*The authors note that these two authors contributed equally.
Butterfly Cartilage Graft Inlay Tympanoplasty for Large Perforations
Article first published online: 2 JAN 2009
Copyright © 2006 The Triological Society
Volume 116, Issue 10, pages 1813–1816, October 2006
How to Cite
Ghanem, M. A., Monroy, A., Alizade, F. S., Nicolau, Y. and Eavey, R. D. (2006), Butterfly Cartilage Graft Inlay Tympanoplasty for Large Perforations. The Laryngoscope, 116: 1813–1816. doi: 10.1097/01.mlg.0000231742.11048.ed
- Issue published online: 2 JAN 2009
- Article first published online: 2 JAN 2009
- Manuscript Accepted: 26 MAY 2006
- Tympanic membrane perforation;
- butterfly graft;
- cartilage graft;
- inlay graft
Objective: Butterfly graft inlay tympanoplasty is a well-established technique for the repair of small perforations. However, the efficacy of the technique for medium and large tympanic membrane perforations remains unknown.
Study Design: Retrospective case series.
Methods: Postauricular tympanoplasty and tympanomastoidectomy using a large butterfly cartilage inlay graft (>4 mm diameter to total drum replacement) were analyzed in 90 pediatric patients (99 ears).
Results: Patient ages ranged from 2 to 20 years; mean follow-up duration was 27.6 months. Successful closure occurred in 92% of the ears. No graft lateralized nor displaced into the middle ear. No retraction pocket occurred during the follow-up period. In 62 cases, intact canal wall or canal wall window tympanomastoidectomy was performed; Fifty-one (82.2%) of the patients having mastoidectomy procedures had chronic otitis media with cholesteatoma. The mean preoperative to postoperative four-tone air-bone gap improved from 23 to 21 dB; the number of patients with 0 to 10 dB hearing results increased from 16 ears preoperatively to 32 ears postoperatively. Postoperative suboptimal results included eight patients with postoperative perforations in the residual tympanic membrane adjacent to an intact cartilage graft; two of these patients were the only individuals who exhibited otorrhea.
Conclusions: Cartilage butterfly graft inlay tympanoplasty is effective in the vast majority of patients with moderate to large perforations. The closure rate exceeded 90% with no graft displacement, postoperative adverse events were respectably low, and hearing results improved or remained stable despite the need for concurrent mastoidectomy in the majority of patients.