Comparative Study Between Tragal Perichondrium And Tragal Cartilage With Perichondrium As Graft Material In Type 1 Underlay Tympanoplasty

Background: Several graft material used in tympanoplasty operation to repair the perforated tympanic membrane. Our aim of this study is to compare the efficacy of tragal perichondrium and tragal cartilage with perichondrium as graft material Matetials and Methods:This study was a prospective one, conducted in Malda Medical College during January 2015 to December 2017, over 60 patients divided in two equal group randomly 30 patients each. One group undergone Tympanoplasty with tragal perichondrium as graft and in the other group we used tragal cartilage with perichondrium as graft material. The data was collected from above patients and statistically analyzed regarding graft taken or rejected and hearing improvement. Results and Analysis: Underlay tympanoplasty with tragal perichondrium as graft show about 86.67% success rate in respect to drum closure and Tragal cartilage with perichondrium show drum closure in about 80%. Post-operative AIR BONE gap improvement also little better in tragal perichondrium group than cartilage with perichondrium group. Conclusion: The study showed that both tragal perichondrium and tragal perichondrium with cartilage are good graft material in respect to drum closure and hearing improvement.

Surgical outcome of tragal cartilage in myringoplasty A prospective study

Background: Tympanoplasty refers to any operation involving reconstruction of the tympanic membrane and/or the ossicular chain. Myringoplasty is a Tympanoplasty without ossicular reconstruction. Chronic otitis media is one of the commonest Otological problems among Sudanese, in both adult and children (43%) and they presented with perforation of the eardrum and different degrees of hearing loss. Aim: To evaluate the audiological and surgical results of tragal cartilage graft in myringoplasty for reconstruction of tympanic membrane perforation. Materials and methods: A total of 25 patients in the age group of 16 - 60 years suffering from chronic suppurative otitis media of tubotympanic type, attending the outpatient department at Rajah Muthiah Medical College and hospital and underwent tragal cartilage myringoplasty between October 2015 to August 2017 were included in the study. Results: The mean preoperative pure tone average was 37 and the postoperative pure tone average was 25.80 at 6th week and 15.60 at 10th week. The calculated p-value was less than 0.001 which was statistically significant. Graft uptake was 92% in our study. There was no postoperative retraction. Postoperative reperforation was seen in 2 (8%) patients. Conclusion: Graft takeup in tragal cartilage myringoplasty has been excellent, hearing results are satisfactory and complications are minimal. Immobility of the transplant during the early stages of the healing process is the most important factor for the successful surgical outcome of myringoplasty.

A study on the outcome of tympanoplasty with various graft materials

Background: Chronic Suppurative Otitis Media (CSOM) is one of the most common causes of preventable hearing loss especially in developing countries CSOM is a disease condition characterized by persistent perforation of tympanic membrane with recurrent or persistent mucopurulent Otorrhoea Aim: This study was undertaken to review the outcomes (hearing improvement) achieved by using various graft materials like temporalis fascia (TF), tragal cartilage (TC), Conchal cartilage (CC), autologous sculpted incus (I), autologous cortical bone (BG) in tympanoplasty surgery Material and methods: This study comprised of 14 males and 16 females patients with age ranging from 12 years to 55 years They were selected for surgery after adequate history taking, clinical, otoscopic and microscopic examination Type 1 tympanoplasty was done in 19 patients, Type 3 tympanoplasty + Modified Radical Mastoidectomy (MRM) was done in 11 patients by using various graft materials The results were evaluated in the form of rate of graft success, hearing gain, and the pre and post-operative Air Bone gap Results: Out of 30 patients, in 20 TF graft patients AB gap improvement seen in 14 patients, 5 patients did not show any change and 1 patient did not come for follow up In 2 TC graft patients, both showed improvement in AB gap In 1 patient where CC graft was used showed improvement in AB gap In 6 patients I graft was used, 2 patients showed improvement, 2 patients did not show any change, 1 patient did not come for follow up and in 1 patient AB gap worsened In 1 patient BG was used and no change in AB gap was seen Out of 30 cases graft uptake was seen in 25 cases and graft rejection was seen in 3 cases and 2 patients did not come for follow up Graft rejection was documented in one case where TF was used, one case where incus graft was used and in another case where BG was used Harinarayana N, Srikanth M A study on the outcome of tympanoplasty with various graft materials IAIM, 2018; 5(12): 77- 82 Page 78 Conclusion: Post-operative hearing gain obtained was found to be better in patients operated upon with tubotympanic disease than those operated upon with atticoantral disease The post-operative hearing improvement depends not only on the graft material used and the type of tympanoplasty but also on the pre-operative status of the ossicular chain

Comparison of temporalis fascia muscle and full-thickness cartilage grafts in type 1 pediatric tympanoplasties / Comparação de enxertos com fáscia do músculo temporal e cartilagem de espessura total em timpanoplastias tipo 1 em crianças

Abstract Introduction: Various graft materials have been used to close tympanic membrane perforations. In the literature, there are few studies in pediatric populations comparing different graft materials. To our knowledge, there is no reported study that measured the thickness of the tragal cartilage in pediatric tympanoplasties. The tragal cartilage is not of uniform thickness in every patient. Objective: To compare anatomical and functional outcomes of temporalis fascia muscle and full-thickness tragal cartilage in type 1 pediatric tympanoplasties. Methods: In total, 78 patients (38 males, 40 females; average age 10.02 ± 1.98 years; range, 7-18 years) who underwent type 1 tympanoplasties in our clinic were included. Demographics, anatomical, and functional outcomes were collected. Temporalis fascia muscle and tragal cartilage were used as graft materials. Tragal cartilage was used without thinning, and the thickness of tragal cartilage was measured using a micrometer. Anatomical and functional outcomes of cartilage and fascia were compared. Audiometric results comparing the cartilage and fascia groups were conducted at 6 months, and we continued to follow the patients to 1 year after surgery. An intact graft and an air-bone gap ≤ 20 dB were regarded as a surgical success. Results with a p-value < 0.05 were considered statistically significant. Results: The graft success rate was 92.1% for the cartilage group compared with 65.0% for the temporal fascia group. In the fascia group, the preoperative air-bone gap was 33.68 ± 11.44 dB and postoperative air-bone gap was 24.25 ± 12.68 dB. In the cartilage group, the preoperative air-bone gap was 35.68 ± 12.94 dB and postoperative air-bone gap was 26.11 ± 12.87 dB. The anatomical success rate in the cartilage group was significantly better than that for the fascia group (p < 0.01). There was no statistically significant difference in functional outcomes between the fascia and cartilage groups (p > 0.05). The average thickness of tragal cartilage in the pediatric population was 0.693 ± 0.094 mm in males and 0.687 ± 0.058 mm in females. Conclusions: Our data suggest that the anatomical success rate for a cartilage tympanoplasty was higher than for a fascia tympanoplasty. Functional results with cartilage were not different than with fascia, even though we did not thin the tragal cartilage. However, further studies should focus on the interaction between the thickness of the tragal cartilage and the tympanoplasty success rate.

Resumo Introdução: Vários materiais de enxerto foram usados para o fechamento da perfuração da membrana timpânica. Há poucos estudos na literatura que comparam diferentes materiais de enxerto em populações pediátricas. De acordo com nossa pesquisa, não há estudo que tenha medido a espessura da cartilagem tragal em timpanoplastia pediátrica. A espessura da cartilagem tragal não é uniforme em todos os pacientes. Objetivo: Comparar os resultados anatômicos e funcionais da fáscia do músculo temporal e da cartilagem tragal com espessura total em timpanoplastias tipo 1 em crianças. Método: No total, 78 pacientes (38 do sexo masculino, 40 do sexo feminino; média de idade de 10,02 ± 1,98 anos; variação: 7-18 anos) submetidos a timpanoplastia tipo 1 em nossa clínica foram incluídos. Os resultados demográficos, anatômicos e funcionais foram registrados. A fáscia do músculo temporal e a cartilagem tragal foram usadas como materiais de enxerto. A cartilagem tragal foi usada sem fresagem e a sua espessura foi medida com um micrômetro. Os resultados anatômicos e funcionais da cartilagem e da fáscia foram comparados. Os resultados audiométricos comparando os grupos (cartilagem e fáscia) foram avaliados em 6 meses, e o acompanhamento dos pacientes prosseguiu até 1 ano após a cirurgia. Enxerto intacto e um intervalo aéreo-ósseo (gap) ≤ 20 dB foram considerados como sucesso cirúrgico. Os resultados com um valor p < 0,05 foram considerados estatisticamente significantes. Resultados: A taxa de sucesso do enxerto foi de 92,1% para o grupo cartilagem e de 65,0% para o grupo fáscia temporal. No grupo fáscia, o gap no pré-operatório foi 33,68 ± 11,44 dB, e 24,25 ± 12,68 dB no pós-operatório. No grupo cartilagem, o gap no pré-operatório foi 35,68 ± 12,94 dB, e 26,11 ± 12,87 no pós-operatório. A taxa de sucesso anatômico no grupo cartilagem foi significantemente melhor que a do grupo fáscia (p < 0,01). Não houve diferença estatisticamente significante nos resultados funcionais entre os grupos fáscia e cartilagem (p > 0,05). A espessura média da cartilagem tragal na população pediátrica foi 0,693 ± 0,094 mm em meninos e 0,687 ± 0,058 mm em meninas. Conclusões: Nossos dados sugerem que a taxa de sucesso anatômico para uma timpanoplastia com enxerto de cartilagem seja maior que a de uma timpanoplastia com enxerto de fáscia. Os resultados funcionais com cartilagem não foram diferentes daqueles com fáscia, embora não tenhamos fresado a cartilagem tragal. Porém, novos estudos devem concentrar-se na relação entre a espessura da cartilagem tragal e a taxa de sucesso da timpanoplastia.

Two Cases of Tragal Cartilage Graft in Rhinoplasty

Ear cartilage is an important source of graft in rhinoplasty. The majority of ear cartilage grafts are harvested from the concha of the ear. However, in some restricted cases, the tragal cartilage can be a more favorable graft source than conchal cartilage. In this report, two cases of tragal cartilage graft rhinoplasty were selected. We used the tragal cartilage for batten graft in one case, and for the shield graft in the other case. Tragal cartilage harvesting technique was fast, simple, and did not require a special dressing. The functional and aesthetic results were relatively good. There was negligible scar formation in the donor site.