title: Medial or medio-lateral graft tympanoplasty for repair of tympanic membrane perforation.
abstract: OBJECTIVE
  To describe and evaluate the medio-lateral graft tympanoplasty(1) for the reconstruction of anterior or subtotal tympanic membrane (TM) perforation and medial graft tympanoplasty for posterior TM perforation.
  
  
  METHODS
  Retrospective study of 200 patients who underwent medio-lateral graft tympanoplasty (100 cases) and medial graft tympanoplasty (100 cases) at community and tertiary care medical centers from 1995 to 2006. All patients underwent preoperative and postoperative audiograms. In the medial graft tympanoplasty, the graft is placed entirely medial to the remaining TM and malleus. First, margin of TM perforation is denuded removing ring of squamous tissue. Tympanomeatal flap is elevated. Temporalis fascia is harvested, semidried, and grafted medial to the TM perforation and malleus with Gelfoam packing supporting the graft. In the medio-lateral graft technique, posterior tympanomeatal flap is elevated same as in the medial graft tympanoplasty first. Anterior-medial canal skin is elevated down to the annulus. At the annulus only squamous epithelial layer of TM is elevated up to anterior half of the TM perforation. Temporalis fascia is grafted medial to posterior half of the perforation and lateral to anterior half of the de-epithelialized TM perforation up to the annulus. Anterior canal skin is rotated to cover the fascia graft and TM perforation as a second layer closure. Patients were followed for at least six months. Outcome was considered successful if TM is healed and intact.
  
  
  RESULTS
  There were four failures (96% success rate) in medial graft method for posterior TM perforation due to infection and re-perforation. In the medio-lateral graft tympanoplasty, there were three failures (97% success rate) due to a postoperative infection, anterior blunting and recurrent cholesteatoma.
  
  
  CONCLUSIONS
  The medial graft tympanoplasty works well for posterior TM perforation. The medio-lateral graft method is an excellent method for the reconstruction of large anterior or subtotal TM perforation. This new method should help otologic surgeons to improve outcome of tympanoplasty for anterior or subtotal TM perforation.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Loma Linda University, Loma Linda, CA, USA. timothy.jung@va.gov
authors.forename: Timothy
authors.initials: T
authors.lastname: Jung
authors.forename: You Hyun
authors.initials: YH
authors.lastname: Kim
authors.forename: Yoon Hwan
authors.initials: YH
authors.lastname: Kim
authors.forename: Seong Kook
authors.initials: SK
authors.lastname: Park
authors.forename: Dusan
authors.initials: D
authors.lastname: Martin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D034381:Hearing Loss / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000473:pathology / Q000601:surgery; D018058:Tympanic Membrane Perforation / Q000150:complications / Q000473:pathology / Q000601:surgery*; D014433:Tympanoplasty / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult