing and infective complications
- Sensorineural loss, vertigo and rare complications
- Summary
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
- Join our WhatsApp groups