Promotion of healing of tympanic membrane perforation by trimming [dissection]

ABSTRACT

Thirty eight patients with tympanic membrane perforations of the pars tensa were treated by dissection of the edges of the perforation and separation of the layers of the tympanic membrane. Complete healing took place in thirty one ears.Central perforation of the tympanic membranes may follow acute of chronic suppurative otitis media, as well as after trauma to the ear. The five distinct layers of the pars tensa of the tympanic membrane from outward inward are-the outer stratified squamous epithilium [epidermis], the fibrous tissue [dermis], the radial fibrous layer and the innermost mucous layer, Shambaugh, 1980].After perforations of the tympanic membrane a ring is formed all around the margin of the perforation as a result of inward creeping of the outer stratified squamous epithilium around the edge of the perforation preventing spontaneous closure. This ring acts as a mechanical barrier for the creeping of the tympanic membrane layers to close the perfoaration and also due to adhesions between the layers. The tempanic graft in simple myringoplasty acts as a scaffold for the epithilium spreading from the margin of the perforation and prevents inward growth of the epithilium through the perforatraon Wrigh [1956], obtained a good rate of tympanic membrane perforations by marginal acid cautary. Juers [1963] reported 88]percent closure of the tympanic membrane perforations with marginal eversion method. The present work was conducted in an attempt to study the effect of discussion and separation of layers at the margin of tympanic membrane perforations on healing