The anterior tympanomeatal angle in tympanoplasty: surgical techniques for the prevention of blunting.

The surgical repair of the anterior tympanic membrane with reconstruction of the vibrating anterior tympanomeatal angle is particularly difficult because of problems with graft separation, recurrent perforations, scar formation and blunting. The multilayer tympanoplasty technique anchors the structural layer of the drum to the annulus, by fixing the underlay fascial graft to the overlay graft, and reduces scar formation and blunting by immediate epithelial coverage of the vibrating anterior tympanomeatal angle. The purpose of this paper is to describe the multilayer sandwich graft tympanoplasty technique that has been effective in reconstructing the anterior tympanic membrane with preservation of the vibrating anterior tympanomeatal angle.