Assessing the Efficacy of Tragal Pumping in a Novel Tympanostomy Tube-Rat Model.

Objective: Tragal pumping (TP) is a practice of pushing on the tragus to raise pressure within the external auditory canal and is a commonly recommended adjunctive maneuver believed to facilitate the introduction of ototopical medications into the middle ear cavity via a tympanostomy tube. To investigate the efficacy of TP in the penetration of eardrops into the middle ear cavity via tympanostomy tube, we established the novel tympanostomy tube-rat model. We investigated the histology of the middle ear to determine the efficacy in moving fluid into the middle ear. Study Design: Prospective controlled animal study. Setting: Animal laboratory in a university hospital. Methods: Ten rats were recruited, and a tympanostomy tube insertion and green dye eardrops into outer ears were performed on bilateral ears. TP was performed only on 1 ear and was not applied on the other ear in each rat. Green dye in a middle ear cavity in hematoxylin and eosin-stained temporal bone sections was evaluated by blinded experts in microscopic anatomy (staining grade) and by using Image J software (staining level). The results of these 2 methods were statistically validated. Results: The staining grade (P < .001) and the staining level (P < .001) were significantly higher in the ears which we applied TP than in the control ears. The results of 2 methods were significantly and positively correlated (r = .898, P < .001). Conclusion: Our results showed that the TP accelerate the penetration of eardrops into the middle ear cavity in the tympanostomy tube-rat model.

Our Experience of Comparison of Hearing Outcomes in Patients Undergoing Type-1 Tympanoplasty with Different Graft Materials.

The present study was undertaken to compare the results of various autogenous tissues: temporalis fascia, sliced tragal cartilage and fascia lata as graft materials for type I tympanoplasty in terms of hearing improvement in safe type of chronic suppurative otitis media. A total of 75 cases with central perforation were considered in the study. Of the 75 cases, temporalis fascia graft was used in 25 cases (Group-A), fascia lata graft in 25 cases (Group-B), and sliced tragal cartilage graft in 25 cases (Group-C). The results were evaluated in the form of hearing improvement with respect to the graft materials. A significant association was observed between the groups, that is, temporalis fascia (Group-A), fascia lata (Group-B), and sliced tragal cartilage (Group-C) in terms of improvement in AB gap (P = 0.047). Improvement in AB gap was statistically significant between groups B and A, but not between the other groups. In the present study, fascia lata showed better graft uptake as compared to temporalis fascia and sliced tragal cartilage. The hearing assessment at post-operative 3rd month showed statistically significant hearing improvement with fascia lata when compared to temporalis fascia.

Correlation of "K" plane to occlusal plane and three different ala-tragal lines in dentulous subjects with different skeletal forms: A cephalometric study.

Aim: Orientation of the occlusal plane is an important clinical procedure for complete denture fabrication. An attempt had been made to reconstruct the occlusal plane using a different reference plane. The aim of this study was to find the correlation of the "K" plane to the occlusal plane and to assess the angular deviation between the K-plane to the occlusal plane (KO) with different skeletal forms. Settings and Design: An in vivo observational study was conducted on dentulous subjects having Class I dental occlusion with different skeletal forms undergoing orthodontic treatment. Materials and Methods: The study was conducted on 54 subjects aged 18-30 years. Metallic balls (3 mm in diameter) were attached to the desired landmarks, and a lateral cephalogram was taken for each subject. Cephalometric analysis was done using the Dolphin Imaging software, and the values obtained were recorded and subjected to statistical analysis. Statistical Analysis Used: The values obtained were recorded and subjected to statistical analysis using simple descriptive analysis, Shapiro-Wilk test, Mann-Whitney U-test, and Pearson's correlation. Results: A positive correlation was found between KO with a mean angular deviation of 8.59° ± 3.05°. The angle was found to be steeper in skeletal Class II subjects. Conclusions: Clinical application of the K-plane to use as a reference plane to orient the posterior occlusal plane can enhance the treatment outcome for a removable prosthesis. The results of this study provide a theoretical foundation for the practical restoration of the occlusal plane in different skeletal forms.

Comparative Study on Temporalis Fascia Graft Versus Tragal Cartilage in Type-1 Tympanoplasty in Paediatric Patients.

The aim of the study was to compare anatomical and functional outcomes of temporalis fascia graft versus tragal cartilage graft in type 1 tympanoplasty in paediatric patients. A prospective, comparative and randomised study. A detailed history was taken from all the patients visiting the ENT OP dept after fulfilling the inclusion and exclusion criterion patients were enrolled for the study. Written and informed consent was taken for all the patients from legally acceptable guardians. Preoperative assessment was done and the patients were subjected to type1 tympanoplasty with Temporalis fascia graft or tragal cartilage graft. All the patients were followed up on the third, sixth postoperative months to assess hearing improvement. All the patients were followed up on the first and third,sixth postoperative months for graft status with otoscopic examination. In the present study out of 80 patients, 40 patients underwent type 1 tympanoplasty with temporalis fascia and the remaining 40 patients with tragal cartilage. Both groups were assessed postoperatively for anatomical and functional success with maximum follow up of six months. There was no statistical significance between the outcome and the age or site and size of tympanic membrane perforation. Both groups had comparable graft success rate and hearing improvement. The cartilage group had a higher anatomical success rate. The functional outcome was similar. However, there was no statistically significant difference found in the outcome of two groups. Tympanoplasty can be performed in a paediatric age group with a good success rate in suitable patients. It can be done at an early age,safely with good anatomical and functional outcomes. The age group, site or size of perforation, the type of graft used for tympanoplasty does not alter the anatomical or functional outcome significantly. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03490-1.

Cartilage transposition and anchoring: A surgical technique for the reconstruction of congenital tragal malformation in children.

BACKGROUND: Because of the various types and complexity of congenital tragal malformation, tragal reconstruction is one of the most challenging objects in otoplasty. This study aimed to introduce a surgical technique of cartilage transposition and anchoring that was used to construct a cartilage framework for natural tragus reconstruction. METHODS: A retrospective study was performed for 49 patients who underwent cartilage transposition and anchoring from January 2020 to August 2022. Gender, age, malformation, complication, operation record, preoperative and postoperative photograph, score of esthetic outcomes (4 = excellent, 3 = good, 2 = fair, 1 = poor), and Vancouver Scar Assessment score were reviewed. RESULTS: Twenty-six boys and 23 girls with an average age of 35.79 ± 32.97 months underwent revision. The follow-up time was 13.87 ± 6.57 months. No complications were noted. The average score of esthetic outcomes and the Vancouver Scar Assessment score were 3.94 and 0.08 in the postoperative period, respectively. The overall effect was satisfactory. CONCLUSIONS: Postoperative results showed that cartilage transposition and anchoring were effective techniques for the reconstruction of congenital tragal malformation. The use of cartilage and fascia tissue around the tragus to fill up the depression and reconstruct the tragus were the emphases. The remolded tragus showed less scars and had the similar appearance like the natural tragus of the patient.

Trans-canal tragal cartilage myringoplasty; a comparative analysis of endoscopic and microscopic approaches.

BACKGROUND: The advent of Endoscopic Ear Surgery (EES) has allowed otologists an improved view of the surgical field compared with conventional Microscopic Ear Surgery (MES). EES presents different challenges for surgeons and a learning curve is necessary. AIMS: The purpose of this study was to compare the efficacy of EES and MES for trans-canal tragal cartilage myringoplasty, an entry level EES. METHODS: We retrospectively analysed patients who underwent push through trans-canal tragal cartilage myringoplasty in our institution over 5 years (2016-2020). Exclusion criteria were: patients with prior ear surgery, non-tragal cartilage tympanic membrane graft, additional procedure at time of surgery and patients with insufficient follow up. EES and MES groups were compared using outcomes such as graft success rate, changes in pure tone audiometry (PTA), operative time and complications. RESULTS: Seventy-four patients met inclusion criteria (MES = 38, EES = 36). Mean age of included patients was 29.3 years with no significant demographic differences between groups. Graft success rate at 12 months was higher among the EES group versus MES (94.4% v 86.8%, p = 0.43). Mean operative time was reduced in the EES group (47.3 min v 53.8 min, p = 0.04). Hearing outcomes did not differ significantly between groups. No major operative complications occurred in either group. CONCLUSIONS: Outcomes were marginally better in the cohort who underwent EES. This supports that EES offers an otologic choice to complement established practice for trans-canal myringoplasty and may be used to facilitate introduction to EES for trainees and otologists wishing to learn this technique.

Unified Anatomical Explanation of Diagonal Earlobe Creases, Preauricular Creases, and Paired Creases of the Helix.

Three types of ear creases have been described in the medical literature in association with several cardiovascular and metabolic disorders: diagonal earlobe creases (DELCs) (Frank's sign), preauricular vertical creases, and paired ear creases of the helix (PECH). The exact mechanism of development of such creases, as well as an explanation of their association with cardiometabolic disorders, remains unclear. Herein, the author provides a suggested unified mechanism of development of all three types of auricular creases. In addition, an anatomical explanation linking the associated cardiometabolic disorders and the three types of ear creases to the common culprit of facial visceral adiposity will be given.

Our Experience with Two Handed Endoscopic Tympanoplasty.

Endoscopic tympanoplasty is a minimally invasive procedure and may be an alternative to conventional microscopic tympanoplasty with less operative time, producing similar graft uptake. Endoscopic tympanoplasty has a major disadvantage of single handedness which is overcome by a novel concept of "Two-handed technique" using Khan's Justtach (endoholder). The aim was to study the outcomes of two handed endoscopic tympanoplasty in terms of graft uptake and hearing outcome. Two handed endoscopic tympanoplasty was performed in 20 patients with chronic suppurative otitis media between April 2018-April 2019, in the Department of Otorhinolaryngology, M.G.M. Medical college and MYH hospital, Indore. Tragal cartilage graft via palisading supported with perichondrium was used. Postoperative follow up was done at 3rd month's period, graft status and hearing evaluation was done using Pure tone audiometry. Graft uptake was intact in 19 (95%) out of 20 patients and infection and failure in 1 (5%) case, average preoperative A-B gap was 15-25 dB loss (minimal) in 1 (5%) patient, 3 (15%) patients had 25-40 dB loss (mild) and 16 (80%) patients had 40-55 dB loss (moderate) hearing loss. The post-operative improvement was evaluated in which 6 (30%) patient had 15-25 dB loss (minimal), 12 (60%) patients had 25-40 dB loss (mild), and 2 (10%) patients had 40-55 dB (moderate) conductive hearing loss. We used Wilcoxon Signed Ranks Test for audiological evaluation with a 'p value' of 0.000 making the hearing improvement significant. "Two handed endoscopic tympanoplasty" is an emerging technique which can overcome almost all the major issues related with single handed technique with high degree graft uptake and good hearing outcomes. Endoscope holder is a valuable adjunct to conventional endoscopic surgery.

Role of Tragal Cartilage in Tympanoplasty.

To determine the outcomes of using tragal cartilage in performing tympanoplasty. It was a prospective study of 57 patients with chronic suppurative otitis media. In all patients, pure tone audiometry was done pre-operatively. Tragal cartilage with attached perichondrium as graft material was used for ossicular chain reconstruction. In fifty out of the 57 participants, the outcome was intact ossicular chain. Of the 7 failures, 5 were recorded in the age group of 51-65 years, where graft uptake failed and hearing was not improved. Two of the failed cases required revision tympanoplasty. Post operative audiograms on follow-up revealed reduced air-bone gaps, with dry tympanic cavity and improved hearing. This study concluded that ossiculoplasty using tragal cartilage as a grafting material was an effective and safe surgical method for reconstruction of the ossicular chain and restoration of sound transmission.

A Comparative Study of Temporalis Fascia Graft and Full Thickness Tragal Island Cartilage Graft in Type 1 Tympanoplasty.

We aim to compare the functional and anatomical outcomes of temporalis muscle fascia graft with that of full thickness composite tragal island cartilage graft in patients who are undergoing Type 1 Tympanoplasty. This is a prospective study conducted on 60 patients. Patients who underwent type 1 tympanoplasty were included in the study. Patients were divided into Group A (temporalis fascia graft) and Group B (tragal island cartilage) with 30 patients in each. Out of the 60 patients, 18 females and 12 males belonged to Group A, 20 females and 10 males belonged to Group B. The mean age group was between 31 and 40 yrs in both the groups. The mean hearing gain and ABG closure for Group A was 13.83 ± 8.11 and 13.39 ± 7.44 and in Group B it was 11.17 ± 4.06 and 11.5 ± 5. The graft uptake rate of Group A was 90% and Group B was 96.67%. The wound healing rate of Group A was 93.33% and Group B was 100%. The mean duration of surgery in Group A was 97.5 ± 17.16 and in Group B was 81.33 ± 11.14. Both the groups had significant post-operative improvement in hearing. No significant results found between both the groups in terms of hearing gain, air-bone gap closure, wound healing and graft uptake rate except lesser duration of surgery in group B. We conclude that tragal island cartilage graft is a better choice in Type 1 Tympanoplasty.

Type 1 Revision Tympanoplasty Using Tragal Cartilage in a Tertiary Care Centre: A Prospective Observational Study.

To evaluate graft success rate and hearing outcome in type 1 revision tympanoplasty using tragal cartilage graft. It is a prospective observational study conducted at Department of ENT, Bangalore Medical College and Research Institute from July 2017 to June 2019. Forty four patients between the age group 18-60 years undergoing type 1 revision tympanoplasty, with conductive hearing loss were enrolled.There were 27 males and 17 female patients in the study group. Cartilage tympanoplasty was done using thin tragal cartilage graft . Postoperative hearing gain and graft uptake was assessed at third month. Graft uptake and hearing improvement was assessed 3 months postoperatively in 44 patients. Forty patients had graft uptake (90.90%). The postoperative hearing gain was 7.12 ± 2.99 dB (p = 0.001) which was statistically significant. Tragal cartilage is a good option as graft material in revision cases in terms of ease of graft placement, better graft uptake and audiological outcome with no complications like lateralization of graft, medialization of graft, epithelial pearl formation and anterior blunting.

An Evaluation of the Relation Between Variation in Arch Forms and Relative Parallelism of the Occlusal Plane to the Line Joining the Inferior Border of Ala of the Nose With Different Tragal Levels of the Ear in Dentulous Subjects: An In Vivo Study.

Introduction The purpose of this study was to evaluate which of the three positions on the tragus (superior, middle, and inferior), when connected to the inferior border of the ala of the nose, was the most parallel to the natural occlusal plane in dentate patients, to correlate the level of the naturally existing occlusal plane with the ala-tragal line when the tragus was divided into three portions (superior, middle, and inferior), and to determine which position in the tragus occlusal plane is the most parallel. The study also evaluated the correlation between the variation of arch forms and the relative parallelism of the occlusal plane to the ala-tragal line at different tragal levels. Methods This study included 1405 subjects between the ages of 18 and 35 years. A custom-made occlusal plane analyzer was used to check the relative parallelism between the existing occlusal plane and the ala-tragal line when the tragus was divided into the superior, middle, and inferior portions. The Fox plane of the occlusal plane analyzer was placed on the occlusal plane and the paralleling rod was adjusted till parallelism was obtained. The point on the tragus (superior, middle, or inferior) at which parallelism existed was recorded. The study also measured the inter-canine and intermolar distance to find the type of arch form and related it to the position (superior, middle, or inferior) at which the ala tragal line was parallel to the occlusal plane. The assessment was done on both the right and left sides of the subjects. Results Out of the 2810 tragi, the most common location at which parallelism was established was the inferior part of the tragus, which accounted for 47% of the total. Seventy-one percent (71%) of the subjects showed ovoid arch form. When the variation of arch forms was compared to the level of occlusal plane, 46.8% of the subjects with tapered arch form, 54.5% of subjects with square arch form, and 46.0% of subjects with ovoid arch form had the level of the occlusal plane at the inferior portion of the tragus. Conclusion The result of the study indicated that in the majority of the tragi studied, 47% of the subjects had the occlusal plane parallel to a line joining the inferior border of the ala of the nose to the inferior part of the tragus. Irrespective of the arch form, the occlusal plane was found parallel to a line joining the inferior border of the ala of the nose and the inferior part of the tragus. Thus the tragal position did not show any correlation to the variation of arch forms.

["Tragus flap" combined with "Z" modification method in the surgical correction of congenital tragal deformity in children and literature review].

Objective:To explore the clinical effect of "tragus flap" combined with "Z" modification method in the surgical correction of congenital tragal deformity in children. Methods:The clinical data of 36 children with congenital tragal deformity who were operated in Children's Hospital of Nanjing Medical University from June 2016 to June 2021 were retrospectively summarized, 30 children（35 ears）with congenital tragal malformation had a natural "tragus flap" structure. During the operation, "tragus flap" combined with "Z" modification method was used to reconstruct the tragus. For the depressed deformity around the tragus, the cartilage and fascia tissue around the tragus were used for filling.In the other 6 cases （8 ears）, because the natural "tragus flap" structure was not found, the tragus was reconstructed by other methods, and a relatively satisfactory tragus structure was obtained. The overall effect was satisfactory. Results:No obvious complications were observed during and after the operation. No obvious scar and cartilage hyperplasia were found during the follow-up of 1-12 months. The reconstructed tragus has a good three-dimensional shape, and the depression at the tragus has been well corrected, which is close to the healthy side. The children with bilateral tragus deformity basically achieve bilateral symmetrical tragus, which is satisfactory to the children and their parents. Conclusion:Although the clinical manifestations of congenital tragal malformation are various， "tragus flap" combined with "Z" modification method for tragus reconstruction can be used for most cases. The method not only has shorter operation time, less skin scar and fewer complications, but also can obtain more natural tragus structure.

Tragal remnant flap reconstruction method for congenital tragal malformation in children.

OBJECTIVE: To explore the clinical effect of tragal remnant flap for congenital tragal malformation in children. METHODS: The clinical data of 23 children with congenital tragal malformation hospitalized in our department from May 2017 to May 2021 were retrospectively reviewed. RESULTS: Congenital tragal malformation has various names and clinical manifestations. It is a kind of rare congenital auricle malformation, which can exist alone or in combination with other malformations. About 78.3% of the children with congenital tragal malformation had a natural tragal remnant flap; The rest of the children without tragal remnant flap were repaired by skin flap＆cartilage reconstruction method (SFC-RM). For the depressed deformity around the tragus, the cartilage and fascia tissue around the tragus were used for filling. The overall effect was satisfactory. CONCLUSIONS: Most children with congenital tragal malformation have natural tragal remnant flap. Tragal remnant flap reconstruction method (TRE-RM) not only has shorter operation time, less trauma, faster healing，fewer complications, but also can obtain more natural tragus appearance.

Long Term Versus Short Term Hearing Results in Endoscopic Sandwich Myringoplasty.

INTRODUCTION: The use of the endoscope in otological surgeries has both diagnostic and therapeutic values. It provides an excellent view in difficult nooks and corners. The use of endoscopic sandwich myringoplasty using cartilage and perichondrium has its benefit in hearing outcome and graft uptake in long-term follow-up. The main objective was to compare the long-term with short- term hearing outcomes in those who have undergone endoscopic sandwich myringoplasty with Dhulikhel hospital (D­HOS) technique. MATERIALS AND METHODS: Forty-two patients who underwent endoscopic sandwich myringoplasty with D-HOS technique using tragal cartilage perichondrium were enrolled in the study. The hearing outcome was analyzed by comparing the pre-operative findings with post-operative findings and amongst post-operative patients, long-term with short-term air bone gap (ABG) and ABG closure in speech frequencies (0.5kHz, 1kHz, 2kHz, 4kHz) were compared. RESULTS: Amongst forty-two patients, 40 (95.2%) had graft uptake in both short-term (6.08 months) and in long-term (20 months) follow-up. The mean pre-operative ABG was 28.1±9.3dB whereas the mean short-term post-operative ABG was 14.5±7.2dB, it showed statistical significance (P=0.001). Likewise, while comparing pre-operative with long-term post-operative ABG (13.4±4.8 dB), it showed statistical significance of P=0.000. While comparing short-term with long-term post-operative ABG, it did not show any statistical significance (P=0.065).The mean closure in ABG in both short-term and long-term hearing assessment was not statistically significant (P=0.077). CONCLUSION: Endoscopic sandwich myringoplasty with D-HOS technique is a reliable procedure with good hearing outcome and graft uptake in both short and long-term follow-up.

Tragal Perichondrium and Composite Cartilage Graft Complimenting Endoscopic Tympanoplasty in True Sense: A Comparison.

INTRODUCTION: In days of scar less surgeries it has become necessary for otologists to concentrate on tympanoplasties without external incisions. This study compares the anatomical and functional results of tragal perichondrium graft and perichondrium-cartilage composite graft for transcanal endoscopic tympanoplasties in Himalayan region. METHODS AND MATERIALS: This prospective study included 60 subjects of chronic otitis media (mucosal type), who underwent transcanal endoscopic underlay type I tympanoplasty and were divided into two groups. In 30 cases tragal perichondrium graft and in rest of 30 cases Tragal perichondrium Cartilage composite graft was used. Anatomical and functional outcomes were evaluated at 6 months time. RESULTS: Hearing gain comparing Audiometric data between the tragal perichondrial graft group and tragal perichondrial cartilage composite graft group at 6 months showed no statistically significant differences (P= 0.9533). Assessment of anatomical outcome indicated a greater number of complications in the tragal perichondrial graft group although it was not statistically significant (P=0.6360 in anterior graft failure group, P =0.1322 in reperforation group and P= 0.1056 in retraction group). CONCLUSION: Functional results validated both the grafting material while anatomical results are slightly better in tragal perichondrial cartilage composite graft group in term of re perforation and retraction. Moreover use of tragal grafts endoscopic tympanoplasty fulfils its true meaning as no visible scar and post operative patient morbidity is prevented.

Anatomical and Surgical Study to Evaluate the Accuracy of "C-M-S" Technique in Facial Nerve Identification During Parotid Surgery.

Facial nerve identification is considered to be a crucial step in parotid surgery as inadvertent injury to the nerve will lead to facial paralysis. Multiple landmarks are described in literature to identify the facial nerve during parotid surgery but controversies remain as the consistency and accuracy of these landmarks vary. Numerous studies exist in literature but they fail to address a single landmark that is most reliable to identify the facial nerve during parotid surgery. The purpose of this study is to find reliable landmarks for identification of the main trunk of facial nerve during parotid surgery by evidence gathered by cadaveric dissection and intraoperative study during parotid surgery and develop a systematic approach to identify the facial nerve trunk. This prospective study included 41 cadavers (82 parotid regions) and 20 patients with parotid pathology who underwent parotidectomy. We evaluated the feasibility of our C-M-S technique to identify the main trunk of facial nerve in both anatomical and surgical study. The relationship of landmarks (tragal pointer, tympanomastoid suture, superior border of posterior belly of digastric muscle) to the facial nerve trunk was assessed and the shortest distance between them from the facial trunk was measured using a slide caliper. The measurements were compared between the anatomical and surgical study. The main trunk of facial nerve was successfully identified in all cases using C-M-S technique in both anatomical and surgical study. Distance of facial nerve trunk to tragal pointer was more in the cadaveric sample (13.04 ± 5.238 mm) compared to live patients (9.95 ± 3.967 mm) with statistically significant difference (p = 0.036). The mean distance of tympanomastoid suture and posterior belly of digastric muscle to the facial nerve trunk was similar in anatomical and surgical study with p value of 0.877 and 0.083 respectively. The tympanomastoid suture, posterior belly of digastric muscle and tragal pointer are the most useful landmarks for facial nerve identification during parotid surgery. In our study we found that the tympanomastoid suture line is the most consistent landmark present in all our cases and being closest to the facial nerve trunk in both anatomical and surgical study. Further we recommend using the "C-M-S technique" in order to locate the main trunk of the facial nerve.

Reconstruction of the external auditory canal: The tragal flap revisited and review of contemporary reconstructive techniques.

BACKGROUND: Primary malignancies arising in the external auditory canal (EAC) are rare and usually are treated surgically. We review techniques to reconstruct the EAC following ablative surgery, and introduce a rarely utilized tragal skin flap which has particular advantages for reconstruction of limited anterior EAC defects. METHODS: The terms "tragal flap", "external auditory canal", "preauricular tragal flap", "reconstructive techniques" were searched on PubMed and Google Scholar. RESULTS: Our review identified one description of a tragal flap to reconstruct the EAC following resection of a malignancy. We add an additional case of a preauricular tragal flap to reconstruct the anterior EAC following resection of a recurrent basal cell carcinoma located in the EAC that led to a circumferential defect. CONCLUSION: There are several surgical techniques that can be utilized to reconstruct the EAC. We describe a novel tragal flap used to reconstruct the anterior EAC following resection of a recurrent tumor.

Endaural Over-Underlay Cartilage Tympanoplasty for Repair of Dry Subtotal Perforations.

OBJECTIVES: We explored the auditory and anatomical success of grafting when the cartilage perichondrium (CP) was prepared using two different methods. METHODS: Patients with subtotal or total perforation underwent tympanoplasty with a CP graft. A V-shaped groove for the handle of the malleus was prepared for CP grafts in patients in group 1. Patients in group 2 did not have a groove on the graft. The anatomical success of the graft was evaluated as success, partial success, or failure. Results of auditory evaluations were compared between the two groups. RESULTS: A total of 195 patients were included in the study. The total CP graft integration rate was 96% for both groups. Significant changes were detected in all hearing criteria evaluated 12 months after surgery compared to the preoperative period (P < .05). There were no significant differences between the groups in terms of the relationship between graft technique and postoperative hearing results. However, rates of partial success were significantly higher for group 1 than group 2 (P = .033). CONCLUSION: Cartilage slice support offers an extremely reliable method for reconstruction of tympanic membrane in cases of high-risk perforation. Partial failures are rare, but when they occur, they most often involved anterior graft medialization. When a piece of cartilage is removed at the malleus interface there may be a higher rate of partial failure.

Do Benign Mass Lesions in the Superficial Lobe of Parotid Gland Influence Landmark-Based Search for Facial Nerve Trunk At Surgery?

OBJECTIVE: To assess the influence of benign mass lesions in the superficial lobe of parotid on the known anatomic landmarks for identifying the facial nerve trunk. METHOD: Patients with unilateral biopsy-proven benign mass lesions in the superficial parotid were selected for this observational study. During superficial/partial superficial parotidectomy, distance of the facial nerve trunk from each landmark was assessed using spring calliper and correlated with the lesion's volume (measured from the pre-operative imaging). At least two identifiers among tragal pointer (TP), posterior belly of digastric muscle (PBDM) and tympanomastoid suture (TMS) were considered. RESULTS: The study involved 32 patients. The lesions mostly involved the parotid tail (50%) and pretragal region (34.3%), and constituted of pleomorphic adenoma (~66%) and Warthin's tumor (~9%), the rest being various cysts and hamartomas. TP was universally uncovered, while PBDM and TMS were exposed in 26 and 25 patients, respectively. Average distances between the facial nerve trunk and TP, PBDM and TMS were 12.79 mm (SD=2.33), 9.78 mm (SD=1.21) and 7.58 mm (SD=1.33), respectively. Correlation coefficients between the lesion's volume and the distance of facial nerve from a given landmark were -0.11, 0.04 and -0.16 for TP, PBDM and TMS, respectively. CONCLUSION: TP was the most easily available landmark on surgical dissection, while PBDM was the most consistent and the least variable when volumetric data of the benign mass lesions in the superficial lobe of parotid were considered as a factor influencing the distance from the facial nerve trunk.