J M Gérard1, K el Makhloufi, M Gersdorff. 1. Department of Oto-rhino-laryngology, University Hospital Saint-Luc, 10 Avenue Hippocrate, B-1200 Brussels, Belgium.
Abstract
INTRODUCTION: Most tympanoplasty techniques require skin incision of the external auditory canal. This step is not without morbidity and postoperative complications such as delayed healing, granulation tissue, lateralization, blunting and iatrogenic cholesteatoma. For small or midsize non-marginalized tympanic membrane perforations of the posterior or inferior quadrants, a transmeatal approach without incision of the cutaneous epidermis of the external auditory canal can theoretically offer advantages such as rapid healing and reduced postoperative complications. In this paper we present the preliminary results of a tympanoplasty technique with a retroauricular approach without skin incision of the canal and an overlay graft. MATERIALS AND METHODS: We performed 10 tympanoplasties without skin incisions for small or midsize non-marginalized perforations, which do not exceed one third of the tympanic membrane surface, located in the inferior or posterior quadrants. RESULTS: With a minimum follow up of 3 months all patients showed excellent anatomical results without complications. Nine of them closed their average air bone gap at less than 10 dB. CONCLUSION: When anatomically feasible, our technique combines a post auricular approach and the absence of skin incision. It ensures rapid healing, preserves the anatomy of the eardrum and external auditory canal and reduces the risk of blunting and lateralization phenomena. The main difficulty concerns the cleavage of the epidermal and fibrous layer.
INTRODUCTION: Most tympanoplasty techniques require skin incision of the external auditory canal. This step is not without morbidity and postoperative complications such as delayed healing, granulation tissue, lateralization, blunting and iatrogenic cholesteatoma. For small or midsize non-marginalized tympanic membrane perforations of the posterior or inferior quadrants, a transmeatal approach without incision of the cutaneous epidermis of the external auditory canal can theoretically offer advantages such as rapid healing and reduced postoperative complications. In this paper we present the preliminary results of a tympanoplasty technique with a retroauricular approach without skin incision of the canal and an overlay graft. MATERIALS AND METHODS: We performed 10 tympanoplasties without skin incisions for small or midsize non-marginalized perforations, which do not exceed one third of the tympanic membrane surface, located in the inferior or posterior quadrants. RESULTS: With a minimum follow up of 3 months all patients showed excellent anatomical results without complications. Nine of them closed their average air bone gap at less than 10 dB. CONCLUSION: When anatomically feasible, our technique combines a post auricular approach and the absence of skin incision. It ensures rapid healing, preserves the anatomy of the eardrum and external auditory canal and reduces the risk of blunting and lateralization phenomena. The main difficulty concerns the cleavage of the epidermal and fibrous layer.